Drugs to fight back to real infections socalled antibiotics it was a great time and they changed the course of medicine but bacteria are very savvy they know how to adapt so that antibiotics cannot work enable the un says that this is one of the biggest threats to Global Health is it really that serious and what can we do about it you as a patient and i as a doctor. If anyone has an answer to that its dr tim. He specializes in infections and serves home in your antibiotics are consumed and which ones have become ineffective thats why im now visiting him here live at what cost. And to be your ticket was this is a Global Challenge but we can solve it together. If pretty. Area getting less sensitive to certain antibiotics we say that theyre getting resistant its a worldwide growing problem one of the courses is an inappropriate and careless use of antibiotics here is a report from kenya. Rosemond asia is taking care of her little boy 5 month old collins is almost always sick with a constant cough and runny nose. The boys a couple worried because he so want to well all the time frame and i dont know why or going to. Resist giving him ticks but theyre not making him better the baby is given one antibiotic after the other. Rose doesnt know what hell she can do. And can take in history i went to the pharmacy and bought antibiotics when they were used up and he was still sick so i went and got more antibiotics in it i couldnt go to the hospital. Very soon had 2 children left in mataura and improvised housing settlement in kenyas capital nairobi she works every day as a domestic help so that she can pay for food childcare and rent she cant afford to pay for hospital visits on top of that. The hygiene standard in nairobis poorer neighborhoods is terrible the roads a full of garbage and human waste bacteria spreads easily hair and that leads to disease people immediately reach for antibiotics 1st gets them from a store around the corner cheap and without prescription. The man behind the counter has no pharmaceutical training people in poor neighborhoods often get poor quality antibiotics the dosage is too overused in the wrong way perfect conditions to create antibiotic resistant superbugs if were able to save the children to buy the kitchens at the local level then it means when we export a few months we export i suppose youre a drug were not taking bugs from one place to another and vice versa. So we must to look to be able to affect the global aspects of what she says. This is been a growing problem for kenyas Health Care System doctors that could jobby hospital are discovering more and more resistant bacteria theyve had to develop new standards for treating patients resistant bacteria can easily spread around the hospital and new infected patients arrive every day is presumed we have. Pharmacies of the boat without any kind of judgment number 2 which is not the medicine. Because. That makes treating resistant bacteria all the more Difficult Health care professionals need help from the government to reduce the dangerous superbugs. How are sensible of the Health Care System for the common citizen to just find out whether they have an exemption but it wasnt a book. 2 years ago a National Campaign was drafted to provide more education and introduce a prescription requirement for antibiotics that didnt help in nairobis poorest districts though they still have access to antibiotics over the counter. Health care workers advises rose to take her child to the doctor. Shed like to do but it costs money that she simply doesnt have. And he was doctor to commence at the what Cost Institute in berlin thanks for having me today youre quite familiar with the situation in africa because you frequently visit there so what do you think about the and to go to queues in africa there is a nice article about that under beauty quick fix and for example the quick fix for if you have diarrhea you get under beauty hygiene in the hospital is not good to get and if you already or you cant do any diagnostic you given under antibiotic under biotics are used but they are not used in a clear way that there is a good diagnostic and their prescription but often its used over the counter patients as you can see can buy it everywhere and so were brought in with under biotics and in this way because this. Is a big problem so what are the consequences of this happening with antibiotics so consequences are for the individual they take antibiotics and its not necessary of the purposes their Worst Development of resistance and in the patients themselves and on the other side you have an increase of resistance all over the world in which countries and in low and middle Income Countries but we have to see the other side as well there are still more people dying of not no huge no access to antibiotic then people of the biotic resistance that we have. In all this but with all this problem still the problem of access to the debate serves as a conflict between too much and too little there so so what needs to be done to change this you need toilet in this countrys people need toilets for sure in hospital and Running Water but at home as well because this is so this is we cant imagine here to live without toilets but if your liberal with our toilets you have much more problems and i think these are the 1st levels where you have to go to infrastructure but then of course you can do programs in hospitals that you build good hospitals was good diagnostic and that people have a good good Health Care System so we know what to do need we need money to do that and i think its not very appropriate for us here in germany or in the rich countries to point the fingers of the poor countries because we ourselves are doing a lot of things which of role in the handling of antibiotics you know for sure there are Different Things for example we use too many under biotics arent good studies which are too many i believe me often use of wrong under biotic there is the power that we serve under biotics and watch under biotics which we use too often