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Living in a Post Penicillin World.
Written by | Dave Ward.
A Phenomenal Discovery Heading for Demise
In 1928 Sir Alexander Fleming a Scottish biologist, pharmacologist and botanist, discovered the very first form of Antibiotic known as Penicillin. As is the case with so many other great discoveries, this came about purely by accident– when Fleming noticed that some bacteria he had left in a Petrie Dish had been killed off. This was caused by naturally occurring penicillin mold, which had attacked the cellular walls of the bacteria. Since Fleming’s initial breakthrough, several other types of antibiotics have been discovered, some biologically engineered in a laboratory.
At the start of the 20th century, the average life expectancy of a human being was around 40 years of age, today that figure has risen to 70. This can be attributed to a combination of several factors– firstly, the pervasive use of antibiotics and vaccines as an integral part of modern medicine. This has brought about a remarkable contribution in increasing the life expectancy of humans across the globe– additionally, a heightened awareness of the importance of good hygiene practices has also provided considerable weight to the equation.
How Antibiotics Work
Antibiotics such as Penicillin work in one of two ways, either as a Bactericidal or a Bacteriostatic— A bactericidal works as a destructive agent to bacteria by killing it off completely, whereas a bacteriostatic retards the growth of bacteria by preventing it from multiplying.
It’s important to understand that antibiotics are only effective in treating diseases rooted in bacterial infection; e.g. syphilis, tuberculosis, salmonella, and certain forms of meningitis, et cetera. They have absolutely no value however, in the treatment of any type of viral disease– since unlike bacteria, viruses replicate themselves by penetrating and entering healthy cells.
The Threat of Increased Bacterial Resistance
In the same way that we humans develop a resistance to infections through our immune systems, bacteria also build up resistance to the drugs we expose them to. This is a natural process and is to be expected– be that as it may, bacteria resistance to antibiotics is progressing at an alarmingly fast rate. In the not too distant future we may reach the point where, antibiotics are no longer effective at protecting us against bacterial infections.
The reasons for this stem from the overuse and misuse of antibiotics– firstly, many patients are circumventing the traditional system of prescription, by getting their antibiotics directly from other sources; such as the Internet. In addition to this, doctors are exacerbating the problem by prescribing antibiotics before they have completed a full diagnosis of the symptoms. This is done as a measure of safety, the net result being, however, that many ailments are inappropriately treated.
Video: CDC Director Tom Frieden on the Growing Threat of Antibiotic Resistance
According to an online article published by the Mayo Clinic, the overuse and misuse of antibiotics is putting us all at great risk. A bacterium which has become resistant to a drug has mutated in some way– either by shielding itself from the drug, or by neutralizing the actual drug used. When this bacterium replicates itself it also passes on its drug resistant properties to the other bacteria– not only this, but it can sometimes directly transfer these properties to any surrounding bacteria– essentially providing them with a manual for survival.
According to an article published in Scientific America, the Center for Disease Control and Prevention (CDC) is quoted as saying “the overuse of antibiotics costs the US Healthcare system upwards of $20 billion each year”. The CDC also states “an even bigger issues lies in the overuse of antibiotics administered to cattle”– this is done not only for the purpose of disease prevention and containment, but also to promote growth and weight gain.
The Race is on to Find an Alternative Cure
Evidence that antibiotics are already starting to fail us is now emerging in the form of the so called MRSA superbug– a strain of Staphylococcus bacteria which has developed a resistance to many types of antibiotics. With the ever increasing threat of a wider spread of resistance, scientists are now battling to find an alternative to antibiotics.
In an article authored by Naina Bajekal for Time Magazine, Bajekal cites a Dutch micro biotech company which is leading the research into new cutting-edge techniques, for a non-antibiotic solution to bacterial infection. The company known as Micreos, already has a prototype drug which has been tested within the realms of a modest clinical trial– where the results are already showing it to be effective, in eradicating the MRSA bacteria as mentioned above.
Scientists claim that because the drug works in a completely different way, it is less prone to resistance than antibiotics. This new method uses enzymes known as endolysins– a naturally occurring form of virus which attack certain bacterial species, whilst leaving other beneficial microbes intact.
The CEO of Micreos echoes these positive results, stating that “the development of the new drug marks a new era in the fight against antibiotic-resistant bacteria”, also adding that millions of people stand to benefit from this new drug.
This is extremely encouraging news, and provides renewed hope for a post antibiotic era– one that potentially avoids the possibility of a throwback to the dark days of medieval misery. A lethal and perilous period in history, where diseases such as the Black Death (Bubonic Plague), thrived and ruthlessly wiped out 25 million lives in just 5 years.
Whilst we obviously welcome this new research, we must at the same time be wary of throwing caution to the wind by becoming complacent. It doesn’t require a lesson in medieval history to comprehend the possible catastrophic effects– which could occur from the potential pandemic outbreak of a dangerous and highly infectious disease. For this we only need to cast our minds back to 2014, remembering the Ebola virus outbreak– which caused a wave of international hysteria, and threatened to annihilate millions of people.
Since the Ebola outbreak of 2014, several countries that were affected by the disease have been declared “Ebola Free”, with Senegal taking the lead. Notwithstanding, for some of the other countries that followed suit, the disease has returned– in the case of Liberia this has happened twice, after the disease repeatedly reared its ugly head.
