This week, Optician contains one of the scariest facts it has ever published.
Our review of bacterial keratitis includes the following – ‘Globally, resistance to fluoroquinolones is becoming more significant and, in the near future, infections may become untreatable with current antibiotics.’ I am not sure that the implications of bacterial resistance to treatment have been fully assimilated yet.
From the viewpoint of eyecare, the inability to control bacterial infection means near certain blindness for anyone unfortunate enough to suffer a keratitis, either where bacteria are the primary pathogen or a secondary opportunistic infection. For the increasing numbers of independent prescribing practitioners, awareness of careful and selective use of existing antibiotics is a priority. No longer can a scattergun approach to infection management be justified.
From a human societal viewpoint, bacterial resistance represents a potential worldwide disaster and serious thought needs to be given to prevention now. First in line for revision has to be the current commercial model of drug development. The exorbitant cost of drug development, with many potential drugs falling by the wayside during the trial process, currently has to be balanced against future profits.
The timescale of development and the resultant cost of drugs, along with a prioritising of tackling diseases with a patient base of potential economic value, is not fit for purpose. Only through coordinated government investment and a focused approach to field work (not dissimilar to the Ebola project) can serious progress be made in preparation against a future pandemic.
And in prevention, greater priority might be given to more novel approaches. I am very interested, for example, in some of the good science looking at influencing immunity by altering the existing human microbiome. Faecal replacement capsules offer the perfect response to the previous poor science offered by the ‘you are what you eat’ brigade.