Antibiotic resistance : prevention vs cure
We are all acutely aware of the ‘ticking time bomb’ of antibiotic resistance and the Holy Grail is new classes of antibiotics that can be held in reserve and used sparingly. The economic problems this poses drives economists to formulate complex and elaborate mechanisms to incentivise companies to include antibiotics in their pipelines. But we must face facts – when we expose bacteria to antibiotics they will develop resistance, it is just a matter of time: days, months or years. Which leads to the question – if we could prevent infections, wouldn’t that be an elegant alternative? Vaccines to prevent bacterial infections would not obviate the need for antibiotics but would reduce their use and therefore reduce the time to emergence of resistance.
Will resistance arise to vaccines?
To date there is no published evidence that prophylactic vaccines (given in advance to prevent infection) result in the emergence of resistance. Such vaccines are not present at the same time as the bacteria, so exert no environmental pressure on them. By contrast antibiotics treat existing infections, so are present with the bacteria and in parallel to killing or suppressing growth of sensitive bacteria, do little to prevent resistant forms from continuing to multiply.
But are vaccines safe?
Until the late 1990s many childhood infections had become rare in the developed parts of the world – then the question of the safety of vaccines became the centre of media attention due to publication of work on the MMR (measles, mumps, rubella) vaccine. The media attention that ensued led to a drop in parents seeking vaccination for their children and a rise in incidence, morbidity and mortality from the infections. Sadly this was unnecessary – the published research on MMR was discredited – but the damage has been done in raising a question of vaccine safety.
The answer surely is that no drugs are without side effects but this doesn’t stop them from being approved – it is the rigorous testing that pharmaceutical products undergo and data in the published literature that gives us confidence in the safety of vaccines. Everyone reading this blog in the UK is likely to have been vaccinated in their lifetime and therefore have not suffered from diphtheria, measles, mumps, polio, smallpox, tetanus…… isn’t that a vote of confidence, albeit made by your parents!
Hospitals are risky places!
In the United States in 2014, one in 25 patients contracted a hospital-borne infection on any given day, according to the Centers for Disease Control and Prevention. Some 722,000 Americans developed such infections in hospitals in 2011, and about 75,000 died during their hospital stay.
Staphylococcus aureus (and its antibiotic resistant form MRSA) lives with us and on us making it a significant challenge in hospitals. A lot has been done in the UK to introduce good hygiene and isolation procedures in hospitals, which led to a 37% drop in MRSA blood stream infections and a 48%% drop in Clostridium difficile infections over the last 5 years. But this trend appears to have stalled with increases seen in the year to 2016, leading to an increased need for antibiotic use.
The number of elective surgery procedures undertaken each year is staggering with over 232 million procedures reported worldwide in 2014 – in England & Wales alone there are >160,000 hip and knee replacement procedures p.a. How many of these procedures involve prophylactic and/or post-operative use of antibiotics?
If vaccination was available to you at the time you went in for your pre-op appointment and that vaccination could reduce your risks of infection while contributing directly and indirectly to reducing antibiotic use and the incidence of resistance: what would you choose to do?
CEO at Absynth Biologics Ltd