Granted, Ebola is not a bacterial disease, yet this should still serve as a wakeup call to everyone, reminding us of the devastating consequences we could endure– from our continued irresponsible and complacent attitudes. The responsibility of slowing down antibiotic resistance is dependent on multiple parties, where each one has a specific role to play in the fight against antibiotic resistance.
In order to assist with this process, the CDC has laid out specific recommendations, designed to help each party in the equation fulfill their role as effectively as possible:
- Ask if tests will be done to make sure the right antibiotic is prescribed.
- Take antibiotics exactly as the doctor prescribes. Do not skip doses. Complete the prescribed course of treatment, even when you start feeling better.
- Only take antibiotics prescribed for you; do not share or use leftover antibiotics. Antibiotics treat specific types of infections. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.
- Do not save antibiotics for the next illness. Discard any leftover medication once the prescribed course of treatment is completed.
- Do not ask for antibiotics when your doctor thinks you do not need them. Remember antibiotics have side effects.
- Prevent infections by practicing good hand hygiene and getting recommended vaccines.
For Healthcare Providers
- Prescribe antibiotics correctly – get cultures, start the right drug promptly at the right dose for the right duration. Reassess the prescription within 48 hours based on tests and patient exam.
- Document the dose, duration and indication for every antibiotic prescription.
- Stay aware of antibiotic resistance patterns in your facility.
- Participate in and lead efforts within your hospital to improve prescribing practices.
- Follow hand hygiene and other infection control measures with every patient.
For Healthcare Facility Administrators
To protect patients and preserve the power of antibiotics, hospital CEOs/medical officers can:
- Adopt an antibiotic stewardship program that includes, at a minimum, this checklist.
- Leadership commitment: Dedicate necessary human, financial, and IT resources.
- Accountability: Appoint a single leader responsible for program outcomes. Physicians have proven successful in this role.
- Drug expertise: Appoint a single pharmacist leader to support improved prescribing.
- Action: Take at least one prescribing improvement action, such as requiring reassessment within 48 hours to check drug choice, dose, and duration.
- Tracking: Monitor prescribing and antibiotic resistance patterns.
- Reporting: Regularly report to staff the prescribing and resistance patterns, and also steps to improve.
- Education: Offer education about antibiotic resistance and improving prescribing practices.
- Collaboration: Work with other health care facilities to prevent infections, transmission, and resistance.
The question isn’t IF but rather WHEN the time will come whereby antibiotics are no longer effective. As we mentioned above, bacteria over time will develop a natural resistance to the antibiotics we expose them to– be that as it may, this process is greatly accelerated through over-prescribing and the misuse of antibiotics.
Hence, as individuals we each have a responsibility to fulfill, by taking the appropriate measures as recommended above. No single group is capable impeding the progress of antibiotic resistance, it is going to take the actions of all 3 groups to do this. The longer that antibiotics are able to play an effective role in curing ailments, the better chance we have for a smoother transition into the new ground-breaking cures. Ideally we would be able to leverage the opportunity of administering these new drugs in parallel with antibiotics for an extended period of time, until we reach the point where antibiotics are rendered obsolete.
Just a few short years ago, this topic may have sounded like the synopsis for a new outlandish science fiction movie– one where the historical medieval nightmare of disease and plagues replays itself again in the 21st century.
The truth however is equally sinister and somewhat more REAL.
- Borland, Sophie, “Doling out too many antibiotics ‘will make even scratches deadly’: WHO warns that crisis could be worse than Aids”, Daily Mail, April 2014, Web 12-16-2015, WHO Warning on Overuse of Antibiotics.
- Walker, Foley, “Antibiotics are Failing and it’s not a Pretty Sight”, Food & Water Watch,October 2012, Web 12-15-2015 An urgent call to address the increase failings of antibiotics.
- Fleet, Anna, “The 9 Dangers of Antibiotics”, Activebeat, Oct 2015, Web 12-11-2015 The Common Dangers of Antibiotic Misuse.
- Bosley, Sarah, “New wave of Superbugs poses Dire Threat says Chief Medical Officer” , The Guardian, March 2013, Web 12-11-2015 The Threat of Resistant Superbugs.
- Walsh, Fergus, “Antibiotic resistance: Cameron warns of medical ‘dark ages’, BBC News, July 2014, Web 12-14-2015 British Prime Minister Warns of Medical Dark Ages.
- DNews, Could This Antibiotic Alternative Save the World?” Online video clip, Youtube. Youtube, November 13th 2014, Web 12-15-2015 Alternative Antibiotic Breakthrough.
- Weisberger, Mindy, “ ‘Last Resort’ Antibiotics Fail Against Superbugs” Yahoo News, Dec 2015, Web 12-15-2015 When the Last Resort Fails.
- LaMotte, Sandee, “Obama Battles Superbug With National Plan”, CNN News, March 2015, Web 12-15-2015, Obama’s Strategy for Beating the Superbug.
- Immuno Valley, “Micreos can Make Antibiotics Redundant”, Immuno Valley, April 2014, Web 12-15-2015, Micreos Could Make Antibiotics Obsolete.
- Editorial Board, “The Rise of Antibiotic Resistance” New York Times, May 2014, Web 12-15-2015, The Increasing Threat of Antibiotic Resistance.