“IT’S PROBABLY a virus.” These are the words every patient dreads. It seems that no matter what your complaint, from stomachache to stuffy nose, this is the doctor’s standard response and an indication that he won’t do anything further. And when you have the flu, you are hardly in the mood to listen to the doctor’s (completely correct) explanation that antibiotics won’t make any difference whatsoever because you have a viral infection. Feverish as you are, you suspect it is all a plot, or the doctor doesn’t really know what is wrong with you.

The public’s lack of understanding concerning the difference between a viral and a bacterial infection is a major factor contributing to the rise of antimicrobial resistance. Both viruses and bacteria can cause disease in humans, but they work in very different ways. Bacteria are single-celled organisms, while viruses are not cells but rather molecules of DNA and RNA surrounded by a protein coat. While antibiotics can recognise and target bacteria (which are living organisms that can reproduce on their own) in your blood, viruses have to penetrate the body’s own cells to multiply. This is why viruses are notoriously hard to kill, as the difficulties doctors experience in curing HIV/Aids shows. Few patients are willing to accept that, essentially, you have to let your body cure itself of a viral infection. They feel that in this age of medical miracles, the “let-it-get-better-on-its-own” philosophy is positively mediaeval.

While it is true that in some cases the only way a doctor can tell if you are infected with a virus or a bacterium is to do a blood or urine test, we already know what causes many common illnesses. Colds and flu are invariably caused by viruses, as are most sore throats and coughs. There is an old adage that says if you take antibiotics for a cold, it will take you a fortnight to get better; if you do nothing, it will take two weeks. Many people might feel that the placebo effect makes it worthwhile – at least you are being proactive – and it is
true that you could develop a secondary, bacterial, infection that will respond to antibiotics. Patients pressure doctors to “just give them something”, but this is dangerous ground. By taking antibiotics unnecessarily, you are just educating the microbes in your blood on how to defend themselves against the medicine. The next time you are ill, you might find that you are resistant to the antibiotics prescribed. You could end up taking much higher doses or much stronger drugs than you would prefer to. The much bigger problem, though, is that you can pass on this resistant strain to other people, creating a community-wide resistance to a certain drug.

An interesting illustration of this was the 2002 anthrax scare in the American postal system. Following the discovery of contaminated letters, about 30,000 official prescriptions of the antibiotic Cipro were handed out,  although thousands more panic-stricken people probably obtained it in Mexico or on the inter-net. Cipro is not only effective against anthrax; it is also a major weapon against other infections. As Dr Chris Willmott of Leicester University puts it: “This was a massive use of a drug and there is a very real risk that more people will develop drug-resistant complications, which lead on to death, than died in the initial anthrax attacks”.

As the World Health Organization points out, resistance is paradoxically caused both by people taking antibiotics when they don’t need them, and by people who do need them not finishing their course, often because of poverty.

Resistance has always been a problem, but a steady stream of new drugs developed during the 1950s and ‘60s (and modifications to these molecules in the 1970s and ‘80s) led us to believe we would always be one step ahead of the bugs. This complacency could be our downfall. Very few new drugs are being developed, mostly because of financial implications. Given the prohibitive cost of research and development, the years of clinical trials and the possibility that your new antibiotic could be useless because of resistance three years after making its first appearance, is it any wonder that the big pharmaceutical companies are less than enthusiastic about this field?

If you still think antibiotic resistance is someone else’s problem, consider the cost to you, the taxpayer. Not only is the NHS subsidising wasted prescriptions, it is also much more expensive to treat cases of antibiotic resistance. When the first and second line of defence is not good enough, a patient may need to be hospitalised while ever more rare and more expensive drugs are tried.

There is growing evidence that our taste for cheap meat is also leading to widespread antimicrobial resistance. A range of drugs – mostly antibiotics and anti-parasitic treatments – is used for therapeutic, prophylactic and growth purposes in livestock, and especially in intensively farmed animals such as chickens. If the antibiotics enter the food chain, human can gradually become resistant to them.

The next time the doctor tells you that rest and plenty of fluids is the best treatment for the flu, perhaps you should take this opportunity to stay at home and allow your immune system to do its work instead of demanding antibiotics. When was the last time you could use the future health of society as an excuse to take a sickie anyway?