Featuring in a recent TV programme on the ticking time-bomb of antibiotic resistance highlighted my own plight with the chronic illness cystic fibrosis (CF)*…
Let’s start with the basics… an antibiotic is a term for a drug or other substance used to kill or slow the growth of bacteria. Antibiotics are the bedrock of modern medicine. For 70 years they’ve been at the forefront of our fight against infection.
Since the manufacture of penicillin in 1943, antibiotics have saved millions of lives by combating infections. But there has been no new class of antibiotic developed for more than a quarter of a century. And bugs are battling back.
Through overuse antibiotics are losing their effectiveness. This is becoming a serious and growing phenomenon in contemporary medicine and has emerged as one of the pre-eminent public health concerns of the 21st century.
Resistance is a common yet problematic issue in treating pulmonary exacerbations or infections in people, like me, with CF.
However, despite a push for new antibiotic therapies there has been a continued decline in the number of newly approved drugs.
How does resistance develop?
Antibiotic or drug resistance results from bacteria changing in ways that reduce or eliminate the effectiveness of drugs or other agents used to treat infections. Not all bacteria are bad. However, there are some that can cause infections. As bacteria are exposed to antibiotics over time, resistance may develop, and the number of antibiotics we have to kill the bacteria decreases as well.
With antibiotic resistance, bacteria are now able to survive the use of these drugs meant to kill or weaken them. In effect, each time bacteria are “exposed” to antibiotics, they can change in a way that the antibiotics are no longer effective. So, the most common way resistance is acquired is by exposure to antibiotics. With antibiotic exposure, resistance generally develops overtime. The length of time depends on the bacteria and the antibiotic, which can range from one treatment course to several hundred.
Another way of acquiring resistant bacteria is through contact with other people or equipment when not using appropriate standard and contact precautions. Hand washing, hygiene, and washing of respiratory equipment are vital. The dynamic of cross infection among CF sufferers, getting too close to each other, is such a damaging one.
As well as feeling first-hand the diminishing effect over time of the drugs on my lungs; my doctors would analyse my sputum samples taken during hospital visits to determine the state of my bacteria. In simple terms, if my bacteria are ‘sensitive’ to certain antibiotics then I will be prescribed them and if I am resistant than I won’t.
On a daily basis, I take two different types of oral, two inhaled and one nebulised antibiotic. My CF catch-22 is that I need to be on a substantial amount of antibiotics permanently but this in turn reduces their every-day effectiveness and eventually builds up my resilience to them.
It’s different for CFers as we don’t tend to have a short burst or a week-long course of antibiotics. We tend to stay on certain tablets, inhalers and nebulised antibiotics continuously; sometimes alternating month on, month off with certain medication.
But as portrayed in the TV documentary which shows me with my family and out on a field hockey pitch, these antibiotics are life-savers. In my case, they act as enablers for me to work, play sport, be a husband and father. They are the breath of life for someone with CF.
One dilemma I faced ahead of the filming of my league hockey game was not how telegenic I was, but the fact that the rain clouds were looming and rain and my lungs are not a good match. Just my luck – I’m about to be filmed for a lot of people to view and I’d be wheezing all over the place! After much deliberation, I chose to play despite the rain and hope the cameraman would edit out the inglorious parts.
Holding my nerve
In the simplest cases, drug-resistant organisms may have acquired resistance to first-line antibiotics, thereby necessitating the use of second-line agents. And so it’s proved with me…
There’s a whole raft of ground-breaking antibiotics (oral and IV) that I was prescribed in the 1980’s that are now no longer part of my medical regime. They shone brightly, boosting my lung capacity, then after a while their effect petered out and I had to wait for the next mini-miracle drug to arrive.
I’ve become completely resistant to some drugs and the effect of other medication has reduced over the years as my body has been over-exposed to them.
Am I panicking about this potential antibiotic Armageddon? The answer to that is yes and no! If I dwelled on the likelihood of no more pipeline of medication I would get pretty depressed. But I tend to exist in the ‘here and now’ world where there are still drugs that I’m sensitive to which help me to fight CF.
To use the Forrest Gump vernacular, antibiotics are like a box of chocolates, you never know what you are going to get next!
For now, I’ll stay the course, hoping that my drugs keep knocking hell out of the bacteria, while I wait for the next miracle to come my way…
I will keep you posted on my life affirming moments, trials and tribulations as and when they happen. Please keep reading and sharing my blog and sign-up (on the right hand side tab) if you have not already done so.
Yours cup half full.
ITV Tonight 24 October: ‘When the drugs don’t work’ documentary (for those in the UK) – See me at 5:10 and at the end
http://stuartharley.com/tim.zip (just my section of the programme for those outside of the UK)
I read that Sir John Batten, UK specialist in chest diseases, has recently passed away. This man started the first clinic at the Brompton Hospital for adults with CF. He also trained my previous Doctor Ron Knight. I owe him a huge debt.
Good News - I have found a publisher for my CF-related book and I hope to launch it during Spring 2014… I’ll keep you posted!
* Cystic Fibrosis is one of the UK’s most common life threatening inherited diseases, affecting over 9,000 people. The condition affects the internal organs, especially the lungs and digestive system, by clogging them with thick sticky mucus. This makes it hard to breathe and digest food. Each week, five babies are born with the condition, however, each week, three young lives are also lost to it. There is currently no cure for CF. However, existing gene therapy trials in the UK are bringing people with the illness closer to a form of cure but CF is not that well known and would benefit from more public donations. For more information and to find out more view the CF Trust Website.