In the absence of solutions, tackling the causes of antibiotic resistance is key | Antibiotics

A decade ago, Britain’s top health official issued a grim warning: antibiotic resistance posed an apocalyptic threat, with patients having simple operations at risk of dying from routine infections that could no longer be treated.

Sally Davies, then the chief medical officer for England, said global action was required to fight antibiotic resistance and fill a drug discovery void by researching and developing medicines to treat mutating infections.

“If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics,” Davies said in March 2013. “And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.”

Her remarks raised eyebrows at the time. But today antibiotic resistance is one of the world’s biggest health threats, killing 1.3 million people a year. Davies, who is now the UK’s special envoy on antimicrobial resistance, was right to raise the alarm.

She wanted governments and organisations everywhere to take the threat seriously and work to encourage more innovation and investment in the development of antibiotics. But 10 years after her call to arms, no new classes of antibiotics have been discovered. The world is still waiting.

In the absence of solutions, tackling the causes of antibiotic resistance is key. The misuse and overuse of antibiotics are the main drivers, and action is being taken against them, with varying levels of success globally.

But now another potential driver has been identified: air pollution.

A study indicates that increased air pollution is associated with rising antibiotic resistance across every country and continent. It also suggests the link between the two has strengthened over time, with increases in air pollution levels coinciding with larger increases in antibiotic resistance.

Doctors have known for some time that long-term exposure to air pollution is associated with chronic conditions such as heart disease, asthma and lung cancer.

But the emergence of a possible link between air pollution, specifically the particulate matter PM2.5, and soaring levels of antibiotic resistance, is yet another reason why action to clean up air quality is so badly needed.

The research offers food for thought. Although measures to regulate and reduce antibiotic use are still needed, tackling air pollution may be a promising way to reduce global antibiotic resistance in the future.

Some experts not involved with the study, published in The Lancet Planetary Health, urged caution and highlighted its limitations.

Kevin McConway, emeritus professor of applied statistics at the Open University, said: “Overall, this observational data analysis and modelling research does indicate that it might well be worth looking further at a role for air pollution in relation to antibiotic resistance, but at this stage there remains a very large amount of uncertainty about what’s really going on.”

Evidence of the harmful impact of air pollution on other aspects of human health continues to grow.

Unrelated to the antibiotic resistance study but published at the same time, research in the journal BMJ Mental Health found exposure to air pollution was associated with increased use of psychiatric services in people with dementia.

The study established that living at an address with exposure to higher levels of PM2.5 was associated with increased use of community mental health services among people with dementia.

The link between air pollution and antibiotic resistance may require more work to categorically prove cause and effect. The link between air pollution and health is unequivocal.