Antibiotics are essential for treating bacterial infections. However, due to random mutations in their DNA, bacteria can develop resistance to antibiotics, reducing their effectiveness. The survival of bacteria in a patient’s body allows the resistant genes to be passed to the next generation, leading to a rapidly reproducing colony and infection.
According to a recent government-backed report, annual deaths due to multiple drug resistance could reach 10 million by 2050 if the inappropriate use of antibiotics continues.
Drug resistance has become so widespread it is now often customary for Doctors to prescribe multiple antibiotics to combat a single infection.
The number of drug-resistance bloodstream infections increased by 35% from 2013 to 2017.
Several cases of resistance to colistin, the antibiotic of last resort, have recently emerged across the world. Some of the key reasons why antibiotic resistance is increasing include:
Perhaps the biggest contributing factor is that GPs feel the pressure to prescribe – and patients expect to walk away with antibiotics. This is an extensive issue:
There’s also a lack of education around antibiotics, causing issues such as:
The regimen for antibiotic therapy can last days, weeks or even months, and patients frequently miss doses or even stop them entirely once they begin to feel an improvement. The most resistant bacteria survive, persist and multiply, and alternative antibiotics must be prescribed all over again.
There are a few key solutions that you need to know about:
There are some targets the government has set on this topic:
Another solution comes in the form of incentivising pharmaceutical companies to research and develop drugs that can save lives by paying them based on how valuable the drugs are – instead of how many are sold. NICE and NHS England are going to trial this new subscription payment model.
Two drugs that have proven to be both safe and effective will be selected to undergo health technology assessment (HTA) by NICE throughout 2021, and this will be used to decide the level of the subscription payment.
One of these, teixobactin, was discovered and found to be effective against common bacterial infections. This new drug was isolated by using an electronic chip to grow antibiotic-producing microbes in soil. However, it is still years away from being tested on humans and may not even work against bacterial infections in humans.
Combination therapy may work to help fight antibiotic-resistant bacteria by using two or more drugs together to increase the effectiveness of both drugs against bacteria that are resistant to normal antibiotics. Drugs working together in this way may even be effective against colistin-resistant bacteria.
The most controversial solution fielded so far is phage therapy. This process involves killing bacteria with a virus that lives inside bacterial cells but is so far unused in the West. Successful studies have been conducted in Russia, Georgia and Poland, but the risk of ingesting viruses has hindered the popularity of the method.
Furthermore, the Department of Health and Social Care has committed £32m for research centres to help improve prescribing and identify patterns of resistance. For example, University College London (UCL) and University College London Hospitals (UCLH) are going to try using artificial intelligence to help tackle antibiotic resistance. They hope this will enable earlier diagnosis and treatment with the appropriate antibiotic and dose. Also, they aim to be able to identify more quickly cases where patients don’t have resistant infections to ensure that unnecessary treatment is not given.
In England, the total consumption of antibiotics in primary and secondary care declined by 9% from 2014 to 2018.
You might be asked questions about prescribing antibiotics in your interview – or you may be able to weave this topic into an answer about something broader, in order to show your knowledge. For example, the topic could come up in questions like:
Take a look at our Interview Question Bank for more questions you can practice.
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