Augmentin

Last week The Boy and his family were in Foreign and Gdau the grand-daughter took sick again.  So sick that her parents took her off to the local hospital and had her diagnosed with bronchitis edging to pneumonia.  There, after a wait rather less than you'd experience in Ireland under similar circumstances, they prescribed her Augmentin, said that she was safe to travel and everyone heaved with relieved.  A couple of days later in a different country on the way home she barfed up as the family were boarding a plane for the last leg of the journey and nearly got them all dumped off the flight.  They had to sign a disclaimer before they were allowed to board.  Anyway they're all home now and the Young Mistress is fine.  Maybe  a broad-spectrum anti-biotic wasn't strictly necessary there but everyone directly concerned was really glad that Augmentin was available.  In my previous post, I mentioned my father's NDE with pneumonia in 1925 and Dau.I's much less traumatic encounter with the lung-filler in 1995 because of the intervention of antibiotics.

I was concerned, in the middle of last month, to hear a wireless report that the supplies of Augmentin were likely to run out over this coming winter as prescriptions of the drug have their seasonal crank up and GlaxoSmithKline experiences a long term production problem. Having heard the snippet, I Googled for  "Amoxicillin shortage" and couldn't get any more information.  Cue Twilight Zone theme.  But after  Gdau's troubs, I went at it again and can confirm what I heard on the radio.  I've also learned that amoxicillin is a derivative of the original penicillin and that once-susceptible bacteria became resistant because they produced an enzyme that degraded the antibiotic. In 1977, a couple of boffins at Beechams added clavulanate to inhibit this enzyme and called the mix Augmentin. We've had nearly forty years of successfully seeing off infections of the respiratory and urinary tract and a lot more beside.

Augmenin is off-patent now and marketed under a plethora of different names in dozens of countries.  But it turns out that almost all these sources buy the product from GSK (who don't have a back-up plant) and package it.  A lot of people are making a living from the creative British scientists who created the drug, and I can't even find out what their names are.  I suspect that it is the clavulanate that is missing to cause the otherwise unspecified 'production problems'.

When your grandmother is being hastened on her way in, say, March next year because there is no Augmentin then we might treat it as a wake up call.  We've known about drug resistance since the week after the first antibiotic was put on a petri-dish, and that's about 85 years ago. Antibiotics are amazing, they save precious lives with so little fuss that we now take them for granted.  But it looks likely that Gdau's generation will be the last which will respond to them, as bacteria resistant to any given antibiotic start to cause those UTIs and pneumonias.  Do you think we'll regret using penicillin as a growth promoter in chickens and pigs?  Or Augmentin as treatment for periodontitis in dogs or urinary tract infections in cats?  Antibiotic resistance doesn't limit itself to the mammalian species where this precious resource has been most widely used. It will, in a trice, jump across the species barrier and start to kill people.  MRSA (Methicillin resistant Staphylococcus aureus) kills at least one person a day in Irish hospitals: people who go in for a hip-replacement and come out in a box.  30% of us have MRSA up our noses, kept in check by our immune-system, so it's hard to keep the bug from the elderly with extensive surgical scars, or the immune-compromised.

We'll soon be paraphrasing Martin Niemöller:

when they came for the small black babies

I remained silent 

because I only saw black babies on the telly

when they came for the elderly

I remained silent 

because I was in line to inherit

when they came for the unemployed

I remained silent 

because I was a tax-payer

when they came for my first-born

I remained silent 

because I wished I was dead