earth to home or saving googling to goes tell stories of creative people and innovative projects around the world ideas to protect the climate and boost green energy solutions by global oil gets bitten by a series of global 3000 on d.w. and online. dishes 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 when the generators was hard to survive then 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 how many antibiotics are consumed and which ones have become ineffective that's why i'm now visiting him here in berlin at what cost you. and to be resistance is a global challenge but we can solve it together. if the. syria 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's 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. so what would take up a new worried because he so want to well all the time name and i don't know why. rose is giving him and cheap aisle 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 i can 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 about it i

couldn't go to the hospital nicky dog. very soon had 2 children live 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 a hospital visit on top of that. the hygiene standard in nairobi's poorer neighborhoods is terrible the roads are 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 dosages to over used 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 they need to be and when we export a few months. during travel we are not taking bags for one place to another and vice versa. so we must act. 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 have 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. the boat without any kind of judgment number 2 we did 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. the civil law the health care system for the common citizen to just go a month find out whether they have an exemption but it wasn't to go to. 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 worker 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 dr tim at all but call institute in berlin thanks for having me today you're quite familiar with the situation in africa because you frequently visit there and so on

what do you think about the and to go to queues in africa there is a nice article about that under quick fix and for example the quick fix for if you have diarrhea you get under beauty hygiene in the hospital is not good you get an antibiotic or you can't do any diagnostic you can under antibiotic under buildings are used but they are not used in a clear way that there is a good diagnostic and the prescription but often it's used over the counter patients as you can see can buy it everywhere and so you have we're brought numbers on to be audited and in this way because this is a big problem so what are the consequences of this hanging with antibiotics so consequences are for the individual that take antibiotics and it's not necessary though perhaps there was development of resistance in the in the patients themselves and on the other side you have an increase of resistance all over the world in rich 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 know you should know access to antibiotic then people of under biotic resistance that we have to stay. all in all this but with all this problem still the problem of access to do better is a conflict between too much and too little you know so so what needs to be done to change this you need toilet in this countries 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 level 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 really i think it's not very appropriate for us here in germany or in the rich countries

to point the fingers at the poor countries because we ourselves are doing a lot of things which of role in the handling of antibiotics yes for sure there are different things for example we use too many of the biotics aren't good studies which are too many are often use of wrong under biotic there is the power that we serve under biotics and watch under biotics which we used to offer when we can regular and to be honest 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. in the morning 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 it can make that we'll save your disease which. it's very dangerous and you can even die from it you can die you can die do you know what a.b.s. means it has nothing to do with carse in that case here it's called antibiotic stewardship initiative and hospitals which have this kind of initiative 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 or i know you and says it has a lot to do with the overprescription of antibiotics. this is. 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 up arrest pre-treat tract infections coughs colds hoarseness where for the most part that makes no sense in it the trouble is that they're 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. ago when i was a small child. 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 extra time they take

a look at my throat and gave me antibiotics for a week. now. 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 bacterial or viral spots on the tonsils or a small red throat don't necessarily indicate a bacterial infection or if it is. this time it looks like a viral infection dr you sometimes patients do need antibiotics this time as 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 is an

inflammation somewhere in the body and that's often caused by a series bacterial infection in most 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. studies have shown that if patients are instructed to take antibiotics as a 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. but 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. 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. 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. the 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. studies have also shown that these measures can reduce mortality in severe infections such as septicemia by up to half. this.

is just. one of many patients who benefit from this more targeted use of antibiotics. antibiotics are used worldwide on a mess of scale not only in medicine but in life stock too you can find them everywhere in the water in the soil and in your food and this has catastrophic consequences. and 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 bowl and can cause a range of infections and that you are not retract 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 and we monitor very closely how

when where it spreads a great deal of research will need to be done in the coming years of fossils but off sign. see where john. wastewater treatment plants don't always remove drug resistant bacteria and they can end up in the environment particularly near 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 fall 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 or the uterus is tense for we don't know if drug resistance then disappears bacteria can pass drug resistance on to other bacteria how it could be that one day the genetic information coding the resistance shows up again in bacteria that do make humans 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 immune vironment 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 with stand all onslaughts can colonise humans 5 percent of people in germany are hosts to m r g n 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 west 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 we have. 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 treatment 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 the death toll could soar. and water into a whole big problem i think you have to divide this problem there is individual brain problem for the poor who is going to a lake or so and i think i think there is no there's no risk of course is person there in the in the water which would be good for them but on the other side there's a public health and and we really want that to be arctic resistant pathogens and with this. rising in the environment that we have. the resistant pathogens and why i'm mad and we don't know if this is or with but 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 are the buildings which are used against a broad array of prettier but you say it's not very smart to do so 1st some perhaps mark because it sounds easy but you have to see that the side effects of this under 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 spectrum antibiotics say they kill not only the one pathogen which makes you all but as well a lot of other bacteria and 99 percent of the bacteria which you have in your body are 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 election of

under unique resistance pathogens so broad spectrum is a really for the individual patient it's a risk and as well for the society 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 antibiotics which we have in a clever way and all these other infrastructure things for the low and middle end income come countries and and there is only then we have really pathogen which is a resistance against all under biotics this is very very very seldom you see it pops sometimes and in very big hospitals 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 doctor 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 schmitz has an infection that doesn't respond to antibiotics and pathogens from his sinuses ended up in his intestinal tract all of them a 19 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 them in a pharmacy. a number of eastern european countries are leading in the use of phage therapy. there for me to go if we definitely helped the bacteria phages got rid of 2 of the 3. rules we have now i have to concentrate more on school that makes it difficult because it takes up so much time. 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 fades 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 in 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 a theme on lighters for a long time time then you can use them but you have to have in mind that this is not in. say this isn't lucian for under resistance because you can't use them 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 to have a healthy life healthy food. enough movement and support and if you take antibiotics take them at the doctors tell you for example if 3 times a day not in the morning in the afternoon and evening but all 8 hours and take them

as long as the doctor tell you and care for yourself and care for your neighbor thank you so much for this very interesting talk all my questions have been oncet and i think all your questions have been answered too but if you do have questions on the different topic send them by e-mail. and upcoming show will take a look at di just how dangerous are intestinal problems and how can you get a malfunctioning digestive system back on track to send your questions to you in good shape at v.w. dot com just write intestines in the subject line we look forward to hearing from. that's it for today see you again next week and on so then let's all try to stay in good shape.

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this is deja news live from berlin police identify the attacker who killed 2 people on london bridge police confirm he was a convicted terrorist the friend who had been released from prison passes by tackle the man armed with a knife and wearing a fake suicide vest police arrived and shoot him dead. and germany's populist a.f.d. party prepares to elect a new leadership that could see it shift farther to the right look at the latest from our correspondent at home for.