Antibiotics: how our miracle medicine may be in danger
The Listeriosis outbreak has focused attention on bacterial infection. Our initial reaction might be to call for its total eradication and to demand answers about how it was able to occur.
That is justified, but hopefully, by the end of this, you will realise that the issue is a bit more complex.
Bacteria are one of the first life forms to have occurred on Earth, billions of years have allowed them to spread and multiply to occupy every environment on the planet. If you tried to count them all you would need a number that begins with 5 and has 30 zeros after it. If all the plants and animals could be weighed, bacteria, despite being minute, would still weigh more than plants and animals combined.
You are infested with them. Your body is composed of about 40 trillion cells, you are home to about 30 trillion bacteria. You may want to read that again, there are almost as many bacteria living in and on you as there are cells that make you.
Don’t think they are all bad though. For the most part, the bacteria on you are either harmless or beneficial. Most of our digestion is reliant on bacteria breaking down our food into easy to absorb nutrients.
There are many types of bacteria that have evolved to thrive in their environments and we are one of them.
Bacteria differ from viruses, although many assume the two to be similar. Bacteria are living organisms capable of growth and reproduction, while viruses contain only their own genetic information and require other living cells in order to replicate. This complicates how we deal with a bacterial infection as you will read later.
Too many of any bacteria and the natural operation of certain kinds of bacteria are toxic to humans and this is the reason we are currently concerned with the Listeria.
It takes its name from Joseph Lister, a surgeon who realised that if surgical instruments were not clean before an operation the patients would become infected. The infection often resulted in death. He and Ignaz Semmelweis before him, who had advocated doctors washing their hands before working with patients, had created the principles of antiseptic procedure. Semmelweis's story is tragic, in that despite being correct, his advice was rejected and he died after being committed to an asylum and beaten, which lead to an infection that resulted in his death at 47.
We need to reduce the naturally occurring bacteria from gaining access to the environments where they can do harm.
From antiseptic we get antibiotic. Where an antiseptic would kill everything, an antibiotic kills only certain bacteria.
This is where we owe a debt of gratitude to Alexander Fleming who noticed that penicillium would kill a certain type of bacteria but not affect others or our own cells.
It is hard to overstate how significant infection was to mortality. In most wars, the injuries were not what killed people, it was the infections that followed.
For children in particular who need to build an immunity to some strains of bacteria and require the good ones to be transferred from their mother, mortality from infection was especially high. It remains one of the leading causes of death in children now who lack access to antibiotics.
It may seem then that all we need is lots of antibiotics, liberally applied to all. It appears that has been widespread, and while initially, it worked very well, bacteria did not get to last 3,5 billion years only to be defeated with a few chemicals. They develop an immunity to antibiotics if exposed to them over a period of time, and not all are killed. If you have a cold and visit a doctor expecting an antibiotic, you are treating a virus with a substance that has little effect on the virus (colds are viral, not bacterial), but a big impact on developing antibiotic resistance.
By overprescribing antibiotics for viral infections, we allow more bacteria to build a resistance to it. When a bacterial outbreak does become a problem the very antibiotic intended to kill it, has limited or no effect.
The bacteria once again regains the advantage, as more develop a resistance to our tried and tested antibiotics. These bacteria you may have heard described as superbugs. They are a real problem in very sterile environments like hospitals. Patients already infected with them will go to a hospital, where they can then spread through the air or in fluids. Not keeping the hospital surfaces clean may allow those resistant bacteria to mutate and render the antibiotic useless.
Overuse in humans is a major issue, but so too is its prevalent use in farming. When animals are farmed intensively, the risk of a bacterial infection spreading rapidly through the population is increased. Antibiotics are cheap and so many farmers in the past opted to routinely feed antibiotics to their animals. This reduced the risk and impact of infections. Over time, bacteria began to develop resistance and the real danger was that many of the antibiotics used for animals are the same as used for humans.
The low cost of antibiotics came, in part, from their relative ease to synthesise them. Many have now passed out of their patent terms and while we are starting to respond now to the growing problem, the time to research and develop new antibiotics takes about 15 years. It could get a lot worse if we continue with business as usual.
So what is the business unusual approach?
We need to reduce general antibiotic use in humans and farming. We need to do more to use the good bacteria to balance the bad ones. You have probably heard about probiotics. These are preparations of good bacteria that we purposely infect ourselves with. They are not only critical for good digestion but if their populations are stable, they will crowd out other bad bacteria.
We need to become more responsible with antiseptics. While it is important to keep surfaces and common use areas clean, the idea that they should be sterile is not necessary as they remain very good environments for bacterial growth. Killing harmless bacteria is only allowing for more space and food for potentially bad bacteria to occupy. Soap and water are sufficient for most purposes, check when you need to use something that promises to kill 99% of germs (which included bacteria).
Accept that the value of an effective antibiotic justifies it being priced at a level that would keep companies developing new ones.
There is also encouraging developments in using viruses to target specific strains of bacteria. Antibiotics tend to work like hand grenades, while bacteriophages, as they are known, are like snipers.
There is more work to be done, and while this will not be the last outbreak, with co-operation between pharmaceutical companies, medical professionals, regulators, farmers, manufacturers and us, we can stay one step ahead of the bacteria that could harm us.
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