One of the reasons I chose to do my PhD in microbiology is that I believe a lot of modern medicine relies on the ability to treat infections. For example, without that ability, things like surgery, transplants and immune suppression will be too risky. And the scary truth is that antibiotic resistance is becoming a big problem. Recently, a review on antimicrobial resistance by Lord O’Neill was published, and this article summarises the key findings.
A brief overview of how antibiotic resistance can occur: sometimes it only takes one change in the DNA sequence of the bacterium to become resistant to an antibiotic, and if that particular species is a fast growing one this can happen quite quickly. Another way of acquiring resistance is by picking up bits of DNA from the environment, which is not necessarily from the same species; these genes exist because antibiotics are based on products which are made by bacteria. So in a way, we’re trying to control nature by using chemicals derived from nature. While bacteria can adapt to this new challenge easily, it can take a while to adapt the chemicals. This leads to a situation where the number of antibiotic resistant infections are on the rise, but the number of agents which are available is not rising at the same rate; it was last year that a new class of antibiotic was found after almost 30 years.
So what can be done to make sure that we keep antibiotics effective? Certainly more awareness and control of its use will be helpful (especially in veterinary medicine), as will improving hygiene and surveillance – points which the report highlighted. But I believe focus on research and development is important, not only to discover new antibiotics but also to create new tests to ensure that appropriate antibiotics are given – again, highlighted in the report.
While these above points are important, I also believe that the pharmaceutical industry need to play a part too – after all, even if discoveries like teixobactin are made, there are lots of steps before it can become a medicine and I believe that this will be difficult without the involvement of pharmaceutical companies. Now, the fact that resistance to antibiotics can occur rapidly means that it can become ineffective very fast – not great if you are trying to cover the cost of its production! There have been proposals both from the pharmaceutical industry and in the report of finding alternative ways to fund antibiotic discovery; this I think will be crucial.
Funding for research I think is another crucial piece of the puzzle in terms of finding new antibiotics or new ways of treating infections – that is how teixobactin was found, and I hope that research like this will be happening long into the future. As technologies improve, we are able to increase our understanding of how the infection process works, and who knows, this may lead to a change in how we approach infection treatment. With genome sequencing improving all the time, there may come a time where a clinician may be able to sequence a patient sample quickly, and then work out if antibiotics are necessary or not, and also work out which antibiotics will be effective/ineffective.
I am hopeful that with the above report and the Longitude Prize being focused on antibiotic resistance we will be able to tackle this problem which may indirectly affect a lot of us.