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The terrifying prospect of an ‘antibiotic apocalypse’ is in the news again, with stark warnings that the one-time ‘wonder drugs’ are becoming dangerously ineffective through overuse.

Because antibiotics have been so widely used – often for conditions which don’t require them –bacteria have begun to evolve which are highly resistant to them. It is now estimated that these so-called ‘superbugs’ are killing around 5,000 people each year in England alone, a number which could rise dramatically unless something is done.

The immediate course of action is to start ‘rationing’ the use of antibiotics so that they are only prescribed for conditions which really warrant them. It should mean an end to doctors handing out antibiotics for minor ailments such as coughs, colds and sore throats – often because their patients have demanded them. Instead, more patients will be told to go home, rest in bed, keep hydrated and take paracetamol.

Antibiotics remain a vital line of defence in cases such as sepsis, pneumonia, bacterial meningitis and other severe infections, but the danger is that such life-threatening conditions will no longer respond to antibiotics because they have evolved a resistance to the drugs. Two-fifths of E. coli infections in the bloodstream can no longer be treated with first-choice antibiotics and instead doctors are relying on a shrinking armoury of ‘last resort antibiotics’ which, for the time being, remain more effective.

It is estimated that by 2050, drug-resistant infections will kill more people around the world than cancer. We could return to a ‘medieval’ era, where just getting a simple cut could lead to an infection which will kill you, because the drugs to fight that infection no longer work. Routine surgical procedures such as joint replacements, cancer treatments and caesarean sections could also become hugely risky due to the danger of picking up a drug-resistant infection.

The sad irony is that many of the minor conditions for which antibiotics have been over-prescribed don’t even respond to them. For example, a cough or bronchitis can take up to three weeks to clear on its own, but antibiotics will only reduce that period by one or two days. In many cases, doctors have simply given in to demanding patients who believe antibiotics to be ‘a cure for all ills’.

Now that is changing, with doctors told to restrict the use of antibiotics only to cases where they are absolutely essential. Many GP surgeries are taking the proactive step of contacting all their patients to advise them that they will no longer be prescribed antibiotics for minor ailments which do not require them. As part of a nationwide “Keep Antibiotics Working” campaign, patients will also be given leaflets explaining how long it normally takes to recover from various common illnesses, and how to spot the warning signs of a more serious problem which might actually need antibiotics.

Professor Paul Cosford, Medical Director at Public Health England, said most people would pick up common infections such as coughs and colds from time to time, but would recover naturally with the help of their own immune systems. People should not go to their doctor expecting to be given antibiotics for such conditions, but instead should get lots of rest, drink plenty of fluids and ease the symptoms with widely available over-the-counter medicine such as paracetamol.

“The fact is, if you take an antibiotic when you don’t need it, then you’re more likely to have an infection in the coming months that the antibiotics don’t work for,” said Prof. Cosford. “A doctor will be able to tell you when an antibiotic is really necessary.”

Worryingly, some infections have already been found which are resistant to all drugs, even the so-called ‘last resort antibiotics’. Work is under way to analyse these highly drug-resistant bacteria and develop new drugs to combat them, but in the meantime it is hoped that using the drugs we already have more sparingly could mean they still work when we really need them.

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