Opinion Former Article

The Longitude Prize 2014 goes to Antibiotics, and tackling the constantly evolving global problem

As patients who have been affected by this problem, more often than not with tragic consequences, we are pleased that this has been the choice of the public who have voted antibiotics as the winner. This means a lot to us, awareness and knowledge is very important in the battle of the superbugs.

Clinicians are often under pressure to prescribe broad spectrum antibiotics to sick patients because doctors have to act quickly on imperfect information. This can cause microbes to evolve resistance to antibiotics. Radical change is needed to address the global problem of growing anti-microbial resistance, to ensure a healthcare system that can sustainably control and treat infections.

Bacteria constantly evolve to maintain their viability in the face of the antibiotics used against them. Increasing resistance in G ram - negative bacteria such as E. coli, is a particular and growing public health concern because of the limited treatment options for infections caused by these bacteria, especially those that are resistant to carbapenem antibiotics , which are the last - line drugs used to treat those infections. Gram positive bacteria, including MRSA, do hold antibiotics in their thicker cell walls, however gram negative bacteria have thinner cell walls and do not hold antibiotics so well – exacerbating the ability to evolve multi-drug resistance.

We have a battle on our hands. Most of us will come into contact with multi- drug resistant strains and may be carrying them innocuously, but if we become sick or need elective or emergency medical treatment then we could be reliant on antibiotics to save our lives and protect the people who we come into contact with, whether that's other patients our colleagues, friends and members of our household. Antibiotics and the bacteria that evolve to become resistant do not stay with their host and transmission needs to be understood.

But its not human healthcare alone that needs to be addressed. With antibiotics being used in agriculture, resistant pathogens have become a large part of the environment we live in and are now part of ecology, pollution in water is showing high levels of multi-drug resistant pathogens which live happily alongside biocides and detergents. The drugs we rely on to treat us are used to treat animals, so we are consuming small amounts all the time, no-one can be certain of the effects all of this is having. There is a long road ahead to understand the problems, curbing the use of antibiotics, looking at alternatives and drug discovery.

The Department of Health, with Department for Environment, Food and Rural Affairs and Public Health England, will lead a wide - ranging programme of work involving organisations from public and private sectors in the UK and will be actively shaping international activity along with the EU.

Devising a rapid cost effective test that can be used in any healthcare environment is just one of many things that need to happen to aid prescribers in human and animal medicine. For healthcare we need to:

- Improve infection prevention and control to reduce the need for antibiotics in the first place;

- Promote antibiotic stewardship, in order to preserve currently effective therapies, focussing on the appropriate use of these drugs (right drug, dose, duration every time); Improving knowledge on resistance mechanisms; Facilitating the development of new drugs, vaccines and diagnostics; 

- Educate the public and GPs on the prescribing of antibiotics; 

- Take action on the counterfeit trade in antibiotics.

The Longitude Prize Award is a welcome first step towards what needs to happen. Anyone who has ideas can subscribe to the newsletter which will contain details of how to apply for funding at www.longitudeprize.org/

Derek Butler
Chair MRSA Action UK
Email: derek.j.butler@mrsaactionuk.net
Telephone: 07762 741114
http://mrsaactionuk.net

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