The A-Z of everything veterinary (and animals): A is for Antibiotics

We begin a new 26 part series by Welsh vet and writer Siôn Rowlands in which he guides us through the animal and veterinary alphabet.

A is for Antibiotics

Antibiotics, or ‘Happybiotics’ as someone once referred them to me as, are widely regarded as one of the most important discoveries in modern medicine.

You might not consider 1928 to be that modern, the year that Alexander Fleming accidentally (allegedly) came across a fungus (Penicillium notatum) attacking some bacteria in his lab, but in the very long history of medicine, the discovery of penicillin and other antibiotics, is very new.

Indeed medicine: the diagnosis, prevention and treatment of disease, whether in relation to humans or animals, goes back some way beyond the antibiotic era.

Take Hippocrates, a Greek physician considered the ‘father of medicine’ began describing diseases well over 2000 years ago. From Hippocrates came the Hippocratic Oath, which newly graduated doctors will take before making their first leap into medicine.

Further back again, and with principles that still hold some value today, very early medicine saw would-be neurosurgeons performing trepanation, or trephining, where holes were drilled into the skulls of patients using sharp instruments.

Skulls discovered of poor patients, with evidence of holes bored into their heads, date beyond 5000 years ago.

The story of veterinary medicine, some believe, goes back to 3000 BC and history has been dotted with people ‘healing’ animals since, with the 18^th century recognised as the start of the veterinary profession with the establishment of a veterinary school in Lyon, France.

Infections

During the 1940s, 50s and 60s, most of the antibiotics available today were brought into general use, providing us with unprecedented access to solutions to so many infections, both in humans and animals.

In animals, an early iteration of one antibiotic became popular in the late 1930s with its principal use in treating cow mastitis.

So, when we think of antibiotics today, what are some of the considerations in their use?

• That they remain a vital drug type and can save lives in so many settings
• Antibiotics work against bacteria, but not all bacterial infections require antibiotics
• Antibiotics are not effective against viruses and so play no part in tackling the flu
• Antibiotic resistance is a real problem with far reaching impacts across the globe. Vets and doctors are acutely aware of their responsibility these days in safe and sensible prescribing of antibiotics

Antimicrobial Resistance, an inevitable result of bacterial mutations, is nothing new and is an inescapable consequence of such extensive use, some use the term ‘abuse’, of antibiotics.

Bacteria have been on Earth for billions of years, continually evolving and striving to survive. It’s no surprise therefore, after so much time, that they (bacteria) have looked to adapt and change in response to hostile environments (antibiotics).

Solutions

There is considerable investment and research continuously underway to identify the next generation of antibiotics, but any such drugs produced will not provide the sole solution.

Every one of us has a level of responsibility when it comes to the prescribing, sale and use of antibiotics. So many of us will have been prescribed antibiotics for ourselves, our loved ones and even our pets and animals.

A fundamental principle of antibiotic use, and crucial when thinking about discouraging resistant bacteria, is to follow the instructions for use very closely. If your dog has been prescribed two weeks’ worth of antibiotics, twice a day, for its skin, it is imperative you give two weeks worth, twice a day.

Stopping the prescribed antibiotics early for your dog’s skin, your child’s eye or even your pneumonia, before completing the course, because they or you are ‘better’, is inviting trouble.

Different era

Many people have already noticed a change in the stewardship of antibiotics over recent years, most notably when visiting the vet or their doctor.

It’s human nature to attach a positive meaning to something people view as having benefited them in the past, or something a trusted source tells them is what they need.

‘You get yourself down to the doctor’s surgery and tell them you need antibiotics, and not the yellow liquid, that doesn’t work’, will have been standard instruction from countless caring grandparents before now as they prepared their children and sniffling grandchildren for a visit to the doctor.

We are now in a different era, one where we must view Antimicrobial Resistance as our collective burden. Antibiotics will still remain a critical treatment option, however there is a need to challenge their extensive use and, where possible, collect evidence to support the selected choice.

Swabs

When thinking of treating animals, there are ample examples, where in the past, antibiotics would have been routinely prescribed, whereas today they would not.

Vets will now be familiar with regularly recommending that swabs are taken of dogs ears, for example, before deciding on treatment options.

These swabs, when sent to laboratories, allow not only the growth and identification of bacteria (and yeast), but with it the selection of an antibiotic the bacteria are susceptible to.

These changes, in the way antibiotics are viewed and used, can be unsettling for pet owners, and many have left my consult rooms disappointed their pets have not been prescribed ‘tablets’ when, in their view, it’s what was needed.

Similarly, GPs all over the UK will be familiar, I suspect, with managing the expectations of patients when it comes to antibiotics.

The developments in human and animal medicine, and surgery, in the last twenty-five years have been astounding.

It is safe to predict that another twenty-five years will very likely see further ground-breaking innovation, with sizeable steps made in disease diagnosis and treatment that will serve the generations we nurture today and dream of tomorrow.

Letting the Cat Out of the Bag: The Secret Life of a Vet by Siôn Rowlands is available from all good bookshops or to buy here