Often when asked about the most pressing dangers to humanity, people will answer with ‘climate change’ or ‘the inevitable and total heat death of the universe’. The common factor there is that both of these things will likely take a very long time to bring about the destruction of the human species. Antibiotic resistance on the other hand is a problem that we are dealing with right now (or at least attempting to).
Bacteria are really really good at evolving. Think of the best thing at evolving you can, dear reader, and they’re even better than that (except arguably viruses). Because they reproduce incredibly quickly, this allows natural selection to rapidly build populations of individuals that are very good at living where they do.
For instance, let’s say you’re taking a course of antibiotics to clear an infection. Naturally, the drug will work and kill a significant portion of them in most cases without too much issue. You then feel better and decide to stop taking your tablets before finishing the course, you naive young fool. This means that any surviving bacteria, which were evidently good at resisting the effects of the antibiotic face much less competition and are free to reproduce again without competition. They will then grow to problematic numbers again, leaving you with an infection that is significantly more difficult to cure, as each one will have inherited antibiotic resistance due to the clonal reproduction of bacteria.
So how do we overcome this terrifying threat? Well unfortunately we’re quite far along the line towards impending doom, but we can yet try. Firstly, reduce antibiotic intake in humans and animals - these increase the background level of resistance for the above reason. There are some situations where they are completely useless, such as cold and flu - these are caused by viruses, and antibiotics will do diddly squat against them.
Second is a more outside-the-box answer - prevent infections in the first place. Immunisation and good hygiene are simple ways to achieve this, as if people do not encounter bacterial infections in the first place, they do not need to be treated at all. This prevents both the development and subsequent spreading of resistant bacteria.
Extensive tracking measures for resistance characteristics will also become vital, as well as proper management of resistant strains that have already developed. Such strains (particularly well known examples including MRSA, methicillin-resistant Staphylococcus aureus) can be easily carried in and around environments such as hospitals or public transport which can become extremely dangerous. If these strains can be isolated and properly dealt with it massively reduces risk of further harm. Different antibiotics can also be used in different hospitals and rotated to prevent establishment of multiple resistances to the entire arsenal of antibiotics.
Lastly, the key factor in dealing with this phenomenon in the long run is going to be developing brand new antibiotics that will catch the bugs unawares. Unfortunately there are a few problems here. Firstly, ideally any new drug developed should not be used unless as a last resort, obviously to minimise any development of resistance. Secondly, it is difficult to demonstrate efficacy of these drugs within trials while avoiding undesirable side effects. Finally because antibiotics need to be a cheap consumer-level purchase, profit margins for pharmaceutical companies are low and are therefore not a good investment from an economic standpoint.
Ultimately very little is going to change without a concerted effort at the manufacturer level, but I freely admit I have no idea as to how it should be brought about. See you in the antibiotic-resistant apocalypse.
