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 anymore 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 infectious observes how many or antibiotics are consumed and which ones have become ineffective that's why i'm now visiting him here and i believe that the what cogs which are. under biotic resistance is a global challenge but we can solve it together. if. tyria are getting less sensitive to certain antibiotics we say that they're getting resistant it's a worldwide growing problem one of the causes is an inappropriate and careless use of antibiotics he has 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 ronnie knight use. the word cup and you worry because he so want to well all the time frame and i don't know why. resist giving him an x. but they're not making him better the baby is given one type i'll take off to the other. rose doesn't know what hell she can do. again back in history i went to the pharmacy and bought antibiotics and he came by dicky when they were used up and he was still sick so i went and got more antibiotics about it she was i couldn't go to the hospital dog. person had 2 children left in matara and they 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 stands it 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 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 all they're used in the wrong way perfect conditions to create antibiotic resistant superbugs if we're able to save the children by the positions at the local level they need to be used when we export a few months of weeks but i suppose if you're a drug we're not taking bugs from one place to another and ways with us so we must act to come 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 at 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 in fact the patients arrive every day is brazil in kenya we have a signal. pharmacies of these you know get botox 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. how accessible of the health care system for a. citizen to just find out whether they have a new section but it wasn't about. 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 poorer districts that 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. give us doctor to ignorance 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 so what do you think about the antibiotic use in africa there is a nice article about that quick fix and for example the quick fix for if you have diarrhea you get it under purity of hygiene in the hospital is not good you get an antibiotic or you can't do any diagnostic you're given under antibiotic under bionics are used but they are not used in a clear way that there is a good diagnostic and the prescription but often it's huge over the counter patient as you can see can buy it everywhere and so we're brought numbers under biotics and in this way because this is such a big problem so what are the consequences of this happening with antibiotics so consequences are for the individual that they take antibiotics and it's not necessary though purposes 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 no usually no access to antibiotic then people of under biotic resistant so we have still in all this but with all these problems 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 we can't imagine here to live without toilets but if you're. 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 to really 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 wrong in the handling of antibiotics you know for sure there are different things for example we use too many of the biotics aren't good studies which are too many antibiotics me often use of wrong under biotic there is the power that we serve under b.r.f. and watch under biotics which we used to offer when we can no regular and we are if and the other side of that infection control is very important infection control in the hospital and in the health care setting so 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 public and your underwear it don't work you have a big problem and the worst is for example the bloodstream infection because then the pathogen is in the blood and can make that we'll see of your disease which. is very dangerous and there you can even die from it you can die if you live 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 in this shooting 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 beats. in 202015 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 of antibiotics. the problem starts with general practitioners who are responsible for prescribing 85 percent of all the antibiotics used in germany and 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 then no longer effective for complex infections resistances develop and they also harm the environment that. bad guy has taken any time by artics again and again over the course of many years . ago when i was a small child this comes off i often had tonsilitis problems swallowing and a fever. and i've been going to the doctors for the same thing ever since. a monster might give you 3 times they take a look at my throat and give me antibiotics 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 bacterial or viral the spots on the tonsils or a small red throat don't necessarily indicate a bacterial infection or even 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 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 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 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 that condition worsened significantly then only 30 percent will take them and. i see light here i do one had a kidney transplant and it's 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. infections such as septicemia by up to half. of the history had to be. called remember 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. this lake in northwestern germany attracts many visitors it's a pleasant place to stroke to 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 maze 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 powell 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 the german it's still rare to find these kinds of drug resistant bacteria in patients and drug resistant scares us. very closely how and where it spreads and a great deal of research will need to be done in the coming years cause of fossils but off sign. sewage and waste water treatment plants don't always remove drug resistant bacteria and they can end up in the environment particularly 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 us 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 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.m. 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 the reform 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. as you have found water into a whole big is the 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 there is no there's no with questions person there are genes in the the water which would be a risk for them but on the other side there's a public health and and do we really want that to be a tick resistant pathogens and with this. rising in the n.y.m. and that we have. the resistant pathogens and in the end why are men 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 on the buildings which are used against a broad array of prettier but you say it's not very smart to do so 1st someone perhaps mark because it sounds easy but you have to see that the side effects of this and the biotics a much bigger than the side effects of small spectrum antibiotics which are very clear and focused antibiotics because there's 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 resistance pathogens so broad spectrum is 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 on this infrastructure things for the lower and middle end and come countries and and new to actually there is only then we have really pathogen which is a resistance against all under we are and 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 person dr should look for help from nature itself because some viruses viruses can kill bacteria and those viruses are called to kill 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 only when the 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 and till they're all destroyed then with no more hosts the bacteria phages disappear but there's only one hitch. 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. definitely helped the bacteria phages got rid of 2 of the 3. rules which is 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 and 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 nighters for a long time time then you can do with them but you have to have in mind that this is not. say that 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 to have a high healthy life healthy food. enough with men and support and if you take antibiotics take them at the doctors tell you for example if we 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 onset and i think all your questions have been ounce or 2 but if you do have questions on a different topic send them by e-mail. are not coming show we'll take a look at diet 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 don so then let's all try to stay in good shape. to. get. even the essential to life in this small village. and the country is rich. but the huge oil revenues have been seeping out into government officials pockets. in the cities people have taken to the streets to protest. what can teachers and schoolchildren in the areas to. 3013. w. 130 goats and a home from tokyo new hope for the police trying to you know reach him but it's beyond what we hope that she can get our economy moving i mean if you do a deal good it up arrived in trentino 8 years ago as a refugee now she owns her own business and is helping to turn this region around integration with goat's cheese and a field beyond in the alps in 60 minutes on d w. i what is the feeling when i arrived here i slept with 6 people in a room. it was hard i was fair. i even got white hair is that. the gentleman language head nods this gives me a little but you need to entrust the lives of say you want to know their story. it's worth fighting and reliable information for margaret. creek bed that created today's world. 79 a historical turning point in politics business religion. in iran a people of the islamic revolution. a man opens up making its initial flirtation but those are strengths in states of emergency put things into chaos who chose to have a 2nd to displacement shem's the people threatens the old order. the water crisis and. the start of an era that defines overmanaged today $979.00 are the big committed a small steps to cymbalta. 3rd. place . this is developing news live from berlin as a major climate summit is due to begin in madrid to the u.n. secretary general sounds the alarm on rising global temperatures will meet an indonesian fisherman waging his own personal battle with the resulting increase in sea levels also coming out germany's ruling coalition on a collision course to social democrats election new leaders who want to change their agreement with aunt and uncle america's conservatives to see the union says no ours will knuckles governments.