Now, health matters with Daniel Martin. Welcome aboard to Health Matters right here on CN A 938. Every year. Around this time, I take the opportunity to speak to you about the what was 16 years ago when I first started talking about it, the rising threat of antimicrobial resistance.
But now is the clear and ever present threat of antimicrobial resistance or am r you see last week, the world recognized antimicrobial resistance week as a result of growing drug resistance, many infections have become almost impossible to deal with due to a lack of effective drug treatment. Where are we in 2023 in terms of am and what will it take to effectively reduce it? We're learning more as I speak to Professor David Patterson who is a professor from the School of Public Health.
Good to meet you, Professor Patterson. Welcome to the studio. Thank you so much. Let's talk about where we are today. So like I said, almost for over a decade, I've been discussing this on air and every uh talking about how this is. It's happening, it's happening, it's happening, it's happening. But right now I can see it is here.
Absolutely. And it's here in Singapore, but to a much, much greater degree it's here in our neighbors. So, you know, if I was to go to a hospital in Indonesia or Malaysia or Thailand, Philippines, people are dying every day from AM R now, they're not dying necessarily, you know, healthy people at home. Typically it's people who are in hospital already with some critical illness. But, you know, I don't know if you've ever seen that uh picture in South America of the road, of death, this sort
of narrow road with a huge drop behind you. You know, you can imagine you're driving on this narrow road and then a great big truck comes towards you, you don't have any chance. And it's the same as, you know, you're s very, very unwell in an intensive care unit and then along comes AM R so an infection that's almost impossible to treat or sometimes completely impossible to treat. Unfortunately, we do have a lot of patients who die in that scenario and simply
put this has all happened because of the judicious and over usage of antibiotics amongst humans. And in our farming system has resulted in strains developing that are completely resistance to our existing Armamentarium. Is that it
to a degree. Although it's fascinating to learn that even before antibiotics were discovered, there was antibiotic resistance. And you might say, well, why chicken egg here, what's going on? So, in fact, bacteria are clever. They don't have a brain but they're clever. So bacteria can naturally produce antibiotics to kill their competition,
to kill other bacteria. So there was uh antibiotic production, but there was also the competition got canny, they became resistant to those antibiotics produced by other bacteria or other substances. And so am R has been around but of course, humans have and the development the access to antibiotics has,
you know, magnified this millions fold. So, you know, we know that if a person goes into hospital, probably at least a third of people will get intravenous antibiotics and in some parts of the world that's even higher. We also have the issue that if you're a busy nurse or a busy doctor, you go from one patient. Oh, that one's got an emergency, you go to the other one. You haven't cleaned your hands. You can carry one person's resistant bacteria on your hands and pass it to another person.
So it's antibiotic use in hospitals. It's cleanliness and part of that cleanliness is not just our hands, it's also the environment of hospitals. But then we have to think, well, where else are antibiotics used? And unfortunately in some parts of Asia, every chicken gets antibiotics for breakfast and you might think, oh, that just is going to be an issue for the chicken. But we eat chickens and you might say, well, I'm a vegetarian, I'm not going to be affected by animal use of antibiotics.
But what do the farmers in many parts of the world use to fertilize their crops but it's animal manure. So in other words, the e coli the other bacteria that have been in the chicken or cow or pigs tummy that ends up uh all that e coli with antibiotic resistance is there contaminating our vegetables? So it's
almost impossible to see that you would not be, you can't escape it. That's right. It's in every aspect of
our lives. It is. But there are things we can do to minimize it and simple things. And of course, we shouldn't be tired of the vaccination message. I know with COVID. Exactly. Exactly. Some people, you know, oh, another needle. But in fact, if you don't get respiratory infections, you are less likely to need antibiotics. You're less likely e even though the, uh, vaccines are typically against viruses,
you know, we, as doctors aren't always that clever. We can't differentiate viral and bacterial infections and we give people antibiotics. But so if you're vaccinated, you have a reduced risk of infections. In general, you have a reduced risk of antibiotics. You have a reduced risk of anti antibiotic resistance. Now, clean hands is obviously something we've been taught ever since we were little.
