Superbugs, antibiotics and me – the key questions

If there is no global action, but action take merely by some countries, will that diminish the threat?

“Most countries have surveillance systems in place for monitoring antibiotic resistance, and the more collaboration between countries there is, the better, in order to diminish the threat. Worldwide travel is increasingly easy, leading to increased risk of transmission of superbugs between countries. Therefore, national and global action is required in order to tackle this effectively, further building on the national and international alliances that are already in place.”

Philip Howard, Mark Gilchrist, Hayley Wicken and, Royal Pharmaceutical Society

“It depends on what actions we are talking about. Better hygiene, restricted use of antibiotics, better sanitation, avoiding release of antibiotics from factories into rivers laden with sewage etc, need to be global to reduce the threat, because if it is still happening somewhere then resistance will still spread around the world from that place.

“Developing new ways of dealing with resistant bacteria (e.g. new antibiotics or alternative strategies like displacing resistance genes) may still make a difference even if not done globally. But the less global it is, the less it will achieve.”

Prof Chris Thomas, Professor of Molecular Genetics, Birmingham University

“It will help, particularly in those countries that take action – it will reduce, but not eliminate, the chances of those nationals encountering an antibiotic resistant pathogen.

“But the spread of antibiotic resistance is a global problem, exacerbated by international travel. Even in those countries with good practice for antibiotic use, resistance is a problem.

“While global action is required to try to reduce the spread and emergence of new superbugs, the genie really is out of the bottle. What is urgently needed is an international effort to develop new antibiotics and to develop new treatments to prevent or cure infectious diseases.

“Governments need to incentivise the pharmaceutical industry in this area, and the latter need to be open to public-private partnerships where academic and industrial expertise can work together to solve a frightening problem.”

Prof Mervyn Bibb, Dept of Molecular Microbiology, John Innes Centre, Norwich

“You could argue the same for global warming and action on greenhouse gas emissions. If everyone took that view, then nothing would change.

“There will anyway be some local effects of reducing antimicrobial resistance, and this has been shown at country level, so there is a local benefit from taking action.

“However, we also need international action because in a globalised world it will be possible to import resistant strains from abroad.”

Dr Michael Moore, reader in primary care research, Southampton University, and clinical champion for antimicrobial stewardship for the Royal College of GPs.

“It may diminish the threat but will not remove it. There are major problems with the non-prescribed use and “over the counter” sales of antibiotics and their incorrect use, which can exacerbate the development and spread of antibiotic resistance.”

Prof Nigel Brown, president of the Society for General Microbiology

More on the warning issued by the chief medical officer on the superbug threat

Does the warning mean we should avoid taking antibiotics, where possible?

“Yes.” Prof Chris Thomas

“Antibiotics are life-saving medicines, however if we misuse or abuse antibiotics then this can drive development of resistance. Healthcare professionals and the public need to be aware that antibiotics do not work in all situations; the common cold for instance, is caused by a virus, and antibiotics do not work on viral infections. When you’re unwell it’s worth having the discussion with your GP or pharmacist about whether you really need antibiotics; your local pharmacist can help you with medicines for relief of coughs and colds.” Philip Howard, Mark Gilchrist, Hayley Wicken

“It means that we should only take antibiotics when there is good reason to do so, and under the guidance of a physician.

“In some countries, antibiotics can be purchased over the counter, and are often used when there is no need. This encourages the development of antibiotic resistance with absolutely no benefit to the patient. In fact, such use of antibiotics eliminates the beneficial bacteria from our intestines, and increases the likelihood of infections from opportunistic pathogens such as clostridium difficile.” Prof Mervyn Bibb

“It is more about responsible use. In some instances antibiotics are useful and effective and in others life-saving.

“It is much more complicated than avoiding antibiotics but more about recognising when antibiotics have only a modest effect, and even if your symptoms last a day longer, tolerating those symptoms to allow your own body to fight off the infections.

“We need to find better ways of identifying those who might benefit from antibiotics and better ways of helping symptoms when antibiotics are unlikely to help.” Dr Michael Moore

“Antibiotics should be used where required. Avoiding their use may put individuals at risk, but patients should not expect antibiotics for all infectious illnesses, many of which may be viral. Some illnesses may be a minor inconvenience rather than life-threatening, and it may be that not using antibiotics in these cases will help.” Professor Nigel Brown

What else can individuals do to mitigate the superbug threat?

“Good hygiene, good diet, be careful where you travel to and what you eat there.” Prof Chris Thomas

“If you are prescribed an antibiotic, make sure you complete the course. Make sure you wash your hands regularly, and especially after blowing your nose, going to the loo, and before eating. Make sure your vaccinations are up to date.