when we commute regular and to be out if and the other side or is that Infection Control is very important Infection Control in the hospital and in the Health Care Setting can you give us some examples of diseases which are prone to resistant bacteria this is for example the ordinary your narrow tract infection then there is for example. Which often is more problematic and if you have a resistant but the gene and your underwear it dont work you have a big problem and the worst is for example bloodstream infection because then the pathogen is in the blood and can make that well see beer disease which. Very dangerous and you can even dying from it you can die you can die do you know what a. B. S. Means it has nothing to do with cars in the case here its called antibiotic stewardship in the city and hospitals which have this kind of initially ship in place a better patient care because theyre using less antibiotics. A study published last year found that between 22015. 00 the use of antibiotics went up 65 percent another study says one in 3 outpatient antibiotic prescriptions is unnecessary so when should they be prescribed and how can pathogens antibiotic resistance be prevented. Thats the time that were in a scary situation at the moment in germany and worldwide bacterial resistance is increasing dramatically ear nose and throat specialist i know you and says it has a lot to do with the overprescription about how by artics this. The problem starts with general practitioners who are responsible for prescribing 85 percent of all the antibiotics used in germany theyre often prescribed for simple upper respiratory Tract Infections coughs colds hoarseness where for the most part that makes no sense the trouble is that theyre then no longer effective for complex infections resistances develop and they also harm the environment that. Bad guy has taken antibiotics again and again over the course of many years. Im trying to figure out when i was a small childs hands off i often had tonsilitis problems swallowing and a fever. And ive been going to the doctors for the same thing ever said. A monster might give you every time they take a look at my throat. For a week. And that up to 5 times a year then she went to see dr you and he takes the time to do a proper examination he only prescribes antibiotics when they are definitely called for. In each case you have to determine if an infection is viral the spots on the tonsils or a smaller red throat dont necessarily indicate a bacterial infection or if it is. This time it looks like a viral infection dr yawned has prescribed an anti inflammatory painkiller and told her to drink a lot of fluids and get lots of rest after 10 days shes fine again but sometimes patients do need antibiotics this time miss bagger has a fever sharp pain on one side of her throat and she feels really bad dr you and takes a swab so that the pathogen can be identified and he tests for c. R. P. C. Reactive protein in the blood the protein is produced in the liver when theres an inflammation somewhere in the body and thats often caused by a serious spectral infection in miss baggers case the level is high the pathogen once identified can then be targeted with a specific narrow spectrum antibiotic rather than one of the Broad Spectrum ones which are used far too often ideas about how long a course of antibiotics therapy should be are changing the trend is toward shorter courses so its not easy to establish exactly how much treatment is adequate some doctors encourage patients to delay the start of the course of antibiotics therapy until they feel its absolutely necessary. To the studies have shown that if paid. Are instructed to take antibiotics by the doctor straight away 98 percent will take them but if you tell them not to take the pills unless they develop a fever or have intense pain or their condition worsened significantly then only 30 percent will take them as. I see life more here i do one had a kidney transplant and has now been hospitalized with a urinary tract infection the pathogen is multidrug resistant hes been given one of the last resort reserved antibiotics. Keep getting infections and have to keep taking antibiotics i could lose my kidney then id have to do dialysis and i really dont want that sort of such cases highlight the importance of the antibiotic Stewardship Initiative which aims to combat antibiotic resistance and optimize the use of antibiotics to treat infections effectively. Gamertag studies have shown and we have seen evidence here in the clinic that such measures lead to a reduction in overall antibiotic consumption and the use of Broad Spectrum antibiotics and. Studies have also shown that these measures can reduce mortality in severe infections such as septicemia by up to half the sky. Is just one of many patients who benefit from this more targeted use of antibiotics. Antibiotics are used worldwide on a massive scale not only in medicine but in life stuck to you can find them everywhere in the water in the soil and in your food and this has catastrophic consequences. This lake in northwestern germany attracts many visitors its a Pleasant Place to stroke the water sports and swim. But its also one of several lakes in the region where potentially dangerous bacteria have been found in the water. The 1st kind are extended spectrum peter lacked a maize or e s b l producing bacteria the enzyme they produce beetle lacked a maze has the ability to break down commonly used antibiotics. The 2nd kind are multidrug resistant gram negative bacteria that means ones that standard antibiotics can no longer kill that strains of bacteria commonly found in the human power and can cause a range of infections in the urine or attract or lungs and even in the blood resistance to antibiotics develops fastest where theyre used a lot in hospitals and also on factory farms its no surprise that multidrug resistant bacteria turn up in lakes says hospital hygiene expert dr your highness cannot block what is surprising is that some are resistant even to reserve