Antibiotics - The Killer Drug
by Yvette Barnett

Imagining March 3rd, 2010

As we entered the new millennium full of hope and optimism for the future, we saw the warning signs but chose to ignore them. The dawn of the new millennium was to be the beginning of a new and much improved era. But scientists were already sounding alarm bells that our misuse of antibiotics in the 20th Century would result in problems for the future. We ignored those signals and today we are paying the price.

As this year’s bout of influenza reaches epidemic proportions, the Government has issued an official quarantine announcement.

‘No person shall after 12 hours after the publication of this notice be permitted to enter into or leave their respective counties on any rail network, by road or in any manner whatsoever by any conveyance, on foot or otherwise without first obtaining a permit from their local health department.’

The government authorities have today closed all schools and forbidden all public meetings and gatherings, including funerals, in an attempt to isolate the epidemic. Spanish flu, also known as the ‘Spanish Lady’ is believed to have reached our shores via the increased number of holidaymakers that have visited Spain over the recent winter months. The Costa resorts in Spain have been making a comeback as the most popular European holiday destinations. They are cheap, cheerful and only a two hour flight away. But it seems that as a nation, we are now paying the price for people’s winter sojourns.

The repercussions of this disease are not just stopping at killing our loved ones. The ramifications stretch much further. Today, the Government has issued a statement that the Euro is at its all time lowest value since it was introduced. Productivity has reached a virtual standstill, the workforce is on sick leave in record numbers and has today reached the 30 million mark.

In a short time the influenza virus has made its way here and is killing people throughout Europe. More than 1.3 million people in Britain alone have died in the last two months and a further 20 million people are currently seriously ill, desperately fighting to stave off this killer flu.

Medical experts are ordering people to go straight to bed and stay quiet, eat plenty of nourishing food and try and maintain your strength to fight off the illness. There is no cure for influenza. The disease must run its course. Evidence seems to prove that this is a disease which is principally spread by human contact, for example by coughing, sneezing and spitting. It is therefore important that if you have any symptoms resembling the common cold, you should remain in your home until they have subsided.

Influenza weakens bodily resistance and there are grave warnings from the medical world that there is an increased danger of bronchitis and pneumonia developing. But we are today learning that there are an increasing number of reported cases of pulmonary tuberculosis which is attacking people whose immune system has been weakened by influenza. The country now offers the perfect condition to encourage the spread of tuberculosis, and this is where an even bigger danger lies.

As early as 1945 Sir Alexander Fleming who brought us penicillin, predicted that the more antibiotics people take or feed their animals, the faster bacteria will become resistant. But we didn’t heed this warning. Throughout the 1980's and 90's, rich people, and particularly women, throughout the world visited the doctor with minor ailments and were given antibiotics like children are handed out smarties. The more that people paid for medical care, the more antibiotics they were given. If the doctor had given them nothing, they would have simply gone elsewhere to a doctor who would.

But when one person takes an antibiotic, it is not just an act of an individual seeking a cure from infection, instead it is a social act that stimulates resistance to the whole world of bacteria which implicates us all. It affects everybody and not just the individual who took the pill. Of course we need the drugs, surgery would be impossible without them and people would have died anyway. But the drug has its limitations, as we are now learning at our cost.

Antibiotics were never intended to be given for viruses; they were always known not to be effective against them. Antibiotics were intended to be used to fight infection. In the United States of America in the year 2000, one third of all antibiotics were mis-prescribed. They were administered for viral infections against which they were powerless. Today we are paying the price of the recklessness of our predecessors.

In Britain it was always a slightly different story. As a nation we only accounted for 4% of the world’s antibiotic consumption. This was due to the fact that we had at that time a National Health Service, controlled by Government spending, and whilst there was medical treatment offered free to everyone, there were certainly far fewer antibiotics handed out than in the private medical sector, where people effectively paid for that ‘luxury.’ Britain was a stark contrast to other countries. For example in the USA, Japan and Spain, antibiotics were sold over the counter in pharmacies without the necessity of prescriptions signed by doctors and the rich took them like common aspirin.

So today why do we have no effective antibiotics that are able to fight the bacteria that surround us? There are many reasons. The most fundamental is that ever since scientists invented antibiotics, the bugs they were designed to combat have been one step ahead of the game. Their introduction has lulled two generations into a false sense of security, people believing that there will always be pills to fight any infection we get. However, unless humans develop a solid immunity to bacteria, our ability to treat infections will always be doomed to failure, just as it is right now. We are now living in an era where the bugs are winning, and people are dying because of it.

Dr Stuart Levy of the Alliance for the Prudent Use of Antibiotics, Boston gave his first warning in 1981. He told us that the misuse of the drugs will, without a shadow of doubt, cause problems for infections in the future. He campaigned to a medical establishment that was not listening. No one would accept that there would ever be a problem.