There's an interesting twist to the cleanliness aspect, hygiene hypothesis. Yeah. And, and it's also, well, if we're cleaning everything, are we actually breeding superbugs? You might have heard about the bedbugs in hotels and bed bugs. Now, this is, they're not bacteria but they are getting resistant to some of the, uh, pesticides
that the pest killers
use on them. That's right. And it's almost this, the more we use anything, the, the more likely resistance is going to develop to it. So, absolutely. I advocate hand, you know, clean hands but we have to be a little bit mindful that we don't go completely overboard and, you know, have everything that isn't really meant to be perfectly clean all the time, you know, around our house. That's why
I love our Hawker centers, except in a hospital surfing. I want it to be pristine in a hospital
and, and of course, before we eat, we should have good hand hygiene. Uh but we don't want to live in an a a completely artificial world because that could actually magnify resistance. So vaccination, clean hands, generally a clean environment. But then we have to also consider, you know, do I need that antibiotic?
So the owners can be on me, the individual to say no. And that would make a
difference. It would make some difference. It's not going to, you know, just it would be silly for me to say, well, every person going around saying, look, I don't want antibiotics is going to solve the problem because there are many, many aspects. As I mentioned, the agricultural use, the, you know, the need for use in sick people, in hospitals of intravenous antibiotics. But just because we've got a cold, even, just because we've got COVID doesn't mean we need antibiotics,
colds and COVID are due to viruses, antibiotics, kill bacteria. So, different, different things. So, yes, there's things we can do, but there's also a level of things that we, as regular people can't control. And then we almost need sort of an extra layer of intervention. So, one of the issues, it's true in Singapore, but it's even much more true in lower income settings in other countries is that we don't have the same antibiotics that are available to people
in the US, for example. So there's this access issue and part of it is that drug companies don't make actually that much money from antibiotics. And so it's not necessarily profitable for them to sell in every country in the world. And in fact, where antibiotics are truly needed often is where the access to antibiotics. And, and I'm talking about intravenous big gun antibiotics is it's least likely to, to have
access to them. And it's almost like the marketplace for antibiotics is broken for most things. We're happy to accept the more that is sold, the bigger the profits. But with antibiotics, we don't want that, we want to restrict them, but we want to have them though available when we really need
them. They're not the, I think the problem is there's somehow this social idea that it is panacea, it solves all problems, but it really should only be there when it is most needed. That's
right. And it's tricky for us in hospitals to work out. Oh, that person's really sick. They've got a high fever. You know, I think most of us would like to have the protection of antibiotics. And we, as doctors also feel that discomfort when our, our patient is suffering, but sometimes we have to sort of step back a little bit and say, even in that situation, is it truly, truly needed or could we get by with a, a narrower antibiotic one that's not as a big gun that's going to
affect all of our good bacteria in our bellies? Because that's an, that's an issue. And that's something I always tell my patients is, do you really want to upset that natural balance of your good bacteria? Because every antibiotic, even if it's for a, uh you know, an infection of the right big toe, those antibiotics are not clever. They're also not just the bacteria on the right big toe, all the good bacteria in our bellies. So,
which is increasingly research and being shown, I mean that we need the complexity of our gut bacteria for everything from potentially, I don't know, dementia to heart disease. I mean, it's so vital to keep that balance there and it's been thrown out of whack with every antibiotic dosage.
That's true. That's exactly true. And, and it doesn't take much, you know, just a small number of days of antibiotics is enough to disturb the, the normal bacteria. Do I got to
leave it off? And unfortunately, if you were to leave one message for antimicrobial resistance, what is the one thing you want my listeners to know today
yet? That it is a problem today that we have to come up with solutions as a global audience because millions and it is millions of people are dying every year from antibiotic resistance
doc Thank you so much for speaking to my listeners. It's been a pleasure having you here. Thanks so much. My guest on the program helping us understand antimicrobial resistance. The president, the problem is here and now professor David Paterson, who is a professor at the Socio School of Public Health. This has been health matters. I'm Daniel Martin. Before making any decisions based on the information in our program, please consult a medical professional.