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10 December 2014

Why we should resist antibiotics

Recent analysis of a bacterium that killed a First World War soldier showed that this bug was resistant to attacks by penicillin and erythromycin, even before we had discovered either of these antibiotic drugs. 

By Michael Brooks

We think we’re so clever, thanks to modern schooling and Google on our smartphones – and then scientists come along and show us we’re not. It turns out that college-educated westerners are no better than indigenous Mayans with no formal education at tasks that require judging situations that involve probabilities and risks and updating beliefs in the light of new information.

This finding, published in the Proceedings of the National Academy of Sciences in November, might shed some light on our attempts to deal with antibiotic resistance. Take the Longitude Prize. This is a new, £10m incentive to develop a diagnostic tool that will distinguish between viral and bacterial infections. The goal for the award was chosen because the British public considers antibiotic resistance the second-greatest threat to our health after cancer.

The British public, however, is part of the very problem. Antibiotic resistance owes its growth partly to the overprescription of these drugs. In a survey of UK GPs released in August, 45 per cent said they had prescribed antibiotics as placebos knowing that they would not help heal the patient. Why? Pushy patients.

Many of the doctors surveyed said they wrote the prescription because they couldn’t tell whether their patient’s infection was bacterial, and so susceptible to antibiotics, or viral – and therefore immune to the drugs. They err on the side of prescribing because, as one doctor told the Times, “If you don’t give the antibiotics they’ll just come back the next day to see another doctor.”

Medical innovation is always useful, but it’s an act of great faith to believe – in the face of vast evidence to the contrary – that pushy patients will respond rationally to a virus test. What we need is a truly transformational response. So maybe we should expand the role of Antibiotic Guardians.

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Since the scheme’s launch last month, more than 12,000 people have signed up, pledging to do their best to halt the spread of antibiotic resistance. For nurses, the pledge might be to administer information – about not sharing antibiotics with others, say – as well as the medicines. Pharmacists can pledge to ensure that every antibiotic prescription they give out complies with all relevant guidance. Members of the public might offer to give their immune system time to deal with an infection before seeking out medicine, or to follow instructions to the letter when giving antibiotics to pets.

Pharmacy teams lead the professional take-up of the Antibiotic Guardian pledge, followed by nurses. At the time of writing, fewer than 500 prescribers based at doctor’s surgeries had signed up, compared to 2,700 pharmacy team members. It is easy to see who is most concerned about current practice.

And there is plenty to be concerned about. Recent analysis of a bacterium that killed a First World War soldier showed that this bug was resistant to attacks by penicillin and erythromycin, even before we had discovered either of these antibiotic drugs. Our widespread use of antibiotics since has only accelerated an entirely natural process. We are fighting a losing battle: we can’t change the tendency of bacteria to develop resistance, we can only hope to slow down the mechanism.

We can’t change human nature either. So maybe we should demand that doctors stand up to pushy patients. We could have a new kind of Antibiotic Guardian: the sneaky one who pledges to harass his doctor for antibiotics, then report the doctor when he gives in to pressure. That, too, is a flawed scheme, of course – doctors are already stressed enough. But something has to give.

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