Jagged little pill
AMR: antimicrobial (same as antibacterial) resistance is the topic for today folks. Grab your popcorn and settle in for a wild ride. I want to share with you my eco-coated pearls on how antibiotics work, how they've become resistant, and why they don't work on viruses. Admittedly it’s a slide chassé away from the plastic-sheathed theme of my usual writing, but I was reminded by some pharmacy colleagues that last week was Antimicrobial Resistance Week, and thought I’d wade in and join the metaphorical pill-party.
It all started nearly 100 years ago, when Alexander Fleming*, seen here donning one of the reusable masks in our trial (thank you Revolution Zero) discovered Penicillin. Imagine my intense disappointment when I found out that he wasn’t related to the James Bond author Ian Fleming (although Ian’s older brother did live in the same apartment block as Alexander, which caused some amusing mix-ups with post. Neat fact right? You’re welcome). But how did it work? Well, basically by breaking the bacterial cell wall. And there's no come back from there. But don't fret, antibiotics won’t kill human cells in the same way they kill bacteria. This is because antibiotics target particular proteins (‘peptidoglycans’ if you’re gunning for the gold star today) which human cell walls don’t possess.
Many patients ask “but why don’t antibiotics work on viruses?” which is an excellent question and the point at which I draw up the fireside chairs, put on my slippers and begin to explain. Viruses and bacteria and really not very alike. At. All. Plants and humans share more characteristics! Bacteria are neatly packaged balls of woe, with a tidy cell wall. Viruses on the other hand, are basically just DNA wrapped in protein. No wall, so antibiotics are useless. Yikes.
So why is resistance such a problem? Think about survival of the fittest: in evolutionary terms, animals throughout the generations developed slightly longer legs, or stronger muscles to outwit canny predators. Those that got away went on to reproduce. Well it’s similar with bacteria. They can also change and adapt; so if some have a quirky feature in their cell wall that means they can defend against penicillin, and jostle their weakling peers out of the way then they'll survive and pass on this trait, spawning stronger 'antibiotic-resistant' bacteria-babies. Sounds cute? Not so much. They can be very difficult to treat and cause some absolutely horrible infections. I won’t include pictures here as it’ll put me off my scrummy vegan brunch.
Hmm but viruses and bacteria - aren't the symptoms very similar? Well yes, so in other countries they use swab tests for throat infections to check the exact culprit. You’re right to question why we don’t do this in the UK. There are 2 main reasons: one is that we don’t have quick enough technology to hand to give us a result same day so it wouldn’t be helpful when we need to make a decision then and there. Secondly cost. Yes this sounds mercenary but, Gollum-like, we have to look after our pot of gold and ensure there’s also enough for e.g. expensive anti-cancer drugs, for CT scans, for mass-vaccinations. Sadly we have a limited amount of money in the health service. Disagree? Please write to your MP. Ask why the government underfunds the NHS’s plight to defend our population’s health and wellness and instead and prioritises futile nuclear weapons and warheads.
So if we can’t use tests to confirm whether it’s a virus or a bacterial cough, how do we know? Well, GPs see a lot of infections. We have experience, clinical acumen, and instinct. I reckon most of us wouldn't argue with advice from a plumber or builder or solicitor. So please trust us to help work out what will make you better, and avoid what might actually do you harm. Remember also that we understand the worry and frustration when a loved one is unwell. As humans we all instinctively want to do something, and it's difficult to accept that there might not be a cure. Thankfully we have a whole raft of ‘symptomatic-relief’ medicines that will help ease things a little. Your fantastic local Pharmacist can help there too. Paracetamol really is excellent at bringing down a fever, dulling the pain of a sore ear, and easing the fug of a fuzzy head. Menthol sticks help with nasal congestion. Difflam sprays numb a painful throat. Visit your local pharmacy! It’ll be a real Aladdin’s cave of lotions and potions, trust me. Just remember to take your own bag and make sure that mask is snuggly over your nose and mouth.
Despite the above explanation and persuasion tactics, here are some of the concerns patients express, when asking for antibiotics:
"I need to get on top of this infection now. I don’t want it to get worse."
Absolutely, your GP shares those sentiments too. It's very rare but possible to develop complications from a sore throat. But, antibiotics would need to be given to 4 thousand people (yes way) with sore throats, to prevent one abscess (called 'quinsy', but not as entertaining as the US medical detective). So that’s increasing 3999 people’s resistance for the future to prevent one quinsy. Yes it’s a tricky tricky balance but you can see how we use science and research to guide our treatment decisions.
"I need to get back to work so I need to be better ASAP."
Well, actually 90% of sore throats would get better within a week with or without treatment.
"I’m in pain! My throat hurts! I know paracetamol only masks the pain, I want to treat the cause!"
Of course that's awful, I feel really sorry for you and want to help you get pain-free ASAP, but did you know that antibiotics only reduce pain by 16 hours? Is a whole week on tablets, four times a day, with side effects of diarrhoea and loss of appetite, and the fact the antibiotics might not work as well for you next time, really worth 16 hours?
And of course I wouldn't be me if I didn't point out antibiotics are implicated in the climate emergency. When you’re on them, every time you go to the loo your body chucks out some of the antibiotics and they end up in our water systems, absorbed by fish. And *low whistle* - 70% of UK animal farming methods use antibiotics. Think I'll skip the Sunday roast today. And clearly, the more we use them, the more bacteria will adapt to become stronger and we'll see nastier infections, pandemics, and these will wipe out communities, put more strain on the health service etc... erm, sorry, but I think we all know how this feels. And research in Europe estimates that when people are off work with these now-antibiotic-resistant infections, this costs society 1.5b EUR per year in healthcare expenses and loss of productivity. So really we need to save our antibiotics to ensure they are effective when we truly need them.
Please continue to ring us if you think you have symptoms of an infection. We are here to help and advise and if you need to be examined, we’ll arrange that. Same day if it’s urgent. We are always happy to discuss the merits and pitfalls of treatments and will be honest if we think you need antibiotics, or not.
With antibiotic resistance
Please accept your GP’s persistence:
Saying “nope, it’s a virus”
Is cos research advised us
AMR threatens our existence.
*No celebrity scientists were harmed in the making of this outrageously overt photoshopping.