In 2016, a woman died in a hospital in Nevada from a bacterial infection that was resistant to all 26 antibiotics that were available in the United States. Hers was a bug that is uncommon in western countries, she was infected with Klebsiella pneumoniae which she likely contracted on a trip to India. It is considered a “nightmare superbug” meaning it is resistant to even the last resort antibiotics.
The World Health organisation considers Antimicrobial Resistance (AMR) as a major global health threat. As increasingly bacteria, viruses, fungi and parasites are not responding to antimicrobial medications. It has been coined a “Silent Pandemic” as it continues to spread and threaten routine medical procedures and recovery from infections. AMR doesn’t just take hold in hospitals, where we all know superbugs percolate, it also spreads through wildlife, people, crops, wastewater, soil and trade networks. The use of antibiotics in environmental and agricultural areas is considered a main driver of the growing resistance.
Key factors for the emergence and spread of AMR include:
- Overuse and inappropriate use of antibiotics.
- Poor access to clean water, sanitation & hygiene.
- Inadequate infection prevention and control in households, health-care facilities and farms.
- Limited access to diagnostics and medicines.
- Lack of new antibiotic development to replace those that no longer work.
The consensus is that antibiotic use needs to be restrained, in people, animals and agriculture, so bacteria don’t have as much chance to develop resistance. 10 years ago, professor of infectious diseases at the University of Minnesota Dr James Johnson said there are new drugs coming along but they will need to be used selectively, not willy nilly. However, no new class of antibiotic has been developed since 1987.
The reason why no new class of antibiotics have been created in the 21st century could perhaps be considered one of the detriments of capitalism – to do so is not financially viable or enticing to pharmaceutical companies. High cost, long timelines, low return on investment compared to drugs for chronic diseases like cancer, diabetes or high cholesterol where the drug intake for a patient is ongoing compared to taking an antibiotic for a week or 2, and increasingly public health guidelines encouraging sparing use of antibiotics means the financial return is not there.
Often framed as an impending catastrophe – some believe as we enter an era of smarter diagnostics, innovative therapies, policy reforms that address stewardship and ecosystem-level strategies, the reality is more hopeful as we build better tools and systems for prevention and protection.
Is Terpinen-4-ol Coming to the Rescue?
Scientists are also looking to nature to find solutions, with terpinen-4-ol, the main active in Tea tree oil identified as the key microbial, a pretty strong candidate in early lab research. In particular, Terpinen-4-ol has been shown as a promising candidate for treating Staphylococcus aureus, the bacteria behind golden staph and MRSA infections, either alone or combined with existing antibiotics. They say more research is needed but it did kill bacteria, completely stopping growth not just slowing it down in 10 different strains. It can work alone or alongside some antibiotics to improve outcomes. It’s also proven to be strong at preventing biofilms – the protective layers bacteria form on surfaces that make infections hard to treat. Terpinen-4-ol cut biofilm formation by 80% and again at 90% with higher concentration.
