To be disappointed that it's world antibiotic awareness week, but hardly anyone seems to know or care?

[Jralli]

So antibiotics are already no longer effective against previously treatable infections. Our children are potentially facing a future where antibiotics will not work at all: no caesarean sections, no hip replacements or appendix removal and no chemotherapy....and a government report estimates resistant infections will kill and extra 10m people every year by 2050. Yet the majority of people remain oblivious. A third of people in a WHO survey thought it was ok not to complete the course if they felt better and over half felt there wasn't much they could do about antibiotic resistance. As parents there is heaps we can do from practicing and teaching good hand hygiene to ensuring those we are responsible for only take antibiotics when they need them and take them as prescribed. if the WHO is struggling to raise awareness may be mumsnetters should help!

It is one of the most read stories on the BBC at the moment so I think a fair number of people do know (or will now).

redbluered and vestal you are so right that discovering new antibiotics isn't going to solve this issue. The time taken for bacteria to develop resistance has got shorter and shorter with each new antibiotic found. We can only conserve antibiotics if we change the way we use them...but I don't think this has been communicated to the public at large leading to the scenarios described in your posts: people not taking full courses, stockpiling their antibiotics or buying abroad to self medicate though totally inappropriate... if I get on my soapbox about resistance other parents generally give me a blank look, or a shrug that there is nothing they can do about it.....

YANBU. We have run out of antibiotics. Carbapenems were the 'super-drug' for resistant bacteria. Now, we have resistance to it. It's very worrying.

There was a long section dedicated to this on the Today programme this morning. They talked about there being an anti-biotic resistant strain in China that affects people and animals, and that the farming industry is a massive contributor to the problem. I signed up to the AB Guardian pledge last year after I was very poorly with Sepsis 2 years ago after a post-op infection.

many people demand AB and GPs give in

I've never asked for AB in my life.

However GPs have prescribed them for me and DC.

I have no idea if they were appropriate - it's usually been serve chest infections with accompanying sever wheezing and rattles in very young DC and asthmatics, burst ear drums and UTI in young girls after doing samples that have been sent off for tests. I assume the GP is more medically knowledgeable than me and when they prescribed them they were needed.

I've never heard other parents demanding them for colds or sore throats and have never met a GP who wouldn't/couldn't say no to such demands.

I do know the farming industry uses a lot and that doesn't help with antibiotic resistance, I know in many countries you can buy them over the counter and that is a major source of resistance - and I believe their use in some care homes has in the past been questioned.

I'm coming up to 40 the message to parents since I was a DC was that viruses cause many of childhood's common complaints and AB aren't appropriate.

Perhaps it's easier to blame patients and parents than find the money to train GP better or research if they are over prescribing and why or tackle the massive over use in modern farming or demand other countries tackle the no prescription use of AB.

I also heard in previous times from media outlets that that their has been a lack of research in AB for many years do to funding structure in the big pharmaceutical industry and the gap hasn't yet been met by government funding or other sources.

I believe I read in the new scientist last week that understanding about AB isn't great in general populations. There is odd prevalent belief that people become resistant to the AB not that strains of bacteria do and that anyone can then catch a resistant strain.

It is very worrying this morning hearing the news in China where they have identified bacteria able to shrug off the drug of last resort - colistin - in patients and livestock.

I always finish the courses prescribed but I'm not sure me refusing AB when GP insist they are necessary is going to change the situation world wide or even have an impact other than negatively on my or my families health.

People do use ABs when they don't really need them - in most cases infections will go away on their own. Even before ABs plenty of people lived well into their 70s, 80s, 90s, so most infections will eventually go. Obviously there is a presenteeism culture that means that you want to get rid of an illness asap to get back to work or school.

But although there are people who misuse ABs, the main problem is with agriculture.

I'm not saying that we can't do more, but the agriculture/farming sectors need to get their house in order.

It's a bit like criticising parents for using disposable nappies when the vast majority of waste is created by industry. You could have a much bigger impact by encouraging businesses to minimise waste. Equally we need a fundamental rethink on how ABs are used in farming. Worldwide. Based on how climate change talks have gone, I don't see any changes coming soon. It is scary.

interesting report on vetinary antibiotic sales in europe

table 5 is about antibiotic sale per 'meat unit'

redbluered and vestal you are so right that discovering new antibiotics isn't going to solve this issue.

Don't understand this at all.

We are in am arms race with bacteria - so surely having more and a wider range of AB is going to help.

