Since the accidental discovery of penicillin in 1928, antibiotics have become an absolute cornerstone of medicine. Used to treat everything from meningitis to acne, and often prescribed to prevent infections after surgery or serious injury, it’s hard to imagine a world where we cannot rely on antibiotics to cure what ails us. However, with the onset of resistant ‘superbugs’, and with no new antibiotics being developed in the last 20 years, this world we can barely imagine could well become a reality.

The Arsenal – an overview of our antibiotics.

• Penicillin, macrolides and fluoroquinolones – penicillin, the mother of them all, is usually the first line of defence against a broad spectrum of bacterial infections. Macrolides like erythromycin and fluoroquinolones are a useful alternative for anyone who has a penicillin allergy
• Tetracycline – most often used to treat bacterial skin conditions like acne and rosacea
• Aminoglycosides – these are the ‘big guns’; as they can produce some unpleasant side effects, they are most often used to treat dangerous infections such as meningitis and sepsis.

All of the above work by preventing bacteria from repairing itself, preventing bacteria from multiplying, or by penetrating and bursting the bacteria’s cell walls.

The Battleground – challenges facing our antibiotics

• Over-prescription: As antibiotics have proven so effective at treating bacterial infections, they have arguably become a pharmaceutical ‘crutch’, prescribed to quickly dispatch illnesses which may have resolved by themselves given time and careful management. Additionally, antibiotics are sometimes mistakenly prescribed for viral infections such as colds and ‘flu. Antibiotics are not effective in treating viruses! However, the antibiotic will target harmless bacteria present in the body, and these encounters make it easier for the nasty bugs to resist that antibiotic in the future.
• Incorrect usage: It might seem counterintuitive to carry on taking medicine once you’ve stopped feeling poorly. But when it comes to bacterial infections, starting to feel better doesn’t necessarily mean that the ‘bugs’ are all dead and gone. Stop taking antibiotics before the course finishes and there’s a good chance that the remaining bacteria may recover, multiply and adapt to resist the antibiotic you’ve exposed them to.

The Enemy – the next generation of superbugs

Hearing the word ‘superbug’, you might immediately think of MRSA and C Difficile. While these infections can spread rapidly and may lead to dangerous complications, they can usually be treated with high-dose antibiotics.

An even greater concern is Multidrug-resistant Tuberculosis (MDR-TB). Despite treatment and vaccination programmes which gave us good control over the disease in the 20^th century, TB is becoming resistant to many antibiotics, meaning that patients often require medicines which are expensive, not readily available, or which cause unpleasant side effects. What’s more, TB is changing fast. Currently, around 9% of MDR-TB cases are diagnosed as ‘extensively resistant’, meaning that even our most powerful TB treatments are ineffective against it.

Just as TB has adapted quickly, there is a real danger of other infections including gonorrhoea and E Coli retaliating against this generation of antibiotics.

The Future – Where do we go from here?

Even before Phase 1 Clinical Trials can begin, drug development is a lengthy process. It can take up to 20 years for a drug to progress from Research and Development to the pharmacy shelves.  Fortunately, there are already a few promising new antibiotics in the pipeline which could hold the key to resisting the resistance!

• Tarocin A and Tarocin B – these molecules attack and damage the cell walls of harmful bacteria. By itself it may not be particularly effective, but it is hoped that a combination of tarocin and another antibiotic could attack bacteria on 2 fronts, rendering even resistant bacteria vulnerable to treatments once again. Lab tests of tarocins have shown promising results, and human clinical trials are expected to begin soon.
• Teixobactin – Lab tests have shown that teixobactin attacks infection in a completely new way, meaning that bacteria have little or no resistance to it. It is naturally present in soil, and does not flourish in the typical, sterile environment of a laboratory. Special technology has been developed to extract teixobactin from soil-dwelling microbes. As this process has been particularly complex, teixobactin is not as far forward in development as the tarocins, but it is believed that it could be used to develop as many as 25 potential new antibiotics.

In The Meantime

It is highly likely that all of us will need to use at least 1 course of antibiotics at some point in our lives. It’s in everybody’s best interest to resist the resistance! Here’s how you can help

• Practice good hygiene – the majority of superbugs are spread through contact with contaminated surfaces. Ensure that you clean your hands after visiting the loo, and after any visits to the GPs surgery or hospital. Using your own towels, flannels etc can help with this too – this is one instance where it’s okay not to share!
• Don’t ask your Dr for antibiotics – trust his or her judgement. You may not be prescribed antibiotics immediately if your Dr suspects you have a viral or a mild bacterial infection. You can always return if your symptoms persist or worsen!
• If you’re given antibiotics, use them all – even if you’re feeling better. That bug could come back with a vengeance and be much harder to shift this time!
• Consider taking part in Clinical Trials – drug development can take up to 20 years, even when there is an urgent need for a new medicine. Healthy volunteers who take part in paid clinical trials with Covance help to speed up the process and get essential treatments on the market sooner.