Should we lock antibiotics away?

Anorexia and bulimia might be effectively treated using antibiotics, scientists say.

Anorexia and bulimia might be effectively treated using antibiotics, scientists say.

Published Mar 15, 2015

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London – Albert Alexander, a 43-year-old Oxford policeman, made world history in March 1941.

While pruning roses, he scratched the side of his mouth. Two strains of bacteria - staphylococcus and streptococcus – invaded the wound, producing lethal abscesses on his eye, face and lungs.

The threat of such agonising infections haunted everyone in those days.

Since the dawn of humankind, people had regularly been killed by bacteria from minor wounds, or through infections from childbirth or surgery.

There were no effective treatments for pneumonia, gonorrhoea or rheumatic fever. Hospitals were full of people with blood poisoning. Doctors could do little for them.

But PC Alexander was the first patient ever to receive the wonder-drug penicillin. Within days of the first shot, his temperature dropped and his appetite returned. Stocks of the new antibiotic were minuscule, however. Doctors at the Radcliffe Infirmary desperately recycled penicillin from Alexander’s urine to keep it in his bloodstream, but after five days all supply ran out. The infection raged again, killing him.

Today we are being thrown back to the world of PC Alexander, where an everyday scratch could spell death.

However, this is not because we don’t have enough antibiotics. The opposite is the case. We are using far too many of them - and unnecessarily so. Thus, by our over-prescription, we teach ordinary bugs to become antibiotic-immune superbugs.

Bacteria around the world are rapidly acquiring an alarming new way to beat our best antibiotics, as if arming for a doomsday showdown with humanity.

These mutant bacteria, which carry a fragment of DNA called NDM-1, are known to have killed more than 20 people in Britain and infected hundreds, if not thousands. No one knows the true toll.

Antibiotic-resistant germs first made headlines in the Eighties with MRSA. This was a new strain of the Staphylococcus aureus bacteria that normally lives harmlessly on the skin and in the noses of one in three of us.

The emerging strain of Staphylococcus had learned to shrug off strong antibiotics, most notably meticillin - hence its name, Meticillin Resistant Staphlococcus Aureus. The official annual death toll in England from MRSA peaked at 1,652 in 2006. Most victims were infected while in hospital.

Susan Fallon, of Newcastle in Staffordshire, knows only too sadly the terrible toll of MRSA. She lost her 17-year-old daughter, Sammie, to it in 2008. Sammie had been admitted to University Hospital of North Staffordshire for blood tests on a suspected viral infection.

A needle was pushed into her hip to take a bone marrow sample.

Three days later, while still in hospital, Sammie complained that her hip had swelled at the needle site. ‘Within a week, the swelling had got worse,’ says Susan. ‘Three days later a nurse gave me a leaflet about MRSA. I had vaguely heard of it. My mother, who had been a nurse, was with me. I saw from Mom’s face that was bad.’

The infection rapidly invaded Sammie’s lungs and other vital organs, beating the hospital’s strongest antibiotics. She began to have fits, then lost consciousness. Her kidneys failed and she was put on dialysis.

Two days later she died.

The death certificate recorded the cause of death as multi-organ failure, MRSA, septicaemia and a viral infection. ‘I was advised to sue the hospital, but after three years, the solicitor said that we couldn’t identify which nurse had put the needle into her hip and we couldn’t prove our case.

‘Sammie was screened for MRSA on admission and found free of the bacteria,’ Susan adds. ‘But we can’t prove legally how she got it. The hospital has never apologised.’

Liz Rix, the trust’s Chief Nurse, told the Mail: ‘In the seven years since Miss Fallon’s care, the trust has improved infection-prevention procedures to radically reduce the number of MRSA bacteraemia contracted by patients in our hospitals from 70 in 2008 to just five in 2014.’

Across the NHS, improved infection control has significantly cut hospital deaths from MRSA, which is spread by touch. In 2012, MRSA was recorded 292 times on English death certificates – 1,360 down from the peak.

However, that hopeful news is quashed by the fact that many other antibiotic-resistant bacteria are on the march.

Last October, a report from Public Health England warned that overall, infections by such bacteria had increased between 2010 and 2013.

For example, infections caused by E.coli that were resistant to key antibiotics had risen by more than 10 percent. Drug-resistant versions of other infections, such as pneumonia and gonorrhoea, are also growing.

Meanwhile, antibiotic prescribing by GPs and hospital medics has increased by 6 percent.

More than 40 million such prescriptions are believed to be written a year by GPs. Often these are for colds, coughs and flu - caused mostly by viruses, which antibiotics cannot treat. GPs claim that they often feel under pressure to prescribe from patients.

Our society is hooked on the fading promise of these wonder-tablets, even if they won’t work. Too often, doctors are happy to oblige, just to clear their consulting rooms.

Antibiotics certainly have had a wondrous effect. Largely thanks to them, between 1944 and 1972, our life expectancy jumped by eight years. I owe my own life to them.

Aged six months, I contracted double pneumonia. This was in 1964, less than two decades after the medicines became available.

The drug that saved me back then would most likely not work nowadays due to the resistance bacteria has built over the years. Our magic swords have been beaten blunt by overuse.

The authorities have tried repeatedly to stop family doctors worsening the crisis.

In 2009, the European Centre of Disease Prevention and Control wrote to every GP in Britain, telling them to stop prescribing antibiotics unnecessarily.

Since then, campaign after campaign has been mounted to persuade GPs to kick their prescription habit, by organisations such as the Royal College of General Practitioners as well as the nurses’ and pharmacists’ professional bodies. All have failed.

Now the medicines watchdog, NICE, is proposing that we bribe doctors to change their ways. Last month, it proposed that GPs be paid extra for not doling out antibiotics unnecessarily.