One particular bug staphylococcus aureus (SA) has always been scientists primary target in the battle against antibiotic resistance. It is probably the world’s most infectious agent. At any one time, one third of us carry SA, usually in our noses, but most of the time it has no effect on our health. However, SA was the main reason that until 1945 modern surgery was almost impossible. Almost any operation would push SA deep into the human tissue and lead to a potentially fatal infection. Penicillin made surgery less risky because it killed SA and with that came the saving of lives.

Within eighteen months of penicillin’s first use, the bacteria SA had developed a system for chopping up the penicillin molecule. By the late 1950's, 90% of all SA strains were already resistant to penicillin.

In 1959, the new antibiotic ‘methicillin’ was introduced which also effectively killed SA, but the same thing happened again. Within eighteen months, SA was resistant to it. The proteins in the outer coat of SA had changed to such an extent that the antibiotic couldn’t bind to it. This we know as MRSA (methiciliin resistant SA).

It’s interesting that MRSA wouldn’t exist as a bacteria we cannot control if it weren’t for the antibiotic SA being invented in the first place. The possibility of contracting MRSA has, since the turn of the century, been overwhelming. Hospitals provide a near-perfect environment for the bug to live and breed; they are full of patients with wounds whose immune systems are suppressed.

This resistance compromises our ability to conduct modern medicine. St Thomas’s Hospital, one of the most keenly aware hospitals and the one with perhaps the best infection control systems in the country has 80 cases of MRSA cases a month, double the figure of 10 years ago. It is still unclear how many people MRSA kills. Death certificates give the cause as cancer or heart attack and never MRSA because it is difficult to isolate this as being the sole reason for death.

Most MRSA strains could be treated with some form of antibiotics and in the year 2000, the most powerful antibiotic called ‘vancomycin’ had been discovered. Scientists believed that it could be used to conquer any infection. It was almost always effective but like its predecessors, bacteria began to evolve that could eat ‘vancomycin.’ By the year 2003 cases of VRSA (vancomycin resistant SA) were appearing across the world. Scientists had been defeated yet again by what had been heralded as the drug to fight all bugs.

Scientists believed that ‘vancomycin’ had won the battle but even they should have realised that whilst man has been on this planet for thousands of years, bugs have been here for millions, vying for their survival the whole time, and more importantly always winning. The dilemma has always been how to get one step ahead of the bacteria.

By the last millennium, the pneumonia bug was acquiring multiple resistance. Food poisoning bacteria such as E-coli and salmonella had also acquired multiple resistance. But we were lucky, the number of fatalities was never as high as it could have been. The Government took an early initiative and stepped in to ban home cleaning agents that had been designed to combat kitchen bacteria. Chemical anti-bacterial cleaners were found to be extremely harmful. They killed the bacteria that were necessary to prevent food poisoning. Our habits were forced to change and we all reverted to the rather primitive method of using good old hot soapy water. The cleaners were believed to play a large part in increasing resistance to antibiotics.

As a result of that ban, Unilever was faced with huge class actions, namely groups of people who joined forces to bring one of the most costly lawsuits of our generation. David took on Goliath and won. Families had lost loved ones to the deadly food poisoning infections and the lawsuit was their only means to fight back. Unilever had been producing anti-bacterial agents for years and we had unknowingly changed our cleaning habits because of this wonder cleaner, believing it to be the most hygienic way to clean the kitchen worktops. Unilever, as a result of the costly lawsuit was forced into bankruptcy.

Potentially the most lethal of all, is the strain of multiple resistant Tuberculosis which emerged at the turn of the century. At first it mainly attacked in the United States, mostly drug addicts and sufferers of AIDS and to a lesser extent people in less well-developed countries. Because it largely affected this relatively small group of people, nobody took any real notice. Today of course, we know that it is sweeping through our populations afflicting those that are still weak after the current flu epidemic.

As we look back to the year 2000 with our 20-20 hindsight vision, we should have been better able to anticipate the potential of the spread of tuberculosis. But we probably thought that we fixed tuberculosis in the 1950's and were confident that it wouldn’t return. However, we only have to look at history to see that it has a nasty habit of repeating itself. Look back at the Spanish influenza epidemic of 1918 and 1919 and it bears a striking resemblance to what we are experiencing now, a little under a hundred years later.

The flu epidemic of 1918 killed millions of people as the illness swept across the world. The American troops, who came home after the First World War, were believed to have come into contact with the bug when they were shipped overseas to Europe to help with the war. When they began to return home, the epidemic hit the East coast ports like wildfire. In a short time the flu made its way to 46 states killing more than 500,000 people in its wake. At the same time, ports in South Africa, Cape Town and Durban, were also decimated.

