For many years antibiotics have been used to treat bacterial meningitis, which is the deadliest form of the disease. But according to a major UK report^[1] last year and a World Health Organization (WHO) resolution, the threat that antibiotics could soon start to fail is upon us.

This is because bacteria find new ways to resist antibiotics all the time. The result is that by the time todays’ generation of first-time parents are becoming first-time grandparents, drug-resistant infections including meningitis could kill 10 million people across the world each year.^[1] This isn’t just a major threat to global health – it will become the major threat.

Antibiotics have had an incredible run. Before they existed, nearly all patients with bacterial meningitis died. Today it’s just 10-30%.^[2] But the bacteria are now starting to win and the death rate will inevitably rise again

The crop of drugs that delivered such staggering results is old. The bacteria have reinvented themselves faster than we have outwitted them with newer versions. Companies that create the drugs struggle to find ways to sustainably fund their development. And without that happening, everyone has to worry.

In an effort to jumpstart and guide the research and development of new antibiotics, WHO  published a list of 12 types of bacteria for which new antibiotics are most urgently needed. Many of the bacteria included in the list compiled by WHO can cause bacterial meningitis and septicaemia.

Because of this rising threat, never before has it been more important to prevent meningitis from happening in the first place. This means vaccines. Affordable vaccines, targeted at people who need them most. We have many of these vaccines right now and they are already proving their worth in preventing disease. 

Not only do vaccines prevent people getting ill, but they can also impact on antibiotic resistance. For example, it has been estimated that introduction of Hib conjugate and Pneumococcal conjugate vaccine (PCV) to 75 developing world countries could reduce antibiotic use for these diseases by 47% and avert 11.4 million days of antibiotic use in children younger than five years old each year. ^[3] Certainly, the introduction of PCV in the USA saw cases of Pneumococcal disease caused by resistant strains halve within a decade of its routine use.^[4]

The problem is not just lack of vaccine provision, but also when they don’t get to the people who need them, even when the official policy is to provide them.

This isn’t just a resource-poor, developing economy, or African meningitis-belt issue either. Just ask the 60% of young people in the UK who were meant to be vaccinated against MenACWY in a catch up vaccination programme – but who slipped through the net.

Gaps in vaccine coverage will mean that effective diagnosis and treatment of meningitis are always essential parts of the health toolkit. And that of course means antibiotics.

But when antibiotics don’t treat meningitis any more two things happen for certain: more people die and more people live with life-long disabilities.

Antibiotics become less useful as more people use them badly. Using antibiotics for a virus is pointless. Not finishing a course of antibiotics means the bug can come back even stronger. Doing both - as frequently happens - is like training bacteria to get smarter and more deadly.

Meningitis Research Foundation considers this issue - known as antimicrobial resistance - to be a major emerging threat to the progress that has been seen in the past 20 years in the fight against this awful disease. It will affect people globally. And it will need a global change of direction towards more effective vaccination programmes and better use of antibiotics to deal with it.

References:
1. The Review on Antimicrobial Resistance Chaired by Jim O'Neill. TACKLING DRUG-RESISTANT INFECTIONS GLOBALLY: FINAL REPORT AND RECOMMENDATIONS. 2016 [cited 2017 March]; Available from: https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf.
2. Prasad, K. and N. Karlupia, Prevention of bacterial meningitis: an overview of Cochrane systematic reviews. Respir Med, 2007. 101(10): p. 2037-43.
3. Laxminarayan, R., et al., Access to effective antimicrobials: a worldwide challenge. Lancet, 2016. 387(10014): p. 168-75.
4. Hampton, L.M., et al., Prevention of antibiotic-nonsusceptible Streptococcus pneumoniae with conjugate vaccines. J Infect Dis, 2012. 205(3): p. 401-11.