Antibiotics are not a human invention. Nature used them for millennia before we learned the trick in 1928, after Alexander Fleming noticed how a green mould in his lab was killing bacteria on a specimen dish.

But in the Fifties, humans began carpet-bombing the globe with industrial antibiotics. Suddenly, this accelerated the evolutionary battle into lightning chemical warfare.

In the process, something unheralded and alarming has been happening to the bacteria surrounding us, warns Timothy Walsh, the professor of medical microbiology and antimicrobial resistance at Cardiff University.

Under the onslaught of medical antibiotics, ‘the bacterias’ structures have become unstable - sloppier and much more reactive to new bits of DNA about them’, he says. ‘These microbes are responding to the environmental stress that our antibiotics create for them.’

It is as though they are trying desperate gambits to retaliate. The most dangerous mutation to emerge so far sounds more like something from an episode of Dr Who than a medical journal.

Professor Walsh explains that the latest bacterial tactic involves NDM-1. This is an enzyme - a mutant piece of DNA - that turns ordinary bacteria into lethal bugs which our best bullets bounce off.

The enzyme is spreading from one strain of bacteria to another, giving every new host the same drug-defying powers. NDM-1 originated in Asia. It is now swiftly colonising Britain and the rest of the Western world.

Public Health England says that the number of laboratory-confirmed cases of bacteria carrying NDM-1 has risen from just five in 2006, to more than 600 in 2013.

The bacteria known already to carry it include mutant versions of common and usually harmless gut bugs - Klebsiella and E.coli.

According to Public Health England, the NDM-1 enzyme has made them immune to our ‘last resort’ antibiotics - called carbapenems, which medics use to beat infections when other antibiotics have failed.

NDM-1 breaks down these drugs, rendering them useless. It is also immune to most other antibiotics, including penicillins. Experts at the U.S. Centres for Disease Control say that it contributes to the death of up to half of patients who become infected.

Earlier this month, it was revealed that 16 people have died in the Central Manchester University Hospitals NHS trust area in the past four years after contracting one of these mutant strains - Klebsiella pneumoniae carbapenemase. Another died at Wolverhampton’s New Cross Hospital.

Hundreds of other patients are believed to have been infected. Central Manchester says all the patients who died had been seriously ill with conditions such as diabetes, cancer, kidney problems or transplant rejection.

Professor Walsh is the man who first identified NDM-1, in 2000. He found it in samples from India. As is his habit, he named it after the city where it originated. It is called New Delhi metallo-ß-lactamase 1.

This is one of the reasons that Walsh is barred from India. ‘Their government objected to what they see as an insult to their capital city,’ he says.

The other reason for the ban is that his work threatens one of India’s rapidly growing profitable industries - medical tourism.

Every year, thousands of Britons travel there for cheap operations, often cosmetic surgery, but also organ transplants that NHS surgeons have declared too hazardous to perform. Hospitals on the subcontinent may charge only one-fifth of what a UK private hospital asks.

However, India effectively acts as a vast petri dish for growing new antibiotic-resistant superbugs. Poor sanitation and healthcare hygiene spread bacteria rapidly. Moreover, antibiotics can be bought cheaply, easily and frivolously at chemists on the subcontinent.

Professor Walsh says his recent study of 2,000 people in Karachi, Pakistan, has shown that 28 percent carry E.coli with the NDM-1 DNA. From this, he estimates that across the whole subcontinent, 250 million people already harbour it.

‘Many people travelling to India for operations must be contracting NDM-1 infections, says the professor. They then bring NDM-1 back to Britain.

‘This combination of threats dwarfs the problem of British GPs over-prescribing antibiotics,’ he claims. He adds that, due to lack of surveillance, ‘no one has a clue how many people are bringing this into the UK or what the prevalence of NDM-1 is here.’

A coroner’s inquest in Swansea last year has highlighted one particularly tragic case involving medical tourism to India. The inquest heard how antibiotic-resistant E.coli killed a baby born 15 weeks premature whose mother had undergone IVF treatment in India.

The bacteria also killed the baby in the adjacent hospital incubator at Singleton Hospital, Swansea, who had been born 14 weeks premature.

The mother of the first child, named only as Baby A1, was unaware she had picked up the particularly deadly mutated form of E.coli, although it was mentioned in her medical notes from India. The inquest last July heard that the notes were not sent to staff in Swansea.

As a result, rigorous infection control procedures were not instituted and the infection passed to the second baby, Hope Erin Evans, from Aberdare, who also succumbed. She was only five days old.

NDM-1 is not going to go away, says Professor Walsh. ‘Once bacteria have the NDM-1 enzyme, they can’t get rid of it without dying because it has become an essential part of their biology. They are held hostage by it,’ he explains.

Meanwhile, Britain is spearheading efforts to produce more powerful new antibiotics. Prime Minister David Cameron has launched a commission to tackle antibiotic resistance. Part of its remit is to create better incentives for the pharmaceutical industry and academic researchers to develop new drugs.

Professor Walsh fears this is naïve. ‘There is no point producing new drugs if we don’t have global patent safeguards to protect them from overuse,’ he says.

The answer, suggests Mark Lloyd Davies, the chair of the antibiotic network at the Association of British Pharmaceutical Industries, is to protect a new generation of antibiotics by stockpiling them in a secure place.

‘There are already systems like this in place for drugs such as vaccines,’ he says. ‘Good stewardship of new antibiotics is absolutely the key by keeping them under strict Government control.’

Certainly, if sense is to prevail, we must use far fewer antibiotics, in far more targeted ways. Even if we have to lock them away.

As in the era before antibiotics, hygiene must again become king. And patients must see the sense of leaving their GPs without a prescription in their pockets.

The alternative is no antibiotics at all - and a return to the days when a scratch from a rose can bring agonising death.

Daily Mail

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