Why Superbugs Bug Us All

Last February I got struck by the worst case of tonsillitis ever known to mankind, which

was accompanied by the highest fever ever measured on a human. Take my word for it. My handsome and, unfortunately, married Scottish doctor gave me a 10-day course of antibiotics, but I was contemplating not taking them so I could go back and listen to his accent again. However, the drugs kicked in even faster than I got kicked out of his office, and in four days I went from googling “can you die from tonsillitis?” to doing a 10km run. With fast results, together with some adverse side effects like nausea, diarrhoea, and thrush, it’s understandable that people don’t finish their prescribed courses of antibiotics. The problem is that even though the infection is gone, it doesn’t mean that all bacteria are gone. The weakest bugs die during the first days of antibiotics, and a 10-day course is meant to kill the more stubborn germs as well. However, if not all pills are taken, the strong ones are given room to proliferate. This kind of drug pressure leads to the development of deadly superbugs.

Deadly what?

“Superbugs”, or antimicrobial-resistant microorganisms, refers to many kinds of resistant infection-causing pathogens, such as viruses, fungi and parasites, but the one most threatening form is antibiotic-resistant bacteria. Superbugs are a product of evolution, as they do occur naturally. Some develop through adaptable changes, like how humans developed different skin colours to adapt to the different amounts of sunshine around the world. Others come from purposeless genetic mutations, like blue eyes (which can all be traced back to one single ancestor). However, the misuse and overuse of antibiotics is the single most important factor that leads to antimicrobial resistance.

How bad can it be?

Pretty bad. My dystopian death-by-tonsillitis googling might seem silly, but the fact is that if we don’t manage to curb the situation, we will be dropping dead from simple infections in a very near future. Superbugs already kill about 700.000 people annually, but despite killing more people than ISIS, plane crashes and shark attacks combined, the issue doesn’t get nearly as much attention as any of those things. The situation is so serious that it was discussed in the United Nation’s general assembly in September 2016. It’s only the fourth directly health-related issue that has been discussed in a high-level meeting in the general assembly, the other three being HIV/AIDS, non-communicable diseases, and Ebola. General secretary Ban Ki-moon referred to it as a “fundamental threat” to global health, but despite being a contemporary issue it’s not a new phenomena. Alexander Fleming, the very guy who developed the first antibiotics, warned the world about antimicrobial resistance 71 years ago. In his 1945 Nobel prize acceptance lecture he said “there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant”.

So what can happen?

Further antibiotic resistance will be a major setback for modern medicine, and Alexander Fleming will be face-palming in his grave. For the average person the emergence of superbugs means that simple infections, like tonsillitis and sinus infections, will last longer and spread more. There are already several strains of common infectious microbes where resistance has been confirmed and treatment is ineffective:

• E. coli is a bacterium found in the large intestine, and quite often this little f*cker makes its way from your butt to your urethra only to cause a urinary tract infection. There are countries in the world where the most common antibiotics for this infection is now ineffective in more than 50% of patients. If left untreated, UTIs can ascend to the kidneys and that’s both unpleasant and dangerous.
• Gonorrhoea is a common sexually transmitted infection, and most people don’t experience any symptoms from it. However, if left untreated, it can cause pelvic inflammatory disease in females and infertility in both males and females. Untreated gonorrhoea also puts people at greater risk of contracting HIV. Even though the infection is often talked about as easy to treat, treatment failure in last-resort medicine has been confirmed in at least ten countries, including Australia. Due to the increased resistance, the World Health Organisation recently updated their guidelines for treatment of gonorrhoea, as well as for chlamydia and syphilis. Prevention is your best option here; don’t be silly, wrap that willy.

And then there’s the ultimate drug-resistant superbug that “might become the most

frightening epidemic since AIDS”; the flesh-eating MRSA. MRSA stands for methicillin-resistant Staphylococcus aureus, and is a strain of the normal Staph that can be found on our skin. MRSA mostly cause skin infections that are hard to treat, but can also cause pneumonia and severe sepsis, which can lead to organ failure and death.

In addition, life-saving medical procedures like cancer chemotherapy, organ transplants and other major surgery, as well as diabetes management will become very high risk without effective antimicrobials to prevent and treat infection.

So what can we do?

Well, antibiotic resistance must be targeted from many different angles, because isolated interventions have little or no effect. To begin with, the distribution of antibiotics needs to be strictly regulated. I’m currently in Vietnam for public health placement, and as it’s available over the counter here, I stocked up on some diazepam for “future long-haul flights”. Whilst it’s well-known that sedatives are easily available here, I wasn’t aware of the

extent of the Vietnamese pill market anarchy until I in a lecture was told that they have absolutely no regulations regarding distribution of pharmaceuticals here. Antibiotics are readily available at the pharmacy, and you decide for yourself how many days you want it for. No GP, no pathologist, no prescription. This isn’t unique to Vietnam or Asia, as I a few years back bought antibiotics over the counter in Greece as well, but this kind of irresponsible handling of life-saving drugs must end.

Luckily, the UN meeting in September led to all 193 member states signing an agreement which included developing surveillance and regulatory systems for the sales and use of antimicrobials. The agreement also included encouraging innovation in antibiotic development, and in February 2016 more than 80 pharmaceutical, biotechnology and diagnostics companies signed a declaration to help combat the antibiotic resistance. They also called for government incentives to help fund the research, as Big Pharma make very little profit from the sales of antibiotics. Research in that field has thus been deemed as cost-prohibitive, and focus has been put on more profitable areas, such as cardiovascular disease and diabetes.

In addition to these macro-level policies, there are several things we as individuals can think about. We should for example not jump on the antibiotics train too quickly, but rather just treat the symptoms and let the body work on the infection on its own. Here’s a list of a few things you can do:

• Make sure to finish your entire course of antibiotics.
• Avoid antibiotics for minor infections.
• Finish your course.
• Don’t share your antibiotics with others, and don’t take anything that wasn’t prescribed specifically for you.
• Finish your damn course.
• Reduce the spread of infections by washing your hands with soap and water, and cover your mouth when coughing/sneezing.
• Finish all the tablets in your course.
• Don’t cough/sneeze in your hands and then go touching things. Arm or inside your shirt it goes. Filth.
• Every. Damn. Tablet.

Luckily the crisis hasn’t gone proper mayhem yet, and on the contrary to the other health issues discussed in the general assembly, the UN has stepped in before hell breaks loose and there’s still time for interventions.

Originally published at The Isthmus.