Obviously if we tacked the practises that help develop resistance in bacteria to AB and the one that then lead to these getting spread - we will have more resiatnant for longer.

www.tufts.edu/med/apua/news/news-newsletter-vol-30-no-1-2.shtml
In 2012, antibiotic development continues to stagnate. Two systemic antibacterial agents have been approved for use in humans by the U.S. FDA from 2008 through the current year. Compare that to sixteen that were approved from 1983-1987. In particular, we have had no new classes of antibiotics to treat Gram-negative bacilli (GNB) for more than 40 years – amazingly, the fluoroquinolones were the last new class of antibiotics to treat GNB. Meanwhile, antibiotic resistance continues to spread like wildfire, particularly among the GNB. The U.S. and global healthcare systems are encountering on a regular basis extensively drug-resistant (XDR) organisms resistant to all antibiotics except for colistin, a highly toxic agent of questionable efficacy whose use was abandoned in the 1960s when safer and more effective therapies became available.

Even worse, we are seeing pan drug-resistant (PDR) organisms, resistant to all available antibiotics, including colistin. Examples of XDR and PDR bacteria that plague the US and global healthcare systems include carbapenem-resistant bacteria, such as KPC Klebsiella and Acinetobacter. Both of these organisms are increasingly XDR, and are causing increasing infections in the US and worldwide. These infections cause high death rates despite available therapy. They will continue to kill a high percentage of infected patients until new prevention and treatment methods become available.

Twelve years ago, Nobel Laureate Dr. Joshua Lederberg wrote that “The future of humanity and microbes will likely evolve…as episodes of our wits versus their genes.” In the 12 years since Dr. Lederberg wrote those prescient words, we have witnessed a continued expansion of antibiotic resistant pathogens due to their genes. Amazingly, we seem to have stopped trying to use our wits to keep up. So, why is this?

There are three principal causes of the antibiotic market failure. The first is scientific: the low-hanging fruit have been plucked. Drug screens for new antibiotics tend to re-discover the same lead compounds over and over again. There have been more than 100 antibacterial agents developed for use in humans in the U.S. since sulfonamides. Each new generation that has come to us has raised the bar for what is necessary to discover and develop the next generation. Thus, discovery and development of antibiotics has become scientifically more complex, more expensive, and more time consuming over time. The second cause is economic: antibiotics represent a poor return on investment relative to other classes of drugs. The third cause is regulatory: the pathways to antibiotic approval through the U.S. FDA have become confusing, generally infeasible, and questionably relevant to patients and providers over the past decade.

DH gets sick a number of times a year with tonsillitis. Sometimes it gets better itself, about once a year he needs antibiotics. His experience is that doctors are very reluctant to give out antibiotics (not that he's pushing for them). They are often rude and patronising saying things like 'You're here for a sore throat....??' Then they actually look in his throat and start asking to take pictures

This is only anecdotal but surely doctors don't just dish out meds like sweeties? Antibiotics in the food chain however...

People do use ABs when they don't really need them - in most cases infections will go away on their own.

Surely that is something to tackle with GPs mostly like with training or stricter guidelines to follow?

I don't have the medical knowledge to know if my chest infections would have gotten better by themselves - I do know a few times I was on verge of hospital admittance if prescribed steroids and AB didn't show improvements.

There was a map www.bbc.co.uk/news/health-34790038 that shows upsurge in AB persciptions.

What there isn't is data and research to explain what is going on.

Would you have more people like me with my chest infection admitted to hospital - would there be downside with more condition getting serious requiring more complicated treatments or ultimately costing more NHS money to treat - would there be an upsurge of test costs?

This is only anecdotal but surely doctors don't just dish out meds like sweeties?

We've moved around a lot in our lives and have been at many GP surgeries and seen many different GP and that is our experience - they are reluctance to prescribe AB - and very firm that course have to be finished.

However that map does seem to show an unexplained upsurge in prescriptions across England that that pressure group maintains can't be explained and doesn't seem uniform - though there could be causes for it - difference in numbers of vulnerable patients very old or young there just isn't the data to explain what is going on.

Thanks for starting this thread, op. What I'd like to know is, if it's an illness caused by a virus, then anti-bioethics won't be effective anyway, right? So how will that create anti-biotic resistant illnesses? Are you saying that even for bacterial illnesses, we must try not to take antibiotics? Or is it that the course must be finished?
Apologies for my ignorance.

Its worth reading up on the research into phage therapy. Something i find fascinating :)

Sorry, thats not an answer to you iron! Taking antibiotics for viruses is just pointless. Taking them for bacterial illnesses is a problem if any of the bacteria survive (much more likely when courses arent finished). They can then reproduce (easily, as competition has been killed off) and that new strain will be resistant to the drug used. If that bacterium then infects someone else and another ab is used, one bacterium survives and they are now resistant to two abs.

