Leading article: Antibiotics, expensive and harmful
“Stop taking the tablets” is not a message often heard in medical circles.
Rather the reverse: keep on taking them is the instruction. Doctors justify their existence by handing out prescriptions for the magic pills, and pharmaceutical companies make a fat living from making and selling them.
When it comes to antibiotics, however, more is less. The world is swimming in a toxic soup of the drugs which have become so ubiquitous that they are losing their power and, more worryingly, stimulating the development of new bacteria that can trigger life-threatening infections. As our front-page report yesterday explained, infections resistant to almost all antibiotics are spreading across Europe at an alarming rate. In some countries – Greece is an example – up to 50 per cent of infections with one bug, K. pneumoniae, which causes urinary and respiratory conditions, are resistant to the most powerful class of antibiotics, called carbapenems. Greece also happens to be the country with the highest use of antibiotics.
While the threat from untreatable infections is growing, the supply of new antibiotics to combat them has dwindled. The difficulty of finding new agents, and the cost of bringing them to market, with all the paraphernalia of clinical trials needed to demonstrate safety and efficacy, have proved prohibitive.
The pharmaceutical industry cannot be blamed for this. New antibiotics are used only as a last-line treatment after other drugs have failed and are taken for only a short period, until the infection has cleared. Compared with a drug for diabetes, say, or high blood pressure, which must be taken for life, this is a poor business proposition. The commercial return is not sufficient to stimulate innovation.
We need a new business model, and the European Commission promised yesterday to provide it with a public-private collaboration to research new antibiotics and accelerated approval for drugs discovered. Where, however, the pharmaceutical industry bears blame is in fostering the “pill for every ill” culture that has brought the world to the brink of the abyss. It must now help us to curb that costly habit.
Antibiotics no more effective at relieving coughs and colds than a sugar pill
The winter may be peak season for coughs and colds but there is no point in taking antibiotics to shift them, experts say.
The largest randomised placebo-controlled trial of antibiotics for acute respiratory infections has shown that they are no more effective at relieving symptoms than taking a sugar pill.
Even older patients given the drugs did not recover more quickly or have fewer symptoms than those who simply waited for the untreated illness to run its course.
The international study run in 12 European countries including England and Wales included more than 2,000 adults with chest infections who were randomly assigned to receive either amoxicillin, the commonest antibiotic prescribed by GPs, or a placebo.
After taking the drugs three times a day for seven days, the two groups were assessed. Little difference was found in either severity or duration of symptoms, even among patients over 60. Those taking antibiotics reported more side effects including rash, nausea and diarrhoea.
Medical authorities around the globe, including Dame Sally Davies, the Government’s chief medical officer in the UK and Dr Margaret Chan, head of the World Health Organisation, have appealed to doctors and patients for restraint in use of the drugs to conserve them for serious conditions.
The world is awash with antibiotics and there is a growing threat from antibiotic resistant bacteria which could transform common infections into untreatable, and potentially fatal, illnesses.
The findings of the latest study, published in The Lancet Infectious Diseases, lend weight to their appeal. Paul Little, professor of primary care research at the University of Southampton, who led the study, said: “Using amoxicillin to treat respiratory infections in patients not suspected of having pneumonia is not likely to help and could be harmful.”
A commentary on the findings, published alongside, says: “[The researchers] have generated convincing data that should encourage physicians in primary care to refrain from antibiotic treatment in low-risk patients in whom pneumonia is not suspected.”