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How to avoid the antibiotic apocalypse? Look down at the ground How to avoid the antibiotic apocalypse? Look down at the ground
(7 months later)
Antibiotics are one of the greatest success stories of modern medicine – they have transformed, and indeed prolonged, our lives. But they may now be endangering lives, too. Bacteria are rapidly developing resistance to antibiotics and the length of time that antibiotics will remain effective has been pinned down to just a few decades – a situation so serious that the UK's chief medical officer is again urging the government to add it to the national risk register of civil emergencies. This is the third time in just four months that Prof Dame Sally Davies has highlighted the urgency of the situation.Antibiotics are one of the greatest success stories of modern medicine – they have transformed, and indeed prolonged, our lives. But they may now be endangering lives, too. Bacteria are rapidly developing resistance to antibiotics and the length of time that antibiotics will remain effective has been pinned down to just a few decades – a situation so serious that the UK's chief medical officer is again urging the government to add it to the national risk register of civil emergencies. This is the third time in just four months that Prof Dame Sally Davies has highlighted the urgency of the situation.
Most of this has focused on the behavioural causes of antibiotic resistance – GPs prescribing antibiotics for patients who do not need them, patients not completing the course of antibiotics they have been prescribed. But this is looking for the cause of the problem in the wrong place. We shouldn't look just at what is happening in our surgeries, but also at the natural environment, and how we interact with it. Soil in particular plays an important role: just 1g of soil contains more bacteria than there are people on the planet, and these bacteria each naturally produce antibiotics to maintain a competitive edge over one another.Most of this has focused on the behavioural causes of antibiotic resistance – GPs prescribing antibiotics for patients who do not need them, patients not completing the course of antibiotics they have been prescribed. But this is looking for the cause of the problem in the wrong place. We shouldn't look just at what is happening in our surgeries, but also at the natural environment, and how we interact with it. Soil in particular plays an important role: just 1g of soil contains more bacteria than there are people on the planet, and these bacteria each naturally produce antibiotics to maintain a competitive edge over one another.
By adding our own man-made antibiotics into the mix, the soil becomes the perfect breeding ground for new antibiotic-resistant strains to arise, as proximity makes it easy for the bacteria to exchange genes – which is how they evolve. And this is an important consideration because the amount of antibiotics that enter our soil systems every year, from a variety of sources, is vast.By adding our own man-made antibiotics into the mix, the soil becomes the perfect breeding ground for new antibiotic-resistant strains to arise, as proximity makes it easy for the bacteria to exchange genes – which is how they evolve. And this is an important consideration because the amount of antibiotics that enter our soil systems every year, from a variety of sources, is vast.
For example, more than half of all antibiotics used are given by us to animals. In the UK alone, about 350-400 tonnes of antibiotics were used each year in food-producing animals between 2006 and 2011 – and an estimated 70m tonnes of animal manure, which would contain the residues of those antibiotics, was spread onto agricultural land each year as well.For example, more than half of all antibiotics used are given by us to animals. In the UK alone, about 350-400 tonnes of antibiotics were used each year in food-producing animals between 2006 and 2011 – and an estimated 70m tonnes of animal manure, which would contain the residues of those antibiotics, was spread onto agricultural land each year as well.
And this is just one part of an ongoing cycle: the new, antibiotic-resistant bacteria in the soil can potentially enter our food chain when we eat the harvested crops and then, when they reach our gut, they can evolve again when they mix with the microflora that naturally live there. Once we excrete these bacteria, they enter our sewerage system and, from there, they can re-enter agricultural systems when sludge is used as a fertiliser, or when wastewater is used for irrigation.And this is just one part of an ongoing cycle: the new, antibiotic-resistant bacteria in the soil can potentially enter our food chain when we eat the harvested crops and then, when they reach our gut, they can evolve again when they mix with the microflora that naturally live there. Once we excrete these bacteria, they enter our sewerage system and, from there, they can re-enter agricultural systems when sludge is used as a fertiliser, or when wastewater is used for irrigation.
As well as agriculture and wastewater treatment, the manufacturing industry needs to take some responsibility for the current threat. Davies has called for pharmaceutical companies to invest in developing new antibiotics, but current manufacturing practice in some countries is actually exacerbating the problem.As well as agriculture and wastewater treatment, the manufacturing industry needs to take some responsibility for the current threat. Davies has called for pharmaceutical companies to invest in developing new antibiotics, but current manufacturing practice in some countries is actually exacerbating the problem.
We have a Dangerous Substances Directive in Europe, which lists 129 substances that are regarded as so toxic that efforts to control their release should be given the highest priority. However, antibiotics are not on that list, so are not routinely tested for, and their high prevalence in the environment has received little attention.We have a Dangerous Substances Directive in Europe, which lists 129 substances that are regarded as so toxic that efforts to control their release should be given the highest priority. However, antibiotics are not on that list, so are not routinely tested for, and their high prevalence in the environment has received little attention.
This is a particular problem in countries such as China and India, where antibiotic manufacturing occurs on a substantial scale but regulations tend to be somewhat lax. Rivers and soils become contaminated when wastewater from these factories is untreated, and both are widely used by humans and animals – for drinking, washing and irrigation. Such places may seem far away and of no consequence to us here, but we travel much more widely these days, which means these pathogens are constantly crossing continents and building resistance in new ways.This is a particular problem in countries such as China and India, where antibiotic manufacturing occurs on a substantial scale but regulations tend to be somewhat lax. Rivers and soils become contaminated when wastewater from these factories is untreated, and both are widely used by humans and animals – for drinking, washing and irrigation. Such places may seem far away and of no consequence to us here, but we travel much more widely these days, which means these pathogens are constantly crossing continents and building resistance in new ways.
To prepare for the threat of antibiotic resistance, we can't just sit and wait for people to change their behaviour. It is clear that if we take action in one area, but not another, it will do little to control antibiotic resistance because so many factors are interdependent. So we need to work collaboratively, and internationally, with people from many different disciplines and areas of expertise if we are to combat what has become this truly global crisis.To prepare for the threat of antibiotic resistance, we can't just sit and wait for people to change their behaviour. It is clear that if we take action in one area, but not another, it will do little to control antibiotic resistance because so many factors are interdependent. So we need to work collaboratively, and internationally, with people from many different disciplines and areas of expertise if we are to combat what has become this truly global crisis.
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