Antibiotic resistance: 6 diseases that may

come back to haunt us

Still think of TB, typhoid and gonorrhoea as infections from the past? WHO's terrifying
report will make you think again
Mike Turner
Friday 9 May 2014 13.40 BST

Neisseria gonorrhoeae, the bacteria that causes the sexually transmitted disease gonorrhoea.
Photograph: Dr. David M. Phillips/Getty Images/Visuals Unlimited
Diseases we thought were long gone, nothing to worry about, or easy to treat could come
back with a vengeance, according to the recent World Health Organisation report on global
antibiotic resistance. Concern at this serious threat to public health has been growing;
complacency could result in a crisis with the potential to affect everyone, not just those in
poor countries or without access to advanced healthcare. Already diseases that were
treatable in the past, such as tuberculosis, are often fatal now, and others are moving in the
same direction. And the really terrifying thing is that the problem is already with us: this is
not science fiction, but contemporary reality. So what are some of the infections that could
come back to haunt us?

Tuberculosis

TB ought to be treatable within six months once people are prescribed a course of drugs
including the once potent antibiotics isoniazid and rifampicin. But today, resistance has
emerged not only to these medicines, but to the wider range of pharmaceuticals used to
treat the disease. This has led to the emergence of multi-drug-resistant TB, the still less
treatable extensively drug-resistant TB (XDR-TB), and even to total drug-resistant TB,
which has only officially been confirmed in India. Countries such as South Africa have run
out of treatment options for many of their patients and are having to discharge them from
hospital. Resistance to TB has reached a global scale with XDR-TB now reported in 92
countries.

Gonorrhoea
The sexually transmitted nature of this infection makes it something many are reluctant to
talk about or admit to having. However, it's long been thought of as easily treatable and
nothing much to fear. Once fixable with penicillin and tetracycline, the bacteria behind the
disease have developed such high levels of resistance that there is only one drug left that
can treat it. Even this antibiotic, ceftriaxone, is becoming less effective. With last-resort
drugs losing their impact, this sexually transmitted infection (STI) could spread throughout
the population.

Klebsiella
It's likely that you've never heard of this common bacterium, which can cause a wide range
of conditions including pneumonia, urinary tract infections, septicaemia, meningitis and
diarrhoea. It fits into a wider group of bacteria with the apt acronym of Eskape owing to
their ability to avoid the effects of the antibiotics used against them. The acronym stands
for the names of the bacterial group members: Enterococcus faecium; Staphylococcus
aureus; Klebsiella pneumoniae; Acinetobacter baumannii; Pseudomonas aeruginosa; and
Enterobacter. Klebsiella and the rest of this group are increasingly being acquired in
hospitals. While we fear MRSA, it is in fact a declining threat in hospitals; at the same time
Eskape pathogens are causing more and more problems. As the WHO report highlighted,
routine hospital visits or treatments could result in these previously treatable bacteria
having fatal consequences.

Typhoid
Routine vaccination against typhoid means it's not a disease that is often on our radar, and
when it is it's rarely something we fear. However, the disease still affects 21.5 million
people each year in the developing world, and globalisation means travel to potential
sources of infection is more common. As a result, more than 5,000 people in the US are
infected annually after eating contaminated food and drink. Typhoid fever, which is caused
by the bacterium salmonella typhi, is treated with antibiotics, but resistance to multiple
antibiotics is increasing. Reduced susceptibility to the fluoroquinolone class of drugs and
the emergence of multi-drug-resistance has complicated the treatment of infections,
especially those acquired in south Asia. Since a vaccination exists, the key is to receive this

before you get on to a plane. Otherwise, consuming that innocent-looking vegetable on a

trip to Thailand could leave you with a potentially fatal fever topping 100F.

Syphillis and Diphtheria

Although resistance to these diseases is yet to emerge, public awareness of them has
reduced as a result of effective treatments. But in an era of resistance there is always the
potential for them to return as a serious public health threat. Although rates of syphilis are
low, they have been increasing in the UK since 1997. This STI is currently treated by a
single injection with penicillin, but resistance to this antibiotic has developed in other
diseases. Imagine the impact if it happened again. The fever and chills of diphtheria are
mainly prevalent in the developing world, but with travellers contracting typhoid even
though a vaccine is available, the same could happen with diphtheria.

So what can be done?

Antibiotic resistance is a problem we can all help to reduce. Good hand hygiene when
visiting people in hospital helps. Only taking antibiotics when prescribed by a doctor is
crucial; as is always completing a full course if you do have to take them. In addition,
doctors themselves should only be prescribing these medicines when patients truly need
them. These may be small things, but if we all do them it will have an impact and maybe
prevent a future where treatable diseases become fatal once more.
http://www.theguardian.com/commentisfree/2014/may/09/6-diseasesbecoming-resistant-to-antibiotics?CMP=twt_gu