Fighting superbugs starts at local doctor

PUBLISHED : Tuesday, 17 August, 2010, 12:00am
UPDATED : Tuesday, 17 August, 2010, 12:00am

Soon after penicillin was introduced in the 1940s, bacteria began developing resistance to the new life-saving class of drugs. Ever since, researchers have produced generation after generation of antibiotics to stay ahead of it. That has not stopped the emergence of superbugs resistant to all but a tiny handful of antibiotics of last resort. The most common in our hospitals, methicillin-resistant Staphylococcus aureus, or MRSA, affects 9,000 patients a year and kills more than 200.

Now the Centre for Health Protection has stepped up an alert over a superbug gene, NDM-1, that has been declared a global health threat by British researchers writing in a professional journal. What sets it apart is that it can make common bacteria, such as E coli, resistant to nearly all known antibiotics, and has been seen in DNA patterns easily copied and passed on to other bugs. Since it emerged in South Asia, bacteria containing NDM-1 has been reported in Britain, Europe, the US and Australia among patients who travelled to India and Pakistan for low-cost medical treatment. The first report of a death in the West, on Friday, was of a Belgian man infected in a Pakistani hospital after a car accident. Experts say it may be responsible for many deaths in the developing world not properly recorded. World health authorities are concerned that medical tourism and international travel could help it spread globally.

Hopefully, the increasing threat from superbugs will encourage drug makers to refocus attention on research and development of new antibiotics. For many years now, this field has not promised the return on investment offered by drugs such as those to treat heart disease and blood pressure, and to combat depression and impotence. The cost of the scientific effort required to find new treatments may not be reflected in sales when they are finally brought to market, partly because cash-strapped health systems tend to save new drugs for severe cases. Thankfully, there is evidence the increasing threat from superbugs has led to a rethink among large drug makers of the value in developing new antibiotics.

Last week the Hospital Authority activated a surveillance system to detect the presence of the new NDM-1 gene. No doubt tried and tested procedures, including strict hygiene measures, are already in place to combat drug-resistant bacteria. The emergence of NDM-1, however, is another example of the overuse and abuse of antibiotics - which helps build resistance - coming back to haunt us. Superbugs are less the result of bad hygiene than poor community medical practices. It is well documented that doctors give antibiotics too freely to patients with a misguided sense of entitlement so they can recover quickly from even the most minor illnesses. These include the cold virus, which antibiotics won't cure anyway. The same patients ignore directions to complete the full course of a drug once they feel better - another contributor to drug resistance. None of this is healthy when doctors already have a financial incentive to overprescribe because they also supply the medicines. The routine use of these drugs in feed for cattle and chickens compounds the problem. As a result, dangerous bacteria have developed resistance to antibiotics faster than new ones are developed.

The emergence of NDM-1 is a reminder that we have to change our ways. We must be less demanding of doctors and they must be less accommodating. This requires common sense and patience, and understanding by employers. Where antibiotics are not really necessary, it is in the best interests of public health for workers to take a little time to get over minor illnesses rather than misuse them.