To prescribe or not to prescribe? The dangers of antibiotic resistance

A recent study by the O’Neil AMR Review stated that the rise in antibiotic resistance by bacteria will cause more deaths than cancer in the year 2050 raising concern by the Public Health Sector in the UK. The University of Manchester hosted a debate on the use of antibiotics last Wednesday evening, mainly focusing on different methods to reduce resistance from both healthcare professionals and the public.

Led by the Antibiotic Guardian, the evening consisted of not educating, a term which many speakers had to correct themselves with, but familiarising the public and students with the implications of using antibiotics unnecessarily and revealing the impact of misuse on a wider scale in the long run. Antibiotics are a course of treatment given to patients who are suffering from a bacterial infection. They work by inhibiting the growth of microbes and destroys any that are already active. Bacteria is an evolutionary imperative for all life forms so it can be dangerous when dealing with bacteria that is beneficial in our bodily systems.

The public were first given an insight on the history of antibiotics by Professor Laura Piddock, who is the BSAC Chair in Public Engagement. Piddock described antibiotics as a ‘wonder drug’ and stated, “most of us wouldn’t be around if it wasn’t for antimicrobials”. She then went on to talk about some of the earlier cases of meningitis that were treated by prophylaxis, an antibiotic. However, due to the recent rise in resistance of the bacteria, children and first-time university students are eligible to receive vaccinations to prevent catching the harmful infection. This can reduce the need of antibiotics and ensures that they are only used when absolutely necessary.

Between talks and discussions given by the panel and key speakers, the audience were introduced to a variety of videos which gave an insight to real-life scenarios. They focused on individuals sharing their stories and how important antibiotics were when they became ill. One particular patient that struck a chord was a recent cancer survivor who had undergone chemotherapy, a treatment that suppresses the immune system making patients more susceptible to catching infections. They said: “If it were not for the antibiotics prescribed, I wouldn’t have survived.”

Antibiotic resistance is at an all time high which reduces the effect of the medication when prescribed to a patient. Dr Andrew Dodgson, of Public Health England and Central Manchester Hospitals NHS, stated that bacteria are not “clever”. Bacteria is a predictable cell that has no brain and therefore we should be capable of slowing down the dangers of bacteria rapidly reproducing. He also noted that we should also be able to pressurise their revolutionary process. However, this can be risky as it may cause harmful bacteria to mutate more, giving rise to strands of antibiotics resistant bacteria.

Dr Mahesh Nirmalan followed next, and proceeded to answer the questions of when it is the right time to prescribe antibiotics and how can doctors distinguish whether an infection is due to fungal, viral or bacterial invasion of the body. Dr Nirmalan, having practiced medicine for 25 years, stated that a subjective component in decision making is inevitable and if you go for the safe option you can always have a reason for prescription. If there is a delay in prescribing the antibiotics, it can make the patient suffer for longer if there is a bacterial infection.

The conclusion to the debate was simply, the more experienced a doctor you are, the more likely you are to have a better understanding of what the patient is suffering from. This result could put pressure on junior doctors as many would rather just “give it rather than risk it”, pushing whether we should prioritise an individual or society.

The discussion finally concluded with what the public can do to prevent the misuse of antibiotics. A community pharmacist, Mohammed Hussain, stated that pharmacists should be given more responsibility and should be asked by patients whether they really think they require the course of antibiotics. The medication gives rapid diagnostics and can easily let the doctor know whether the patient is suffering from a bacterial infection or not.

Studies by Bad Bugs, No Drugs IDSA in 2004 led a series of investigations revealing that at this rate, bacteria is ahead of us and individuals may no longer see the impact of antibiotics, changing global health forever. So the next time you visit the doctor ask yourself: “Do I really need these antibiotics?”