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Published on 21st November 2017 by lauram

NHS Hot Topics- Antibiotic Usage

Welcome to our new series on NHS Hot Topics 2017! These blogs will cover one recent piece of medical news from this year in detail.

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In a Nutshell

Since the early 2000s, the paradigm shift of pharmaceutical companies from producing essential antibiotics to more “fashionable” treatments such as those for cancer and chronic disease has been well noted.

The last new class of antibiotics developed for widespread use was founded in 1993 and this has led to a reduction in the variety of treatments available to treat a whole range of illnesses, from community acquired UTIs to pneumonia.

Antibiotic resistance is still a huge problem throughout the world. Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth, so when using this antibiotic to treat an infection, the bacteria aren’t killed.

What are the causes?

One key paper titled The Antibiotic Resistance Crisis gave an excellent summary of the main causes responsible for antibiotic resistance.

Overuse

  • Epidemiological studies have demonstrated a direct relationship between antibiotic consumption and the emergence and dissemination of resistant bacteria strains.

Inappropriate Prescribing

  • As cited in the paper, studies have shown that treatment indication, choice of agent, or duration of antibiotic therapy is incorrect in 30-50% of cases.
  • The exposure of bacteria to inappropriate antibiotics, or antibiotics that have been administered for too long, can lead to bacteria more easily being able to develop a gene coding for resistance.

Extensive Agricultural Use

Availability of Few New Antibiotics

  • As discussed above.

Regulatory Barriers

  • Current pharmaceutical regulations means that clinical trials are expensive and time consuming, and it often takes years before a trial drug becomes widely available.

What are some of the issues?

MRSA

Prevalence of MRSA (Methicillin-Resistance Staphylococcus Aureus) colonization in the UK population currently lies between 1-3%. Though most of these individuals do not develop a harmful infection, if an infection develops, not one of the current methods to control the spread of MRSA has been proved to be effective.

However, there is hope in the fact that a study performed by Public Health England, the number of MRSA bacteraemias has reduced from 4451 2007/8 to less than 800 in 2013/14. This significant drop has shown that MRSA management has improved (by quarantining patients more quickly and identifying MRSA more rapidly), but more still needs to be done.

Incurable Gonorrhoea

Following an outbreak of a “Super Gonorrhoea” STI outbreak in Leeds during September 2015, there was a fear that it would spread throughout the UK during 2016.

The problem occurred when Neisseria Gonorrhoeae, the bacterium responsible for causing the disease, became resistant to Azithromycin, meaning that the only drug able to treat it was Ceftriaxone.

However, widespread use of the second line drug raised fears that the strain would also become resistant to that (as a result of increased exposure), leading to an untreatable illness. Gonorrhoea can in rare cases lead to infertility and septicaemia, meaning that control of the illness was paramount.

Further Research and the Future:

Vaccination:

Alternating Therapy:

  • Alternating therapy is a method involving the use of pairs of drugs which are cycled during treatment for a bacterial infection.
  • Evidence suggests that alternating therapy can be used to successfully treat bacterial infections. Development of resistance of drugs were slowed by 40% and above when using a combination of drugs compared to single drug use alone. However, the article in question only used drug treatments on the Staphylococcus Aureus bacterium, so further research may need to be performed.

What questions might I be asked about antibiotic resistance at interview?

  • Why is antibiotic resistance such a huge problem in the UK/World?
  • What are the current major issues regarding antibiotic resistance?
  • Tell me about future treatments for antibiotic resistance and why they may be effective?
Read more NHS Hot Topics 2017

Words: Ben Fox

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