Today is the day the antibiotic era ends. British scientists announced this week that they have found bacteria that are resistant to our final antibiotic frontier – polymyxins, a last-resort drug used when nothing else works. Discovered in hospitalised patients in China, the superbugs, similar to E.coli, have probably already spread to Laos and Malaysia. And scientists have warned that they could have also crossed over into Britain.
Antibiotic resistance is passed between fellow bacterial species by gene-swapping, a deadly act of cooperation that allows microbes to constantly stay one evolutionary step ahead of our drugs arsenal. Now that our final line of defence has been breached, it’s only a matter of time before currently treatable bacterial illnesses – from strep throat to tuberculosis and pneumonia – mutate so that they develop resistance too.
Huge swathes of the world are already resistant to antibiotics when it comes to common ailments such urinary tract infections, or pneumonia. About 3.6 per cent of all new tuberculosis infections are multi drug-resistant. But things get more serious still if we aren’t far off being crippled in how we carry out cancer and HIV treatments, organ transplants and kidney dialyses – even hitherto uncomplicated childbirth would become a mortal risk.
A little over a year ago, David Cameron commissioned a report on the state of antibiotic resistance, and its potential impact on global mortality. The conservative estimate was 10 million deaths per year (more than cancer and diabetes combined) and roughly $10 trillion in sacrificed GNP, by 2050. Currently, such resistance accounts for an estimated 50,000 deaths in the US and Europe alone.
We could console ourselves that scientists might develop new antibiotics that attack different bacterial genes, or doctors could be encouraged to extend the lifespan of antibiotics by changing dosage, or combining them with other drugs, but the bottom line is that we can’t ultimately win the evolutionary race. Human habits are too hard to break: we will continue to leave antibiotic courses unfinished, take penicillin for the flu, and over-drug our agricultural livestock.
Meanwhile, superbug evolution will continue, because it’s what bugs do. Bacterial populations can double every 20 minutes, while drugs take decades to develop. So the solution is not more antibiotics, but post-biotics. We need to start investing in and inventing new alternatives now.
Some of the alternatives to antibiotics range from the use of viruses, to engineering harmless bacteria, genetic mute buttons and gene-editing techniques – all to kill harmful bacteria.
Certain viruses, known as phages, naturally destroy bacteria by infecting them and then ripping them apart by bursting out. Unlike antibiotics, phages are abundant in nature, so can be constantly deployed to attack newly evolved bacterial strains. Bacteria can also be turned against each other. They already release toxins to kill competing microbes, which can be harnessed. Scientists have manipulated E.coli to kill a pneumonia microbe.
And finally a new gene editing technique – a cut-and-paste tool for DNA, known as CRISPR – can be used to destroy bacterial DNA. These therapies are all being explored by scientists, some of which have already moved on from animal testing to human clinical trials. The science is there, but it now needs the money.
A follow-up report to the UK’s antibiotic resistance review said, “There is a problem of chronic under-investment in both the financial and human capital needed to tackle antimicrobial resistance.” It found that in Europe, only 1.8 per cent of all medical research funding is spent on alternatives to antibiotics, while the US National Institutes of spends only 1.2 percent of its research budget on resistance.
Let’s push to find out what a truly post-biotic world would look like – it’s the only option we’ve got left.