Are you saying that even for bacterial illnesses, we must try not to take antibiotics?

absolutely. most infections are self limiting no matter if they are viral or bacterial. that means your body fights against the bugs and gets rid of them. you might feel like shit rough for a few days, but you can get relief from painkillers to help you through.

you can also try to prevent infections by good hygiene (esp hand washing) and vaccination.

The main problem is World Wide farming methods and our over dependency on Meat and Dairy, to fill up our diets, but whenever this debate surfaces, the idea that we can change our shopping and eating habits is laughed at.

'awareness' as always is a stupid term that does nothing.

yes, we need not to demand antibiotics for every sniffle. But while much bigger nations hand them out like sweets and stuff their animals full of them, we are helpless.

it's the same muddled thinking that means we are closing all our coal power stations with no replacements, while China, India and the US continue to belch the smoke out. All that we will achieve is being in the dark.

The UK allegedly has influence. Time to start using it.

I'm not optimistic for the world in 50 years. At least it won't be my problem.

lostinthewash a new antibiotic is not going to solve the problem of resistance because if we keep using them inappropriately then as fast as we develop new drugs the bacteria will develop resistance. Its only by using them sparingly, when really needed that we will conserve them. Flemming predicted the spread of resistance when he first discovered pencillin and since then the time between a new drug being invented and resistance being seen has become shorter and shorter see timeline. Definately something needs to be done to simulate new drug development, but alone its not the answer. We need greater public engagement and understanding and we all need to take responsibility in the areas where we can make a difference

Yanbu and good on you for spreading the word however you can! I'm going to share a link to the bbc news on antibiotics today on fb as well. And the government needs pressure on them to do something.

Bumping again for you

There are some interesting alternatives to antibiotics that are being investigated - the first is phage therapy, which uses viruses that attack and replicate within bacteria. This has been on the go in Russia for some years but was abandoned in the West when antibiotics became widespread.

The second is a way of sabotaging a sort of chemical messaging (called quorum sensing) that happens within bacterial colonies. Harmful bacteria usually only start getting nasty within a host when they 'know' there's enough of them to survive an attack from the host's immune system - if you can mess with this process, you can effectively render them harmless.

lostinthewash a new antibiotic is not going to solve the problem of resistance because if we keep using them inappropriately then as fast as we develop new drugs the bacteria will develop resistance

I did say we needed to constrain the evolution pressure of AB on bacteria but that involves world wide changes to AB availability and changes to widespread modern intensive farming practises. It needs doing but it's not an easy task.

It does not mean we guilt or encourage people to not take AB prescriptions from medical professionals who should have their full medical histories and hopefully good reasons for the prescription.

Though looking at what and why AB are currently being prescribed wouldn't hurt and trying to encourage countries that allow AB to be bought without prescription to stop.

Plus AB resistant already exists and will continue spread for example resistance to colistin has emerged before. However, the crucial difference this time is the mutation has arisen in a way that is very easily shared between bacteria. So we will need new drugs even if resistance to them is happening faster - and it is an area suffering with issue with funding research the impact of that has been less progress than might have been expected.

The conclusions in this paper make most sense to me. www.ncbi.nlm.nih.gov/pmc/articles/PMC2937522/

Basically saying that we do need to control antibiotic usage, prevent dumping of antibiotics into the environment through sewer systems, insist on complete destruction of antibiotics before disposal but also have no letup in the search for new antimicrobial agents. Despite the negative attitude of big pharma, the microbial parvome is nowhere near being exhausted in the search for new antimicrobials. Likewise, many investigated drug targets exist in bacterial pathogens.

There is no perfect antibiotic, and once the most appropriate uses of any new compound are identified, it is essential that prescription of the antibiotic be restricted to those uses. This means that defined “niche” antibiotics should be developed as a class separate from broad-spectrum agents. Given the increasing knowledge of environmental reservoirs of resistance, it should now be possible to have early warning of potential resistance mechanisms to new or old antibiotics and thus prepare for problems in the clinic in a proactive manner.

It's been interesting reading about the first is phage therapy not something I heard about before..

Some of the people that I nurse are on antibiotics approximately every six weeks. This isn't a good thing to do, but people can't accept that elderly people die.

Chest infections used to be called 'the old man's friend', but now, everyone lives forever of course.

Nature finds a way to fight back unfortunately. It's the younger generations who'll suffer though.