Antimicrobial A
LEADING cause of death among school children almost 100
years ago, which was almost wiped out by modern medicine, could return unless doctors and patients curb the over-use of antibiotics.
Rheumatic fever is a bacterial infection caused by a member of the Streptococcus family of bacteria which damages joints, kidneys and the heart. This same family of bacteria is also responsible for tonsillitis and many cases of pneumonia and meningitis.
In the 1920s, the condition was the leading cause of death in school children. This situation was only transformed by the discovery and introduction of antibiotics and, in particular, penicillin in the 1930s and 1940s.
Nowadays, rheumatic fever has essentially disappeared in Scotland, such that most of the doctors currently working in Scotland will never have seen a case.
But, as an increasing number of bacteria develop an immunity to antibiotics a doomsday scenario which seemed unlikely a decade or two ago is now an all too real threat.
In 2014 a report by the World Health Organisation into the extent of antibiotic resistance globally found the problem is already a serious concern in every region of the world. Antibiotic resistance – when bacteria change so antibiotics no longer work in people who need them to treat infections – is now a major threat to public health and can affect anyone, of any age, in any country.
Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security, said: “Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill. Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also
32 February 2016
In 2013, Sally Davies warned MPs of an “apoca- lyptic scenario” of antibiotic resist- ance akin to a na- tional emergency
change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”
WHO identified widespread resistance to antibiotics from infections such as tuberculosis, gonorrhoea, malaria and Staphylococcus (a common cause of skin infections like impetigo and cellulitis). Resistant gonorrhoea, for example, has been identified in at least 10 countries, including Scotland.
As recently as December 2015 the Chief Medical Officer for England, Sally Davies, wrote to all English GPs warning them that “Gonorrhoea is at risk of becoming an untreatable disease due to the continuing emergence of antimicrobial resistance.”
Resistance occurs when microbiological agents (bacteria, fungi, parasites, viruses) no longer respond to a drug that previously treated them. Although it occurs as a natural phenomenon, our over-use and misuse of antibiotics, including in farming and veterinary medicine, has greatly accelerated this process.
The development of resistance means that people are once again being killed by infectious diseases which until recently we could have cured, restoring the victim to normal life. But now, people with resistant Staphylococcal infection are 64 per cent more likely to die as a consequence of this resistance.
In addition, resistance will make current routine medical situations such as childbirth, surgery, organ transplants or chemotherapy substantially more risky in the future.
In 2013, Sally Davies warned MPs of an “apocalyptic scenario” of antibiotic resistance akin to a national emergency such as a major terrorist atack, pandemic flu or severe flooding.
Antimicrobial susceptibility testing
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