antibiotics the last resort option is used when standard varieties dont work using resistance and in order many its still rare to find these kinds of drug resistant bacteria in patients and drug resistant scares us show and we monitor very closely how and where it spreads a great deal of research will need to be done in the coming years of fossils but offside. Sewage and waste Water Treatment plants dont always remove drug resistant bacteria and they can end up in the environment particularly in your hospitals. After heavy rain a lot of bacteria can be flushed into rivers in runoff from intensive livestock farming operations directly and without any treatment. Water fowl and other animals can also deposit bacteria in bodies of water. Almost all human gut bacteria die quickly and rivers and lakes but that. Doesnt necessarily solve the problem the uterus is tense for we dont know if Drug Resistance then disappears bacteria can pass Drug Resistance on to other bacteria it could be that one day the Genetic Information coating the resistance shows up again in bacteria that do make human sick even mention crack mongering the transmission of resistance among different kinds of bacteria could generate new strains that are resistant even to last resort drugs the more multi resistant bacteria there are in the environment the greater the risk. Not all melty resistant bacteria make us sick on our skin they can be challenge and vanquished by a whole range of resident bacteria that protect us. And if people ingest any the acid in the stomach kills most of them. But those the do withstand all onslaughts can colonise humans 5 percent of people in germany are hosts to bacteria without actually falling ill. Their immune system keeps them in check they can become dangerous if they enter the bloodstream as a result of an injury or during surgery so should Healthy People avoid lakes and rivers where such bacteria have been found. If you have an open wound you probably shouldnt go swimming but not because of multidrug resistant bacteria i would say that the chances of a healthy individual being infected by a multi resistant pathogen was swimming in a contaminated lake or about the same as getting rich harvesting particles of gold in the water so via. The greater risk is the possible spread of resistance to antibiotics among bacteria that do make us sick its important to keep them out of the environment in the 1st place. Is that if you type one option is to upgrade wastewater. Arent another more important one is 3 form the use of antibiotics for humans and livestock so that much less makes its way into the environment and then has to be filtered out again. Unless these problems are addressed and resolved Drug Resistance among bacteria is set to get worse if more and more diseases become untreatable that death toll could soar. Antibiotic residual founded water into soil so ho big is the problem i think you have to divide this problem there is individual brain problem for the person who is going to a lake or so and i think i think there is no theres no risk was a person there of a puff of genes in the the water which would be a risk for them but on the other side theres a Public Health few and and do we really want that under biotic resistant pathogens and resistance genes rising in the n. Y. M. And that we have more and more. Resistant pathogens and in then why im at and we dont know if this is a risk but that it might be in the future so we have to investigate and think and have a walk for this if you take a look into the general practices from doctors some doctors are using Broad Spectrum antibiotics in many infectious cases and Broad Spectrum antibiotics antibiotics which are used against a broad array of prettier but you say its not very smart to do so 1st its perhaps market presence sounds easy but you have to see that the side effects of this and to beatrix a much bigger than the side effects of small spectrum antibiotics which are very clear and focused antibiotics because theres the one way the side effects which are going on the on the kidneys on the nerves and on the other side these groups beck. And we are if they they kill not only the one pathogen which makes you all but as well a lot of bacteria and 99 percent of the bacteria which you have in your body and great and you need them and if you kill them you have a broken for example like diarrhea and other problems and you have the lection of resistance pathogens so Broad Spectrum is really for the individual patient its a risk and as well for the societies so if existing antibiotics dont work any longer why dont we just develop new ones i think this is not the main point the main point is to use these under beauty which we have in a clever way and all these other infrastructure things for the low and middle end and come countries and and there is only that we have really pathogen which is a resistance against all under biotics this is very very very seldom you see it pops sometimes and invariably cost the world on the i. C. U. Intensive care unit but not in the norm of that away ssion that this is not the main problem. The main problem is the clever use of the under which we have so i think its much better to invest in this principle doctors should look for help from nature itself because some viruses special viruses can kill bacteria and those viruses are called back to you for ages. Maximillian schmidts has an infection that doesnt respond to antibiotics. Pathogens from his sinuses ended up in his intestinal tract a woman 1000 year old had to have an operation his doctors tried to treat him with antibiotics but they had no effect on the rod shaped bacteria. Maximillian read up on them and discovered an alternative bacteria phages a bacteria phage or phage is a virus that infects a bacterial cell by injecting its d. N. A. Or r. N. A. Into it the bacterium is then forced to produce new faces until it explodes that releases more bacteria phages which attack other bacteria until theyre all destroyed then with no more hosts the bacteria phage