What does the post-antibiotic era actually mean?
Prof. Adam Roberts is Senior Lecturer in Molecular Microbiology at the UCL Eastman Dental Institute, and Advisor to the Longitude Prize.
There are multiple reasons why we are in the precarious position we are in at the moment, seemingly teetering on the edge of post-antibiotic catastrophe. Our consistent, increasing, inappropriate, over and under-use of antibiotics is well documented and the effects of this on the evolution of resistance in microbes are understood. We are fully aware of why we are locked in a discovery void due to the lack of financial incentives required to kick-start the process once again. What is less well understood is the impact all these events could have on the everyday lives of citizens, and it is arguably this audience that has the power to demand change from those who can implement it.
Terms such as "post-antibiotic era", "antibiotic apocalypse" and variants of "a time when a simple scratch may once again kill" have been widely used in the media as a catch-all to try and convey the magnitude of the problem that we face. Unfortunately science communicators and commentators rarely get more than a matter of seconds, or a few column inches, to get their message across to the public when using mainstream media outlets. I will use this opportunity to explore what it could mean for individuals if the trends of antibiotic usage and resistance continue to rise.
The most understandable effect of having no useful antibiotics is our inability to treat a bacterial infection. We can acquire an infection from pretty much any activity we do, but we can take care of the vast majority of them with our highly developed immune systems. However, if you are immune-compromised or you have a particularly nasty infection, the outcome without antibiotics may well be dire.
There are an unquantifiable number of ways bacteria can get into our body and cause infections. These include a graze, a scratch or a splinter that cuts through our skin or a bite from insects, spiders, dogs, cats, other pets, wild animals and children. How many of us have had irritation following a shaving cut? Minor injuries from everyday activities including sports, cleaning, our occupations, travelling, can result in infection. As a society we have moved away from being preventative of minor injuries for fear of infection to one where we are reliant on antibiotics to cure them.
In 1940, just before the mainstream use of antibiotics began, the grandfather of one of my colleagues had a toothache. He underwent a routine tooth extraction in hospital. He was 33 years old, fit and healthy. He died within a month from sepsis as a result of an infection following the extraction.
Can you imagine someone dying in our time from a bad tooth? Can you imagine somebody at your child's school dying following a tooth extraction, and having to explain it to your child? Imagine if it was your own child. The increased average lifespan of a human over the last few decades is a direct result of antibiotic use and this would probably decrease when we can no longer rely on them.
Consider sepsis, an infection of the blood caused by many bacteria that rapidly leads to multiple organ failure, coma and 40,000 deaths per year in the UK alone. The key to its treatment is catching it early so antibiotic treatment can begin. A clinical colleague of mine recently told me, "With no antibiotics I could not save lives from sepsis."
If treating infections was the total extent of our antibiotic usage then we might possibly be able to cope by being more careful, reducing the risk of infection on an individual level, allowing us to survive into old age.
Unfortunately, not only do we use antibiotics to treat bacterial infections, we also use them to support many other medical activities. Surgeries, including Caesarean sections, cancer treatment, transplants, joint replacements such as hip and knee, and many others would be far riskier. Some would be virtually impossible without the prophylactic support provided by antibiotics, which dramatically reduce post-operative infections.
A consequence of this would be a completely overstretched healthcare system. It could be argued that, at best, our own NHS is just about managing at the moment. Imagine a situation where there are far less successful outcomes and situations where there is actually little, if anything, a doctor can do. It is conceivable that modern health care as we know it would collapse or change beyond all recognition in order to cope. Numbers of medical staff could rapidly dwindle due to demoralisation and emotional overburden as a consequence of their inability to treat patients.
Cooks, builders, mechanics, veterinarians and many other professions may decide that their occupation is too risky for the money offered as payment to do it. Waste collection workers may demand more personal protection and financial compensation for carrying out tasks essential to society. We could conceivably see very different employment patterns as a result of the antibiotic crises, and the transition may well precipitate the kind of actions seen by an unsatisfied electorate in 1978-79 during the Winter of Discontent.
Society will also have some extremely tough decisions to make. What then if we have one antibiotic left to treat infections? Do we give it to everybody who needs it or do we restrict its use? Maybe only front-line medical staff should be allowed to have it in order to try and preserve the efficacy of the healthcare system. If everybody has access to it, resistance will more rapidly emerge as every single use of an antibiotic selects for resistance. It is an almost impossible decision for society to make. It would be nice if we never had to.
Watch Dr. Adam Roberts in a special episode of Al Jazeera's The Cure series. In this episode, reporters aim to uncover why antibiotic resistance has become such a huge and real threat across the world. They expose how rising resistance is already affecting patients in the hospitals of the UK; how cattle farmers are exacerbating the problem; why the hunt for new antibiotics is taking researchers to the caves of South Dakota; and how a new diagnostic tool is helping identify drug-resistant TB in the townships of South Africa.