Wards in British need to be redesigned to provide defences against the spread of deadly, antibiotic-resistant superbugs. That is the stark warning of scientists, who said last week that the danger now posed by drug-resistant infections had reached crisis level. In the long term, governments must encourage the pharmaceuticals industry to develop new generations of drugs, said a group of British experts. However, these new drugs will take so long to reach the market that short-term measures must also be introduced to hold back resistant diseases that now threatens to overwhelm health professionals.
A group of senior scientists – including Dame Sally Davies, the chief medical officer, and Professor Jeremy Farrar, director of the Wellcome Trust – told the Royal Society last week that the planet faced the prospect of people dying from routine infections because effective antibiotics no longer existed. Changes to be made to hospital wards should, they said, include greater distances between beds, lower bed occupancy rates, improved staff-patient ratios and large, openable windows.
“We are talking about returning hospital wards to the type we had 100 years ago,” said microbiologist Professor Kevin Kerr, of Hull York Medical School. The crucial point of such “old school” measures is to buy time, added fellow microbiologist Professor Mark Fielder, of Kingston University in Surrey: “We need to hold back the spread of resistant bacteria while finding ways to persuade pharmaceuticals [companies] to improve their output of new generations of antibiotics – for we are facing a future in which there might be no effective antibiotics left on the planet.” Kerr said: “In the near future it is possible that a scratch from a rose thorn could become septic. Without effective antibiotics, septicaemia could easily set in and result in death. It is a terrible prospect, but a very real one. We are facing a return to the state of affairs that existed before antibiotics were discovered.”
Resistance to antibiotics arises as a consequence of the processes of natural selection. In a population of bacteria, some are more resistant to drugs than others. Occasionally these resilient strains survive, multiply and become more resistant to antibiotics. This is how superbugs such as MRSA have evolved. Scientists estimate there are 5,000 deaths a year in the UK due to strains of bacteria that have evolved resistance to antibiotics. In future, the continuing rise in resistance could have wider repercussions. Surgery, and treatment for diseases such as leukaemia, would be hard to carry out if there were no means to kill off random infections in patients. Yet only a handful of new antibiotics are in development. “In the 1960s, there were plenty of new versions appearing,” added Fielder. “But that has stopped. Essentially we took our eye of the ball.” The problem for medicine is that antibiotics do not offer good returns to shareholders in pharmaceuticals companies. Drugs that can tackle diabetes or high blood pressure offer a much better prospect of good profits. “If you develop a chronic condition like high blood pressure, you will have to take drugs for it for the rest of your life,” Fielder said. “By contrast, you usually only take antibiotics for a week at most, when you are suffering from an acute condition. That represents a poor financial return for the pharmaceuticals companies that make the drug.”
The urgent issue of persuading drug companies to develop new antibiotics should be tackled by the medical equivalent of a body like the Intergovernmental Panel on Climate Change, Davies and Farrar said. Possible steps could include giving companies tax breaks for making new antibiotics or lengthening the period for which a new drug is protected by patent. Other approaches could also be promoted to develop alternative ways of killing bacteria, added molecular geneticist Professor Chris Thomas of Birmingham University. “Another very promising technique involves the use of bacterial phages, viruses that attack specific bacteria. If you know the bacterium that is causing an individual’s illness and you know a phage virus that attacks that bacterium, you could inject your patient with those viruses and so treat their condition. The crucial point is that we need to develop a range of different approaches to this crisis. Essentially this is a race against time.”