be clear with you i have to act in ways that i feel necessary to people who just simply understand that. if you're sent a message to the ends justify the means. to terms with mrs stuart's december 13th on t w. this is in good shape. with your host dr carson like a touch. hello and welcome to in good shape we have a problem you do i do we all do just 100 years ago we had the same problem in mine a cut could mean a severe infection and manage itas was hard to survive when scientists developed

drugs to fight back to real infections so-called 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 it's dr tim. he specializes in infections and serves home in your antibiotics are consumed and which ones have become ineffective that's why i'm 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 they're getting resistant it's 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 boy's a couple worried because he so want to well all the time frame and i don't know why or going to. resist giving him ticks but they're not making him better the baby is given one antibiotic after the other. rose doesn't 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 couldn't go to the hospital. very soon had 2 children left in mataura and improvised housing settlement in kenya's capital nairobi she works every day as a domestic help so that she can pay for food childcare and rent she can't afford to pay for hospital visits on top of that. the hygiene standard in nairobi's poorer neighborhoods is terrible the road's 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 we're 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 you're a drug we're 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 kenya's health care system doctors that could jobby hospital are discovering more and more resistant bacteria they've 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 wasn't a book. 2 years ago a national campaign was drafted to provide more education and introduce a prescription requirement for antibiotics that didn't help in nairobi's poorest districts though they still have access to antibiotics over the counter. health care workers advises rose to take her child to the doctor. she'd like to do but it costs money that she simply doesn't have. and he was doctor to commence at the what cost institute in berlin thanks for having me today you're 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 can't 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 it's used over the counter patients as you can see can buy it everywhere and so we're 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 it's 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 country's people need toilets for sure in hospital and running water but at home as well because this is so this is we can't 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 it's 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 aren't 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 don't 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 we'll 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 it's called antibiotic stewardship in the city and hospitals which have this kind of initially ship in place a better patient care because they're 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. that's the time that we're 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 they're often prescribed for simple upper respiratory tract infections coughs colds hoarseness where for the most part that makes no sense the trouble is that they're 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. i'm trying to figure out when i was a small child's hands off i often had tonsilitis problems swallowing and a fever. and i've 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 don't 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 she's 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 there's an inflammation somewhere in the body and that's 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 it's 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 it's 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 multi-drug resistant he's been given one of the last resort reserved antibiotics. keep getting infections and have to keep taking antibiotics i could lose my kidney then i'd have to do dialysis and i really don't 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 it's a pleasant place to stroke the water sports and swim. but it's 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 multi-drug 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 they're used a lot in hospitals and also on factory farms it's no surprise that multi-drug 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 don't work using

resistance and in order many it's 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 don't 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. doesn't necessarily solve the problem the uterus is tense for we don't 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 shouldn't go swimming but not because of multi-drug 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 it's important to keep them out of the environment in the 1st place. is that if you type one option is to upgrade wastewater. aren't 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 there's 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 there's 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 i'm at and we

don't 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 it's not very smart to do so 1st it's 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 there's 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 it's a risk and as well for the societies so if existing antibiotics don't work any longer why don't 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 it's 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 schmidt's has an infection that doesn't 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

they're all destroyed then with no more hosts the bacteria phages disappear but there's only one hitch. indoors in germany and unfortunately in much of the e.u. therapy with bacteria phages is not permitted doctors don't know about them and if you go to a pharmacy and ask about them they'll look at you strangely because they don't know about them either i had to go to eastern europe to find the made a pharmacy. a number of eastern european countries are leading in the use of phage therapy. if you go away from it definitely helped the bacteria phages got rid of 2 of the 3. now i have to concentrate more on school that makes it difficult because it takes up so much time. so i. now finish researchers have identified a mixture of bacteria phages that they think could help maximillian schmidt but due

to import restrictions he'll have to take a trip to helsinki for the treatment. in many parts of the world fetes therapy is still unknown but will it one day become an effective alternative to antibiotics. what's your take on bacteria phages there's a lot of research going on here as we've been a long time and i think they have their place in quitman of patients but these are very special cases for example if you have an option one lighters for a long time time and you can do with them but you have to have in mind that this is not. say this isn't lucian for under resistance because you can't use him in a wide range of patients only very specific patients and what can every single one of us do to fight bacteria resistance see the best thing is have a high healthy life healthy food. enough with men and support and if you take

antibiotics take them at the doctors tell you pro sample if we times a day not in the morning in the afternoon and in the evening but all 8 hours and take them as long as the doctor tell you and care for yourself and care for your neighborhood thank you so much for this very interesting talk all my questions have been on set and i think all your questions have been answered to but if you do have questions on a different topic send them by e-mail. on an upcoming show we'll take a look at digestion how dangerous are intestinal problems and how can you get a malfunctioning digestive system back on track to send your questions to any good shape at d w dot com just right intestines in the subject line we look forward to hearing from . that's it for today see you again next week and on

c.n.n. let's all try to stay in good shape. the

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this is g.w. news live from berlin fridays for a future goes global get thousands of young people are taking part in rallies around the world it is also black friday and some demonstrators are protesting against overconsumption the call to action comes ahead of next week's un climate summit. also coming out of hong kong thanks president trump for signing legislation supporting democracy in the territory but china condemns the united states for meddling in its domestic affairs and promises counter measures. and ball just cry.