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Why we should handle antibiotics with care

More and more people worldwide have infections caused by bacteria that are resistant to many types of antibiotic. Why is this and how big of a problem is it? And what can we do about it? Internist and Professor of Infectious Diseases Mark de Boer explains in his inaugural lecture.

How big of a problem is antibiotic resistance?

‘Every year an estimated million plus people die worldwide of an infectious disease that cannot be properly treated because of resistant bacteria. Nowadays, that is more deaths than from HIV/AIDS and malaria. If the bacteria that causes the infection is resistant to a certain antibiotic, you can often use another one, but they regularly have side effects, are more expensive and are not always available – maybe in the Netherlands but not in Southeast Asia or Africa.’

Have you ever used antibiotics?

‘Definitely. I don’t think you’ll find many people in the Netherlands who have never used antibiotics. I had a knee operation, for example, and was given an antibiotic to prevent infection afterwards. On average, two thirds of patients who are admitted to hospital are prescribed an antibiotic during their stay. This can be to prevent or treat an infection. Modern medicine relies heavily on antibiotics. But using them now limits their efficacy in the future. And the problem is wider than healthcare alone.’

Why is the problem bigger than healthcare alone?

‘All antibiotics that are used, wherever that might be, affect the development of resistance. Antibiotic resistance is also linked to a number of the big challenges of our time. At least ten of the UN’s 17 Sustainable Development Goals to make the world a better place by 2030 are linked to it. Reducing hunger, for example: food production increases fastest with antibiotics; cattle grow ‘big’ faster and have more meat on their bones. Antibiotic use in livestock farming has already been reduced in the Netherlands and Denmark, for instance, but it is still widespread in many countries.

‘Climate change is causing antibiotic resistance to increase: global warming means that infectious diseases like dengue and West Nile virus are becoming prevalent in larger areas. More antibiotics will be prescribed because people will come to the doctor with a fever – even though antibiotics don’t work for viruses anyway, but only for bacterial infections.’

What will you be researching in the near future?

‘How antibiotic resistance and its development should inform our antibiotics policy and how we can make the very best use of antibiotics. We are using artificial intelligence to look at who might get an infection after an operation and when. In another study we are looking at prosthetic infections and whether we can reduce antibiotic use by treating the patient with one instead of two drugs. Antibiotics policy will be one of the big healthcare challenges in the next few decades. We do have guidelines but they need improving. So only use them when you have to and not when you don’t. Antibiotics can be really useful but you need to handle them with care.’

Mark de Boer will give his inaugural lecture on 9 June 2023: Antibiotic resistance and the hunt for the boundaries between undertreatment and overtreatment with antibiotics. Watch the lecture.

Text: Thessa Lageman
Photo: Unsplash

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