Antibiotics - a wonder drug?

WITH the recent news that we're in danger of becoming resistant to antibiotics, here's a look at the history of one of medicine's most important discoveries.

It used to seem so simple - you caught a bug, went to the doctor, collected your prescription for antibiotics and got better.

But those halcyon days of relying on the 'wonder drug' are now over, according to the Government's Chief Medical Officer, Dame Sally Davies.

Last month she warned that the threat of resistance to antibiotics posed by new strains of 'superbugs' was so great, it should be considered on a par with terrorism and climate change.

The problem is two-fold: antibiotics are routinely being overprescribed by doctors, to keep patients happy, which helps bacteria learn how to resist them - and there are no new antibiotics being produced because they're not seen as profitable by big pharmaceutical companies.

Dame Sally said: "We haven't had a new class of antibiotics since the late Eighties, and there are very few antibiotics in the pipeline."

She warned that, unless urgent action is taken, in the next 20 years, what we know consider to be relatively simple surgical procedures, such as hip replacements and organ transplants, could become deadly, as medical developments are dragged back by 200 years.

"If we don't take action, then we may all be back in an almost 19th-century environment where infections kill us as a result of routine operations."

So what exactly is going on? A new breed of drug-resistant bacteria, including new strains of E coli and Klebsiella, which causes pneumonia, is on the march. Found in the gut, they're extremely dangerous to older people and there's little that antibiotics can do to stop them.

A new infection surfaces every year, while no new class of antibiotics has been developed since 1987.

Meanwhile, doctors are needlessly prescribing 1.6 million courses of antibiotics every year - almost one in 20 unnecessary prescriptions. The more antibiotics we take, the more end up getting flushed into the water system, where bacteria can 'learn' to resist them.

But is this really the end for effective antibiotics?

Here's a look back at the history of one of modern medicine's greatest developments...

THE BEGINNING The term antibiotic came from 'antibiosis', a word coined by Louis Pasteur's pupil Paul Vuillemin in 1889, to mean a way in which life could be used to destroy life (anti means against, bios means life).

But the treatment has its roots in ancient history - the Egyptians, Chinese and American Indians apparently used mold to treat infected wounds, but didn't understand why the antibacterial properties of the mold were doing the trick.

Fast forward to 1928, when Scottish bacteriologist Sir Alexander Fleming was about to throw away a culture plate covered in mold - there was nothing unusual about this as it had been left for over a week.

But when he looked a little closer, he noticed the mold producing a substance that was killing the bacteria. This was the discovery of the first modern antibiotic, penicillin. It has since been known as one of the single greatest contributions to medicine. A revelation made entirely by mistake but creating a global medical revolution.

Treating soldiers and TB Fleming attempted to purify penicillin for the use of animal and human trials but failed.

It wasn't until 10 years later that three scientists in England, Howard Florey, Ernst Chain and Norman Heatley exposed the method which meant penicillin could be made in industrial quantities, just in time for World War II. The use of penicillin meant soldiers affected by wounds maintained a higher survival rate and could recover quickly.

Meanwhile in America, scientist Selman Waksman had discovered the second most famous antibiotic named streptomycin. Streptomycin was extracted from a soil bacterium and Waksman was able to show its ability to fight against the bacterium that causes tuberculosis.

Waksman and his students discovered a further 15 types of antibiotics during the 1940s. Scientists continued to reveal several new classes of antibiotics throughout the 1950s and 60s and research since then has refined and synthesised antibiotics even further.

Early warning signs In December 1945, speaking in Stockholm, Alexander Fleming said: "The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant."

His warning was ignored. Antibiotics were made freely available for the public to buy. Viewing the oral drug as a quick fix and easy treatment, people would take them for the common cold which is caused by a virus, something antibiotics are useless for.

The first antibiotic-resistant strains of bacteria were isolated in 1946, six years after the drugs were first used. This was the start of antibiotics becoming a prescription drug, only given out by doctors.

Patients today still insist on having antibiotics to treat viruses like colds and flu - and often don't finish the course they're given, which, as Fleming warned, would help make the bugs resistant.

What's next for us?

The future concerning antibiotic resistance is bleak and seems to be an extra thing on the list to fear for our future children and grandchildren.

But action can be taken. Dame Sally's recommendations include better hygiene in schools, hospitals, care homes and public places. She is urging GPs to prescribe antibiotics only when necessary and patients to not demand the drug when it isn't needed.

Scientists are still trying to develop new types of antibiotic but, as fast as they are produced, bacteria develop strategies to avoid their effects. Dame Sally advises better incentives and more innovation for pharmaceutical companies to develop new drugs, the biggest hope of winning the battle.

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