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Superbugs and the threat they pose to our healthcare systems have somewhat dropped off the radar following the events of the last few years, but given the number and variety of bacteria now achieving pan-drug resistance, it’s probably worth another discussion.
We have recently learned of a number of diseases which are effectively incurable with modern medicines. STDs, Tuberculosis, e.coli, the list is longer than anyone would like. These previously easily treatable infections are once more fatal.
The antibiotics which made their treatment straightforward have become ineffective because of the way they have been misused, over prescribed and incorrectly administered.
The use of antibiotics in farming has been alarming. In agriculture they are used to increase crop productivity and in livestock to accelerate growth. Their misuse in healthcare is almost as bad - historically doctors have been able to hand out antibiotics almost at will (no doubt partially as a result of the way drug companies promote their products in healthcare).
Even now, when the problems of resistance have been well known for decades, as many as 30% of all antibiotic prescriptions are not needed. When incorrectly prescribed, and especially when prescribed courses aren't completed, bacteria are able to mutate, producing offspring which aren't affected by the antibiotic.
One often ignored source of resistance is water. Humans and animals pass antibiotics into water where it interacts with more and more strains of bacteria, helping them to develop new resistance.
The result is that today vancomycin, the antibiotic of last resort (only prescribed in cases where all others have failed and whose distribution is tightly controlled) is losing its effect. There are strains of some diseases which are now untreatable with the antibiotics we have.
We need new antibiotics. And that's a problem.
Our primary source of new antibiotics are microorganisms found in the soil, trees, plants and fungi. It is now nearly forty years since a new class of antibiotics was discovered. As we sweep through our environment destroying the rainforests, soil and plant species we reduce our ability to find sources of new and effective antibiotics.
How much of a problem is this? Well it's estimated that globally 700,000 people a year die from a drug resistant bacterial infection and the US CDC believes that this number will rise to 10 million by 2050.
Over the next few decades our options for treating patients with infections resistant to bacteria will be little more than those available to Victorian era physicians - amputation, organ removal and eventually palliative care.
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