It takes five to ten years to develop an antibiotic from the first stages through to production and to the ultimate sale of the final product. Unfortunately in the 1990's drug companies failed to see the development of antibiotics as a lucrative enough field of research. They lost interest and switched to more profitable areas. This ultimately led to a lull and indeed a gap between old antibiotics that were SA resistant and new ones that could possibly combat the bacteria.
In 2003 ‘Linezolid’ was heralded as the drug to save the world and was even successful against MRSA. It was seen as the drug to supersede ‘vancomycin’ - the ultimate antibiotic to continue where its predecessor had ceased to be effective. But by 2006, it was already struggling in its effectiveness and the battle was still being fought to find a drug that was MRSA resistant.

Supercomputers began producing millions of possible compounds. The experiments were changing to a more genetic means of testing which enabled scientists to target bacteria more precisely. In 2006, with the aid of computer technology, we believed that we were for the first time in history half a step ahead of the game in the battle against MRSA resistant bacteria.

How wrong could we have been? The next wave of resistance was due to come in the year 2020 or possibly 2025 which would have been completely predictable, but it is here now in 2010. The problem is: we have no new drugs ready and tested to fight the deadly bacteria.

The size of cities, the increase in Britain’s population and the longevity of people’s lives have all added to the necessity of our health service infrastructure changing, and changed it has. Gone are the days when we had free health service for all. Admittedly there were always queues and waiting lists for operations and consultations with the medics but the most important thing was that it was free at the point of service for all who needed it. There has nearly always been an alternative private health service for those that could afford it or for those who simply wanted to pay for a better service and a private room with baskets of fruit.

Today of course, it is a completely different story. The National Health Service, already beginning to lose favour at the turn of the century, no longer exists at all. Today, we have only one, the Government private health service. Today everybody needs to have some sort of private health cover to pay for their medical bills. People used to think that we would never end up with a health service that mirrored America’s, but here we are with exactly that. Most of us grew up with a national health service, and people assumed that the Government would always need to find the funding for the service, no matter what. Votes, would be lost if a Government lost the national health service altogether. But we were wrong.

Of course, if people are so desperately poor that they can’t afford health cover then there is emergency cover available, but it is a standard that is indifferent and in a separate part of the hospital. People are left waiting for great lengths of time or sometimes they simply die waiting. Doctors attend their private patients first. It is a sad cry from the days of our once beloved National Health Service.

Variations of the ‘Linezolid’ drug have constantly been updated, but to no avail. Nothing seems adequate to combat tuberculosis. Back in the year 2000, St Thomas’s hospital began screening patients for resistant infections before allowing them into the hospital. Ten years ago, it seemed overly sensitive and viewed as something that would never be the normal way of accepting admissions. Today of course it is the norm. Everybody is screened before they are admitted.

In every hospital in the country there are isolation wards. We have been forced to go back to a drug-free era, back to a life before penicillin was ever invented. Before penicillin, hygiene was of paramount importance but once it was discovered it led to a complacency that was always inevitably going to lead to problems.

In the days of Florence Nightingale, hospitals were spotlessly clean with doctors and nurses acutely aware of the perils of infection. As penicillin became more widely used, doctors failed to even wash their hands as they went from patient to patient doing their daily rounds. Germs were so easily transferred between bedding. Nurses were more aware of the spread of germs, always diligently washing their hands between patients but doctors on the other hand seemed to rely and act in a manner that suggested that if any disease spread it would be okay; antibiotics would look after the problem. It is attitudes such as these that led to a heavy reliance on the drugs in the first place.

Today, the Government have issued the warning that nobody is to leave their respective county without a permit for fear of spreading the influenza bug. But the reality is a little different. The spread of Tuberculosis is proving to be the bigger threat to us.

We no longer have a penicillin drug that is tuberculosis multiple resistant. We had the drug and abused it and now we find ourselves living in a time that few people thought would ever come. The gap in the research, when no new drugs were being discovered, has hit us harder than we might have imagined. If it hadn’t been for this latest flu epidemic, perhaps a new drug might have been found in time.

Without the effectiveness of penicillin to fight tuberculosis, what are we left with? We have the rather archaic method of cutting out the damaged lung caused by the disease, followed by the waiting - will they die or won’t they? We have reverted to the wait and see method. Today, all we can do is isolate our victims to prevent the unnecessary spread of the disease. But with the isolation, comes the division of the family unit, children forced into the care of social services to pray for sick relatives, hoping they will recover from the killer disease.

Before we had penicillin all we could do was wait and pray, and today as I watch people die, all I can do is observe the irony of how we have come full circle.

© YVETTE BARNETT 2000

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