Fleming’s legacy – a ticking time bomb?

Doctors have been tearing off prescriptions for antibiotics for so long that it’s hard to imagine what they’d do without them. For close to a century, infections that would in ages past have slain people by the thousands have been rendered little more than trifling annoyances.

But, while we continue to waltz into chemists,with the most blasé certainty that all will be taken care of, the number of effective drugs tumbles, and new ones simply aren’t being developed to take their place. In the last four years, the number of new antibiotics approved by the FDA clocks in at only two. Even as recently as the 80’s, the number was almost ten times this amount.

So now humanity is on the verge of being caught with its pants around its collective ankles. With the Centre for Disease Control reporting an impending catastrophe if major changes aren’t made, and increasing reports of superbug outbreaks across entire hospitals, this certainly isn’t a cosy catastrophe-threat like climate change, or fossil-fuel depletion, which may very well only affect our children, rather than us. A resistant strain of bacteria could quite possibly gain a foothold in any one of us, right now, whilst we recover from procedures as routine as having tonsils removed.

There’s no getting around a basic truth: antibiotics are the central cornerstone of modern medicine. Every diagnosis, treatment and recovery-program is designed around this great safety-blanket. Never mind that surgeons can install a pacemaker in your chest like they were fitting a gas-meter; that you can break every bone in your body, and live to tell the tale; have a severed limb reattached; or even cheat death with transplanted vital organs – it all goes out the window if the wound gets infected with an incurable super-bug in the recovery room.

The crux of the issue is its simplicity: all our drugs are sourced from the biosphere. The stuff in the pills we pop wasn’t cooked up from scratch in a lab, it was lifted right out of some incredible organism – some rare flower in the Andes, or an ocean-trench anemone. What if dear Mother’s treasure trove is all but spent after a mere century, whilst the world hungrily reaches for more?

It may seem downright absurd to think that nature, in all its complexity, could possibly be so limited. But the smallness of that stretch of time is precisely the problem: when viewed on evolution’s timescale, our civilisation would very much seem to have popped into existence in the blink of an eye. There simply hasn’t been time for selection pressures to work their magic, and produce new antibiotics.

For all intents and purposes, we’re stuck with a finite supply, and so our problem is misuse. Medical professionals should forgo using antibiotics unless they’re strictly necessary, and then as sparingly as possible. Whilst the work of the WHO, CDC, and other official bodies may have spread this message in the developed world, there are still vast tracts of the globe where public wisdom on the subject sums to nil. Large parts of Asia are especially at risk, where there is a great abundance of drugs available without prescription, at rock-bottom prices, and the scatter-gun approach can be relied on: swallow a fist-full of pills, and rest assured that one of them will cure what ails you. This is precisely how one would go about breeding a super-bug if one wished to do so, and the ubiquity of cheap transportation that we now enjoy is the perfect delivery-system.

The World Health Organisation called a conference this year to address the problem. Whilst most current alternatives are more conceptual, and reliant on as-of-yet undeveloped technologies, there has been progress.

Nanotechnology could provide targeted treatments capable of coating bacteria in neutralising substances, or injecting specific poisons directly, or even swallowing bacteria up. Phage Therapy involves purposefully introducing viruses that infect bacteria. The list even extends to using a burst of enzymes to inhibit the very mechanisms by which bacteria operate, preventing them from dividing, and thereby halting their spread.

At present, it’s possible that Mother Nature has a few saving graces hidden amongst Earth’s great slab of biomass, and the question of whether these will arrive in time is an open one. But, in the meantime, just to be safe, maybe consider trying to kick that chesty cough on your lonesome.