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What is antibiotic resistance - and how can you protect yourself from it?

Antibiotics are lifesavers but their effectiveness is under threat. Julia Molony looks at the steps we can take to reduce the risk

Antibiotic resistance is a growing problem. The main driving factors behind antibiotic resistance are the overuse and misuse of the drug. So do you know when you need them and when you don't? Here are 10 top tips to help you keep your resistance strong.

1. The threat is real

It's hard to overstate how critical effective antibiotics are to our way of life and what we stand to lose if they are rendered ineffective. In 2016, the British economist, Jim O'Neill, authored a report that concluded, "if we lose the arms race against bacteria, 10 million lives could be lost globally by 2050". Without action, deaths from superbugs will outstrip the number of deaths from cancer.

It is thanks to effective antibiotics that routine surgery, childbirth, dental work and treatments such as chemotherapy can be considered safe. They are a precious resource and one that is gravely under threat. According to Dr Margaret Chan, the former director-general of the World Health Organisation (WHO): "A post-antibiotic era means, in effect, an end to modern medicine as we know it."

2. The problem is evolving all the time

At the end of last year, it was reported that the number of patients diagnosed with the superbug CPE (Carbapenemase-producing Enterobacteriaceae) is increasing. CPE is defined by the WHO as representing a serious risk to patient safety, and is particularly feared because it is immune to some or all of the antibiotics of last resort.

3. Antibiotic resistance is evolution in action

Bacteria are adaptable and hardy organisms, capable of altering their genetic structure rapidly in order to thrive in all environments on Earth. When we attack harmful bugs with antibiotics, the hardiest amongst them will survive and multiply. Those surviving bacteria have an evolutionary advantage and as they reproduce, they pass on that advantage to the next generation.

Over-use of antibiotics actually selects for antibiotic resistance - the more we use antibiotics, the more we create favourable conditions for resistant bacteria to thrive. Since antibiotics revolutionised healthcare in 1945, we've taken them for granted.

"We all thought this was not going to end, that antibiotics were this wonderful thing and we had won the war against infection," says Dr Nuala O'Connor, a practicing GP. "And so patients in the community, as well as doctors, were lulled into this false sense of security ... Doctors knew they were over-prescribing, but we didn't realise the harm that could come from over-prescribing. Now we know that in many instances, we don't need to use antibiotics because the patient probably has a viral infection rather than a bacterial infection."

4. Our record for tackling the problem isn't great

Antibiotic use is higher in Northern Ireland than the rest of the UK and NI's chief medical officer, Dr Michael McBride, warned last year that overuse poses the "greatest danger" to health. NI's antibiotic usage was 30% higher than England's, with 1.9m prescriptions issued annually, he revealed, adding this was contributing to a "global crisis".

He continued: "Currently, 700,000 people die worldwide each year from drug resistant infections and this figure is expected to reach 10 million deaths by 2050, if the problem is ignored. This statistic should be enough to make us all stop and think about the impact of the continued overuse and misuse of antibiotics.

"If we don't act now, it could mean that even the simplest infections cannot be treated and the most straightforward operations cannot be performed."

5. The way your GP prescribes antibiotics is changing

GPs still rely largely on making a clinical judgement on whether a patient is suffering from a viral infection - for which antibiotics have no effect - or a bacterial one. "Sometimes it's quite obvious to your GP whether you are suffering from a bacterial or viral infection, but other times it's less clear and requires a judgement call," says Dr O'Connor.

Where they once might have prescribed antibiotics "just in case", they are likely now to be more circumspect and perhaps wait to see how your symptoms evolve. "We're trying not to do harm, but the trade-off with that is sometimes people will get a little bit sicker before we will institute the antibiotic," she adds.

"We ask the public to come on board with us to understand why we prescribe sometimes and why not in other cases."

You may have been used to getting an antibiotic for something, but things are changing, says Dr O'Connor, who gives the example of the common ailment, sinusitis. "We now know from studies and investigations that only about two per cent of sinus infections are actually bacterial. The vast majority are viral."

6. It's good to ask questions

"Ask your GP, do I really need this antibiotic? Do you think it's a viral or a bacterial infection? Can I hold off for a few days? Something we sometimes use is a deferred prescription," says Dr O'Connor. It's also worth asking about the particular drug you are prescribed, she explains, with GPs now favouring "narrow spectrum" antibiotics that attack only the specific bacteria causing the infection rather than a "broad spectrum", one which takes a carpet bomb approach.

If you are prescribed antibiotics, it's important to always take them exactly as prescribed, she adds.

7. Preventing the spread of infection is key

The fewer infections that are contracted, the fewer antibiotics will be prescribed. That means washing your hands regularly and thoroughly, as well as practising what Dr O'Connor calls "good cough and respiratory etiquette". "The best thing to do is practise coughing into your elbow or tissue and binning it. Turn away from people and cough into your elbow, particularly when you are around vulnerable people," she says, adding that we have to accept that "our hands are contaminated a lot of the time. People often ask me at work, why don't I pick up infections. And I say one thing I do is I train myself to keep my hands away from my face. I know that one of the main ways that people pick up bugs is that they've touched a surface with bugs on it, and then their hands are dirty and they actually contaminate themselves".

8. New drugs are not a silver bullet

While Jim O'Neill's report placed emphasis on incentivising drug companies to develop a new generation of antibiotics, they are unlikely to represent a solution. "Experts believe that the current antibiotics we have are probably the best we'll ever have," says Dr O'Connor.

"There may be completely different advances," she says, and completely different types of drugs. "It may not be antibiotics, it may be other ways to actually combat bugs. But we really have to be extremely careful about how we use, and preserve, the effectiveness of the antibiotics that we currently have. And there are ways that we can do that."

9. A simple blood test may become part of you GP consultation

One area of hope for real progress in the fight against antibiotic resistance is the development of rapid diagnostic tests which can be carried out in-surgery by GPs. "By 2020, it should become mandatory to use rapid diagnostics before antibiotics are prescribed," wrote Jim O'Neill in his 2016 report.

"The technology is there," adds Dr O'Connor, who has been campaigning to institute widespread availability of tests for a marker called C Reactive Protein, which helps a physician distinguish more clearly between a viral and bacterial infection. "It is actually being actively looked at in terms of the economic analysis for it. And it is introduced in other countries," she says.

"If I did that test, it would give me a probability factor. Above a certain value, yes, much more likely to be a bacterial infection, so I'd know, go for the antibiotic. Below a certain value, much more likely to be a viral infection. I still have to monitor the patient, but I'm much more confident and the patient is more confident."

10. You can help by protecting yourself

Instead of expecting a prescription when you head to the doctor, there are important self-help measures that you can take to aid your body in its fight-back against infection. "People have forgotten that sometimes you need a bit of rest," says Dr O'Connor. "If you are fighting an infection, you need to take a bit of time out, a bit of rest, plenty of fluids. Eat a little if you can.

"And the other thing to remember is that antibiotics don't do anything for pain, or for fever. What you need for those is rest and over-the-counter medicines to relieve symptoms."

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