By Professor Colin Garner
The events of 28 September 1928 could justifiably lay claim to being called the most significant breakthrough in medical history.
With typical ingenuity and a quantity of genius, Sir Alexander Fleming discovered bacterial-killing mould in a petri dish he had left by a window before going off on his holiday.
Thus was penicillin discovered, Fleming’s legacy established and the treatment of bacterial infections revolutionised forever.
Antibiotics were a miracle medication, extending life expectancy, treating blood, lung, skin and kidney infections, their potency being displayed at the Normandy Landings, where their use saved thousands of lives.
And yet upon receiving the Nobel Prize in Physiology and Medicine in 1945, Fleming used an interview with the New York Times to warn that one day “misuse of the drug could result in selection for resistant bacteria.”
Ninety years after his discovery, that nightmare vision is coming true.
In August this year, the US Centre for Disease Control and Prevention warned that gonorrhoea could soon become resistant to antibiotic treatment. Meanwhile, a report by the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) showed that one in three (34%) of the urinary tract infection samples they had analysed were found to be resistant to an antibiotic called trimethoprim, compared to 29.1% in 2015. Then there are the 700,000 deaths globally from antibiotic resistant bacterial infections each year.
Now we have a situation where antibiotics, because of poor stewardship, have got everywhere in our environment, our water and our food.
Set against this background, the consumption of antibiotics has grown by 65% between 2000 and 2015. Despite some efforts to reduce needless antibiotic usage in livestock, reports by organisations such as the US Food Safety Inspection Service (FSIS) have shown that they are still being utilised in unacceptable quantities. Prescribers – including here in the UK – are still dishing out too many antibiotics and the internet has given rise to online buying, a truly dangerous pursuit.
Governments meanwhile, pay mere lip service but do little else to ease what has been described as the “biggest health problem humankind faces”, while big pharma is closing down its research and development into new antibiotics because there isn’t enough money to be made from the production of these new antibiotics. Today there are only four large pharmaceutical companies researching into new antibiotic therapies.
And so 90 years on from Fleming’s discovery, we have reached a crisis point which could return us to a pre-antibiotic age where routine hospital operations are cancelled due to fear of infection, and people die of something as simple as an infected scratch.
Put simply, now is the pivotal time for action. Whether by incentive or taxation, large drug companies need to be persuaded to get back into developing new treatments. Their much-vaunted breakthroughs in areas such as cancer will mean nothing if a cancer patient treated with the newest breakthrough therapy then succumbs to a hospital acquired infection because we have run out of antibiotics.
And those hospitals need to keep up their robust progress in infection control. The public should learn not to demand antibiotics as a silver-bullet cure-all and guidance around their prescribing ought to be clear. I am encouraged that so many medical and research charities are coming together to tackle the problem, but remain concerned that antibiotic resistance is perceived as a peripheral political issue.
One of the joys of celebrating the 90th anniversary of penicillin has been to meet up with Fleming’s granddaughter, Sarah Whitlow. She revealed that Fleming was an inquisitive man, always learning, never dismissing and guided by a sense of service (late in his life he had been working on vaccinations). As scientists, we could learn from his ethos. As individuals we can champion the cause of finding the cures we desperately need to save lives. And as employees we should seek to sway decision makers to ensure finding a solution to antibiotic resistance is a top priority.
The media has recently been full of stories of new antibiotics solutions being found in everything from soil to bear spit and platypus milk! It is easy to be dismissive. Now is a good time to remember that a single petri dish which became contaminated with mould has changed the world. We need inquisitive scientists who like Fleming will once again find the new breakthrough medicines so that the legacy of penicillin continues – we need resource and brainpower to help preserve the health of generations to come.
Professor Colin Garner is the founder and chief executive of Antibiotic Research UK (ANTRUK), the world’s first charity to fight bacterial antibiotic resistant infections. ANTRUK aims to raise sufficient funds over the next few years to bring at least one new antibiotic therapy to market by the early 2020’s. To learn more about their work and donate to their cause, visit www.antibioticresearch.org.uk