Good news, bad news: lower antibiotic use, more antibiotic resistance in UK

Public Health England (PHE) is cheering about a significant fall in the number of antibiotic prescriptions in England over the five years between 2014 and 2019, when it has dropped by 17%. However, with more and more bacterial infections showing antibiotic resistance every single year, there is no room for complacency.

The only way out is for the public to join the fight by not taking antibiotics for minor infections. Says PHE’s Susan Hopkins, “Taking antibiotics when you don't need them is not a harmless act – it can have grave consequences for you and your family's health, now and in the future.”

Why are scientists growingly concerned about global antibiotic overuse? Expert Helen Stokes-Lampard says, “Antibiotics can be lifesaving drugs but when bacteria become resistant to them – as they increasingly are – they will cease to work, and in many cases we will then have no viable therapeutic alternative, which could be disastrous for the patients affected.”

In just the last year – 2017 to 2018 – the number of antibiotic-resistant infections rose by 9% to hit a high of almost 61,000. In fact, over the same five-year period, says PHE, there were at least a third more of the most serious infections, namely, bloodstream infection with antibiotic-resistant bacteria, most commonly with the gut bacterium called Escherichia coli.

Escherichia coli bacterium, E.coli, gram-negative rod-shaped bacteria, part of intestinal normal flora and causative agent of diarrhea and inflammations of different location, 3D illustration Credit: Kateryna Kon / Shutterstock
Escherichia coli bacterium, E.coli, gram-negative rod-shaped bacteria, part of intestinal normal flora and causative agent of diarrhea and inflammations of different location, 3D illustration Credit: Kateryna Kon / Shutterstock

Antibiotics and resistance

Antibiotics are powerful cell toxins that affect bacterial growth and/or proliferation, with relative selectivity. They go back all the way to penicillin, the first wonder drug to be discovered, and have been game-changers in infection control ever since. They are essential when it comes to the treatment of serious bacterial infections like sepsis, pneumonia and meningitis, which can easily be fatal if not properly treated. However, they don’t need to be used on a routine basis for simpler infections such as a cough, a sore throat or a earache – the body can usually take care of these on its own. Such infections are described as self-limiting, and do not require antibiotic therapy.

But what’s wrong with popping an antibiotic unnecessarily? Plenty, it turns out. Every antibiotic kills more or less bacteria of the type it is supposed to. However, there are always some survivors, due to the presence of certain bacterial genes that help the microbes to bypass the mechanism used by the antibiotic to suppress or kill them. This is what leads to drug resistance. To make things worse, these genes tend to get shared around between different bacteria, making each species resistant to many more types of antibiotics.

What this means is that we are finally left without too many options when it comes to treating such infections.

When antibiotics are overused, the number of these resistant bacteria can overwhelm the normal susceptible bacteria in the population – which means they are free to infect more and more people. And these infections are not easily cured at all.

What we can do

Describing this as a “worrying” trend, Hopkins says, “We want the public to join us in tackling antibiotic resistance by listening to your GP, pharmacist or nurse's advice and only taking antibiotics when necessary.”

The public health agency said it had not found that reducing antibiotic use had resulted in more cases of serious infection requiring hospitalization. Instead, she said, praising GPs for working to reduce antibiotic use wisely, the “positive steps” taken had resulted in less antibiotic use without delaying recovery from infection. Such efforts resulted in a 6% fall in prescriptions by 2016, and the present 17% reduction by 2018.

The rates of antibiotic prescription declined from 750 to 624 prescriptions per 1,000 people per year, over five years, most markedly in people under 65. At the same time, the number of dental antibiotics was less by over a quarter. The UK government is committed to bring about a further 15% fall in January, part of a larger plan to reduce antibiotic resistance over the next two decades.

The PHE is starting up its third Keep Antibiotics Working campaign, to educate people about antibiotic resistance and to encourage them to listen to their healthcare provider when advised not to use these drugs in certain situations. This is good advice for people everywhere, as well as for their doctors. In fact, it is the only way to make sure antibiotics will be available in future to treat the more serious and potentially crippling or lethal infections.

Says Chris Whitty (Chief Medical Officer of the UK), “The decrease in consumption of antibiotics is good news but the rise in resistant infections shows the threat is increasing and so there is more to be done. Antibiotic resistance is not just a matter for clinicians - the public also have a crucial role to play in helping to preserve these vital medicines.”

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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