Further Confessions of a GP

This is the losing battle that the medical profession is fighting every day. There is no long-term solution. Pharmaceutical reps travel the nation promoting their companies’ latest erectile stimulant or antidepressant but they never try to sell us their new antibiotic because the drug companies have stopped making them. There hasn’t been a new one for a decade or so. Pharmaceutical compan-ies don’t want to invest money into developing new antibiotics because they know that there will be resistance too quickly for them to be of any real selling value. When I first qualified just a few years ago, ciprofloxacin used to be a special antibiotic that was still considered to work against all bugs. It was akin to the best china that would only be brought out on special occasions so that it wasn’t ruined. It was expensive and there was a real push to use it as little as possible so that bugs didn’t develop resistance to it. I seem to remember that in the hospital I worked in you had to be a consultant to prescribe it. Ciprofloxacin is still a good antibiotic, but it is as cheap as chips now and is prescribed quite readily by GPs and junior hospital doctors. I regularly see urine infections that are resistant to ciprofloxacin and there isn’t really an alternative. The best china is faded and chipped now and there isn’t likely to be any great investment in a new set.

In hindsight it could be considered immensely arrogant of the human race to think that we could control bacteria and eliminate them from harming us. Bacteria are the oldest living organisms on earth, having been around for billions of years. They have adapted through a multitude of changing environments from hot and cold to dry and wet. Their ability to mutate and adapt means that they have outlasted many millions of plant and animal species that could not keep up with the changing environment. In the 1940s, when antibiotics arrived, bacteria were probably sitting around thinking: ‘Hey boys, these antibiotics are a pain in the arse, but if we mutated through that Ice Age of 10,000 BCE and the great volcano season of 1 million BCE, this is nothing.’ I’m sure bacteria will adapt to survive many more changes and challenges and will still be around many millions of years after the human race has disappeared.

Doctors now talk about preparing for a post-antibiotic era. This will be when all the common bacteria are resistant to all antibiotics and we will simply have to rely on our immune systems again. For those among us who are fit and healthy adults this will probably be okay. However, for the elderly or very young, or those who have weakened immune systems for whatever reason, this will be disastrous. Infectious diseases could once again become our most common cause of death, taking over from cancer and heart disease.

To be fair, simple antibiotics do still work against many simple infections. We still are within the ‘antibiotic era’ and some good old-fashioned penicillin should still treat a good old-fashioned bout of bacterial tonsillitis. (When the GP says please finish your course of antibiotics, please don’t stop after two days because you’re feeling a bit better. This is how the resistance gets a hold.) Things are getting better. Patients increasingly understand the limitations of antibiotics and most GPs try to avoid prescribing antibiotics unnecessarily. Although we probably still prescribe vastly more antibiotics than are strictly necessary, some reports have suggested that GP antibiotic prescribing rates are down 50 per cent in the last decade. Well done us! Our slightly more frugal antibiotic prescribing does seem to have helped stem resistance rates.

If you catch a bacterial infection in Portugal, the chance of the bug being resistant to antibiotics is much higher than if you picked up the same type of bug here in the UK. This is almost certainly because in much of southern Europe, antibiotics can be bought over the counter without a prescription. In countries where this is the case there is a strong culture of popping to the local chemist and buying a couple of days’ worth of antibiotics if you’re feeling a bit peaky, no matter what the cause. This has led to antibiotic resistance flourishing. Other common offenders are those elements of the farming industry who often blanket treat their cattle with antibiotics in an attempt to ward off disease and keep their profit margins up.