Antibiotic Armageddon

The 18th August was the 47th anniversary of the Battle of Long Tan, in which 105 Australian and 3 New Zealand soldiers fought off a much larger force of between 1500 and 2500 Viet Cong in a four hour fire fight. In a replay of her 2009 radio interview, singer Little Pattie described how she was in the middle of her third show, singing for the troops when she was given a sign to cut. She was immediately whisked to safety in a helicopter as tracer streaked through the night in the rubber plantation below. It is difficult to imagine the Armageddon horror of tooth-and-nail armed combat unless you were there.

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One who was there on the ground at Long Tan was Terry Burstall. He writes;

The battle ebbed and flowed for four hours. When relief finally broke through, we hurriedly evacuated the area in order to fly out our dead and wounded. Some of them had to be left in the area overnight, however, and we returned at mid-morning the following day. The sight was horrendous – no-one who was there could ever forget the horror and the carnage. Two of our wounded were found where they had lain helpless all night while Australian artillery pounded the area.

[quoted from The Penguin Book of Australian War Writing. ed M Dapin. Viking, London, 2011].

For most of us the horror of the battlefield is reduced to a flickering window in the corner of our living room. We can switch off Armageddon with a single click of the remote control. The Viet Nam conflict is in the history books, the country flourishes as a member of the community of nations and increasing numbers go there on holiday. Gaggles of  tourists from these parts visit the relics of past conflict. The more thoughtful reflect on how the values that were fought over have been replaced. Propaganda has given way to advertising. A command economy has developed middle-aged spread and now looks remarkably modern.

Sadly, the freedoms earlier generations fought over in various parts of the Western Pacific have left some untidy loose ends. A consumer economy applied to pharmaceutical products equals unrestricted access to antibiotics in many parts of the region. Combine widespread over-the-counter antibiotics with a lack of public sanitation and you have plenty of scope for widespread antibiotic resistance. International travellers returning from exotic holiday destinations return in higher numbers with seriously resistant strains of bacteria. Some of these are almost untreatable with current antibiotics. The gathering storm clouds are the warning signs of something much worse than the slowly rumbling MRSA pandemic, which restricts treatment options for serious staphylococcal infections. Recent surveillance in Europe shows that the new CPE strains are already affecting health care delivery there.

The newly emerging forms of antibiotic resistance pose a more extreme challenge to medicine. The rumble of distant guns is steadily moving closer. It should warn us that our diminishing supply of antibiotic ammunition must be conserved. We need to re-stock our stores of infection countermeasures, re-learn the skills of infection control and recruit every health worker in this process. If we stick to the ‘she’ll be right, mate’ line, we’ll soon be outgunned, outnumbered and surrounded: antibiotic armageddon. Antibiotic-resistant strains of common hospital bacteria will not give up without a lengthy fight.

Some of the approaches being taken very seriously include

  • antibiotic stewardship in hospital and general practice
    • better targeted use of remaining effective antibiotics
    • prescriber-only use of antibiotics
  • resistance surveillance
  • infection control 
    • additional precautions for inter-hospital transfers
    • additional precautions for known carriers of resistant bacteria
    • targeted precautions for contacts of known carriers of resistance
  • antibiotic governance
    • pharmaceutical vigilance for poor quality and counterfeit antibiotics
    • restricted use of antibiotics in agri- and aquaculture

[NOTE: for enthusiastic readers of military maps, a series of maps following progress of the battle of Long Tan will be posted here in future]


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