“Don’t give your antibiotics to other people – they are prescribed for you!” Philip Howard, Mark Gilchrist and Hayley Wickens

“Do not take over-the-counter antibiotics unless advised to by a doctor. Always complete the course – this reduces the opportunity a pathogen has to develop resistance.

“Do not put pressure on your GP to prescribe antibiotics unless they really believe they are necessary. When entering hospital wards, ALWAYS disinfect your hands before and after leaving the ward – this will help to curb the spread of resistant bacteria, and the opportunities they have to become multi-drug resistant.” Professor Mervyn Bibb

“Be open to advice from your family doctor. By all means see the doctor if you have an infection and are troubled by the symptoms, but if the doctor feels on balance that antibiotics are unlikely to help, then be prepared to accept that advice.”

“Many doctors will offer a delayed prescription (waiting a few days to see if symptoms start to improve). This approach has been shown to substantially reduce antibiotic uptake without any adverse effect on recovery for sore throat, acute cough and ear infections.

“If you go to the doctor with a respiratory illness and they offer antibiotics, you could ask if it would be safe to delay a few days.” Dr Michael Moore

“As shown from hospital infection rates, personal and domestic cleanliness will help avoid contamination with antibiotic-resistant organisms.” Prof Nigel Brown

If a doctor prescribes antibiotics for your child, should you follow the doctor’s advice?

“Question the reasons why the doctor is prescribing them so you are sure it is because of a real or likely bacterial infection, and also that the consequences of not taking them could be serious. But at the end of the day the doctor is doing his/her best for your child’s health.” Prof Chris Thomas

“Absolutely, unless you have good reason to doubt your doctor’s opinion. Then seek a second opinion. A doctor should prescribe antibiotics only when needed – so follow his/her advice.” Prof Mervyn Bibb

“Yes. We can assume that doctors are aware of the issues. What we really need is rapid diagnostic techniques to be developed that will allow the doctor to prescribe an antibiotic that will specifically target the infectious organism, rather than prescribing powerful “broad spectrum” antibiotics as the first resort.” Prof Nigel Brown

I have discontinued a course of antibiotics before completion on several occasions. Does this make me more vulnerable to a superbug threat?

“It may do but this is not guaranteed. However, the best course of action is to complete the full course when you are prescribed antibiotics because even if the symptoms disappear, it does not mean the infection has completely gone away, and if that is the case it may reoccur if you stop too soon and the resurgence might be more difficult to treat.” Prof Chris Thomas

“No. But it could mean that you harbour bacteria that have developed resistance to the antibiotic you have taken because you didn’t complete the course. If an opportunity arises for that bacterium to cause an infection, then the antibiotic you used previously will not be effective.

“You may also have added to the pool of antibiotic resistant bacteria that exist in nature – not a good practice. Antibiotic resistance spreads very rapidly among bacteria, so you may be contributing to the development of a new superbug. You should always finish the prescribed course.” Prof Mervyn Bibb

“Not particularly. We still don’t know the optimal length of an antibiotic course for many infections, nor in detail whether a shorter course might be sufficient.

“The key thing is, if you don’t finish a course and do get better, what do you do with the left-over antibiotics? I suggest returning them to the pharmacy for safe disposal. Don’t save them for use later on as you may end up taking further courses which are not necessary.” Dr Michael Moore

“No, it should not make you personally more susceptible to a superbug threat, but it may be instrumental in allowing antibiotic-resistant organisms to develop.” Prof Nigel Brown

“If you stop taking your antibiotics early, and the infection returns, there is a chance that the same antibiotics might not work the next time. With the rise of resistance, we have a decreasing number of antibiotic options available, so it’s really important to take antibiotics as directed by your doctor.” Philip Howard, Mark Gilchrist and Hayley Wickens

Is the UK economy, with its strong pharmaceutical base, in line to benefit from any scientific advances in response to the superbug threat?

“Yes, it may do, but bear in mind that the general view is that we must limit the use of new antibiotics and so we may not be talking about huge new blockbusters that earn billions (although I could be wrong).” Prof Chris Thomas

“It may be – but the large pharmaceutical companies, with the resources to take a new antibiotic to market, are international, and many of their research facilities that focus on the discovery and development of new anti-infectives are not based in the UK.” Prof Mervyn Bibb

“This depends on the nature of the national and international response to the threat and the willingness of UK companies (Both SMEs and large pharma) to engage in the search for new antibiotics.” Prof Nigel Brown

“We are always going to need new antibiotics, so given the strength of the industry in the UK, the country would stand to benefit from advances in this area. However, unless the current processes for introducing new antibiotics into the UK and Europe changes, there will be little to encourage the Pharmaceutical industry to invest here.” Philip Howard, Mark Gilchrist and Hayley Wickens.

Answers from the experts gathered by the Science Media Centre for Channel 4 News