The rise and fall of modern medicine

Since the discovery of penicillin in 1928, antibiotics in their various forms have become a cornerstone of modern medicine but now, after decades of overuse, these miraculous drugs have begun to lose their touch.

“We see it already where simple urinary tract infections were once treatable with an oral antibiotic now occasionally require a more intensive IV antibiotic,” says Dr. Paul Bonnar, physician co-lead of the Nova Scotia Health Authority Antimicrobial Stewardship Program. “Of course the great fear is that even powerful intravenous antibiotics won’t be enough in time.”

The usefulness of antibiotics in combating and preventing infections has led to their widespread use across health care but with more exposure to our star drugs, the more likely bacteria are to develop resistance. Their slow but steady adaptation to our antibiotics is a disaster in the making.

“In time, it’s possible for bacteria to become resistant to every antibiotic we have.”

-Dr. Ian Davis

“Antibiotics are necessary in all areas of medicine,” says Dr. Bonnar, “which is why it’s so important to preserve their efficacy over time.”

Dr. Ian Davis, the program’s microbiologist lead, works alongside Dr. Bonnar and Dr. Andrea Kent in clinical pharmacy. He brings extensive experience with infectious diseases on the issue of antibiotic resistance. He says that, already, this worrying trend has given rise to so-called “superbugs,” such as Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant enterococci (VRE), which can no longer be killed by certain drugs. There are other, mercifully uncommon bacteria which cannot be beaten by any single antibiotic but instead require several at once.

It’s difficult to say when the business-as-usual scenario would end the age of antibiotics, says Dr. Bonnar, but he mentions a 2014 report from the United Kingdom predicting 2050 would see more deaths worldwide from resistant infections than cancer and diabetes combined.

“In time, it’s possible for bacteria to become resistant to every antibiotic we have,” says Dr. Davis.

The aforementioned Antimicrobial Stewardship Program was launched in July 2017 to address this issue at the QEII Health Sciences Centre and across the province. While these drugs are indispensable in most healthcare settings, Dr. Bonnar says at times they’re prescribed unnecessarily or for excessive durations.

Along with the leads, Valerie Murphy, the Central Zone stewardship pharmacist, works to engage their fellow healthcare providers and patients on the responsible and appropriate use of antibiotics.

“We don’t want to police antibiotics,” says Dr. Bonnar, “but want to encourage that long-term cultural change of using antibiotics correctly.”

In addition, Dr. Davis says many antibiotics are prescribed before the physician knows which bacteria they’re dealing with, given the traditionally slow identification process, but with recent advances in the QEII’s Division of Microbiology, an infection’s name can be learned much quicker. This allows antibiotic prescriptions to be tailored to the bacteria in question, also leading to the reduced exposure of bacteria to our most versatile drugs. These changes and others will allow for the same standard of care at the QEII, while preserving the drugs still available to us.

“Our minimal goal would be to slow the resistance, hopefully stall it and potentially even reverse it,” says Dr. Davis.

When bacteria develop resistance to an antibiotic, it must then dedicate energy and resources to maintaining that resistance. By minimizing antibiotic overuse — which is the program’s intended outcome — resistant bacteria lose their survival advantage. In this way, the responsible, targeted use of our current drugs could turn back the clock on antibiotic resistance.

The development of new antibiotics has slowed considerably in the last 15 years as pharmaceutical companies have experienced less incentive to develop them. As a result, few new antibiotics are expected in the next decade, so we must protect this limited resource.

Programs such as this one at the QEII are establishing themselves in hospitals across Canada and the world, a testament to the growing awareness surrounding this global crisis.

“It’s early days but I’ve been very pleased with the reception we’ve had so far,” says Dr. Bonnar.

For more information about antibiotic resistant bacteria and how to optimize antibiotic use, please visit www.cdha.nshealth.ca/nsha-antimicrobial-stewardship.