NHS hot topics - antibiotic resistance

NHS hot topics are a common interview question and in this blog post, we will be discussing antibiotic resistance to help you prepare for your medical school interview and MMI circuits.

nhs-hot-topics-antibiotic-resistance


Why is antibiotic resistance so dangerous?  

When was the last time you needed antibiotics? Perhaps that one time you developed raging tonsillitis which wouldn’t go away, or perhaps you got bitten by a dog and had to have antibiotics to prevent further infection. All in all, you would have thought antibiotics were great, right? After popping a few pills, you felt right as rain!

But, let me ask you this, how many times have you or your family & friends, come back from the primary care GP empty-handed after expecting an antibiotic prescription for a persistent flu or fever? So, the question is, why are Public Health England and doctors becoming increasingly more aware of their antibiotic prescribing in this modern era where we are developing more and more lifesaving medications to treat medical illness? Well, the answer is simple, it’s called antibiotic resistance! 

Antibiotics - a quick history lesson 

Antibiotics were first discovered by Alexander Fleming at St. Mary’s Hospital in London in 1928. He returned from holiday to discover that mould had grown in a petri dish full of bacteria. Mould can, of course, be seen growing in many places on a day to day basis. Just like bacteria, mould is a multicellular form of a living organism called fungi. Alexander Fleming used the properties of the mould to help create the very first antibiotic: Penicillin.   

the-history-of-antibiotics

Penicillin revolutionised medicine and patient care. Life-threatening illnesses like meningitis & pneumonia could be treated easily. Soldiers that suffered from fatal wounds could be treated with antibiotics to prevent them from developing fatal blood infections. Operations could be performed with a much lower risk of developing infections after the procedure if the patient was given antibiotics.

Over a few decades, several different types of antibiotics were invented to fight different types of bacterial infection. However, as antibiotics became cheaper and easier to access, antibiotics began to be overused. Pause a moment, and have a quick think of any circumstances of situations in which antibiotics may be used inappropriately?

Something was bound to happen because of the overuse of these wonder drugs. And it did. This is where we come onto the hot topic of antibiotic resistance.   We started this blog with a classic example. GPs were readily prescribing antibiotics to patients who came into surgery with viral infections. These antibiotics were not helpful in killing viral infections and so were given unnecessarily to patients. Some doctors were prescribing inappropriate types and doses of antibiotics to patients for certain medical conditions. Antibiotics were even used in the livestock industry to prevent infections in animals.   

antibiotic-resistance-and-its-effects

What is antibiotic resistance?   

All living organisms evolve to survive. What did the bacteria do? The evolved of course! Antibiotic resistance is the ability of a microorganism such as a bacteria, virus or parasite to stop antimicrobials such as antibiotics and anti-viral medications from working against it. As a result, standard treatments become ineffective and these resistant organisms can spread to other hosts. Don’t take our word for it, just have a look at this timeline. 

antibiotic-timeline

On the left is the emergence of new, antibiotic resistant bacteria, and on the right, are our attempts of developing new antibiotics to treat these resistant bacteria.  Who do you think is winning? It’s easy to see that there are more new resistant bacteria than antibiotics on this list. How does antimicrobial resistance occur? In simple terms, bacteria can become resistant to antibiotics in four ways:

  1. They inactivate antibiotic by disabling a fundamental part of this chemical mechanism 
  2. The resistant bacteria produce proteins which actively pump out the antibiotic chemicals from their cells  
  3. The bacteria change the binding site with allows antibiotic chemicals to be activated rendering them useless 
  4. The bacteria change their metabolic pathways which the antibiotic seeks to inhibit  

All it takes is for one resistant bacteria to develop by spontaneous mutation, and because antibiotics tend to destroy all the other bacteria which would compete normally compete with this resistant strain to keep it from flourishing, there is nothing left to stop it from growing rapidly and taking over its host. Sounds like a horror story right out a zombie movie, right? Well, you better believe all this fiction is becoming fact sooner than you think! 

the-dangers-of-antibiotic-resistance

Antibiotic resistance - let’s focus on the word ‘dangerous’ now 

Image a world where we are unable to perform major surgery on patients, where organ transplants and chemotherapy is no longer possible. Antibiotics play a key role in allowing all of these common procedures, that we take for granted, to occur. 

You don’t even have to imagine, to realise the global impact of diseases such as MRSA and multi-drug resistant tuberculosis. These are all organisms that were allowed to flourish through our overuse of antibiotics. These infections are becoming more common day by day and claiming thousands of lives. They say a picture says a thousand words, here is a projection of deaths from drug-resistant infections by 2050.  

antimicrobial-resistance

Hopefully, we have given you an idea of why the word ‘dangerous’ fits in very appropriately before the word antibiotic resistance.  

How can we prevent a zombie apocalypse? 

This concept of ‘anti-microbial stewardship’ has become increasingly popular amongst medical professionals and is the goal of tackling the overuse and misuse of antibiotics. As a future healthcare professional, you will also be expected to accept responsibly over this time critical issue.

antibiotic-resistance-effects


Antibiotic resistance cannot be eradicated, but we can prevent the emergence of new strains by being conscious about the way we prescribe antibiotics in the future. How can we do this? Well, it all starts with antibiotic awareness for our general practitioners and hospital doctors. We need to be careful with prescribing appropriate antibiotics for medical conditions.

Instead of prescribing broad-spectrum antibiotics, we should look to focus on the exact cause of infection and give targeted antibiotics to treat this infection. For example, if we suspect a patient has a urinary tract infection, we should test a sample of the urine first to decide on the most appropriate antibiotic to prescribe for them instead of giving them an antibiotic which covers a wide range of infections, such as chest infections, skin infections and urinary tract infections all at once.

We should document the dose, duration and indication for each antibiotic we prescribe to allow audit teams to trace back the source of any resistant organisms and prevent further spread of organisms. We need to keep up to date antibiotic resistant patterns to stop us from over-prescribing these antibiotics. Finally, we need to follow hand hygiene and infection control methods to prevent the spread of potentially resistant microbes.  

These are a few examples of what we can all do to prevent the antimicrobial resistance. The world is now said to be on the cusp of a ‘post-antibiotic era’ where antibiotics may become useless in the fight against infection. Long gone are the days when antibiotics could be called ‘wonder drugs’.

However, there are new antimicrobial treatments such as ‘teixobactin’ and the use of special ‘phage’ viruses to kill bacteria in pipeline. Will they emerge fast enough to make a significant difference in the future, it’s hard to tell. For now, let’s hope we have recognised the significance of antibiotic resistance and have done enough to prevent a zombie apocalypse.  

For other hot topics make sure to check out our blog post on the Irish abortion referendum or our Online Interview Course for more expert interview preparation videos. Good luck and don't hesitate to get in touch via hello@themsag.com if you have any questions or need any advice.







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