Antibiotics and bacteria, or the arms race

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Life around us is invisible to the naked eye. We are surrounded by a huge universe of microscopic microbes. Bacteria, because we are talking about them mainly, inhabit almost every corner of the world, as well as our bodies.

For most of them, we humans are indifferent, we cannot do without others, because their presence around us and in us ensures mutual benefits from such intercourse, for example, it helps to digest food or increases resistance to infections. When it comes to infections, we must not forget about the group of bacteria and viruses, which are not only not beneficial for humans, are not even indifferent to health, on the contrary, are an enemy that is waiting for gaps in our immune system to launch a storm. .

Discovery of penicillin

Infectious diseases of all kinds have been a fear to mankind throughout the ages. Great epidemics decimated populations, thinned human clusters, were a scourge and a bane. It seemed that there was no rescue and one had to come to terms with fate and live in the shadow of death. It is only at the turn of the 1928th and 1881th centuries, when microbiology flourishes, that humanity realizes the nature of the danger – bacteria are discovered, the perpetrators of infections, and then viruses smaller than them. It took a while longer for the world to see a light in the tunnel in 1955 – Alexander Fleming (1945-XNUMX) discovers the first antibiotic, penicillin, for which (along with Howard Florey and Ernst Chain) he is awarded the XNUMX Nobel Prize.

Penicillin was a godsend, it became a golden weapon in the fight against bacteria. With its help, doctors fought diseases caused by bacterial infections, which previously were often fatal, and were certainly difficult to cure in any other way. After penicillin, it was the turn of other antibiotics, the arsenal of which grew larger over time. Mankind triumphed and announced the end of the disease associated with infections caused by bacteria. Antibiotics have built a solid barrier that separates humans from suffering and death previously caused by these microorganisms. Medicine and science in general, triumphed, Man could breathe a sigh of relief – he had a great protection and a guarantee of an advantage over pathogenic bacteria.

Bacterial resistance to antibiotics

Today, antibiotics are standard in our lives. Who of us did not use antibiotics, who did not use them in the case of minor infections, as a cover during surgical procedures, who did not ask his doctor to prescribe this miracle drug because of a cold or flu that bother us? How about all the bacteria, pushed to the corner of the ring, the former winners and oppressors? Are you sure you have finally defeated your old enemies?

The arsenal of antibiotics is substantial, we know several dozen of their varieties, but new varieties have not been discovered for many years. Perhaps we have rested on our laurels, or perhaps we have exhausted the deposit of these miraculous substances. Either way, what we have at our disposal has provided salutary peace and a sense of security for decades. However, for at least a dozen or so years, there has been more and more disturbing information that there are strains of bacteria against which the antibiotics used so far have not been successfully treated. Unfortunately, this alarmist news is confirmed by scientific authorities and raises the old, now forgotten fear of contamination with their sinister consequences. What’s happening? Are we really in danger of going back to the past?

Misuse of antibiotics

Delighted with the possibilities offered by antibiotic therapy, we reach for these substances without need and without moderation. We use them in the case of trivial ailments, such as the common cold. We demand a prescription for an antibiotic from the doctor because we have flu (otherwise it should not be underestimated) and, in our opinion, its use will certainly speed up recovery. We take antibiotic tablets on our own for two or three days until we feel better, not even sure if the drug is needed and without paying attention to the dosing schedule. In some Asian countries, antibiotics are available over the counter. We overuse antibiotics on a larger scale by adding them to the feed of farm animals (as stimulants to increase muscle mass), as plant protection products or as preservatives.

Bacteria, although simple in structure, even primitive in comparison with the human body, and certainly devoid of even residual intelligence, can nevertheless escape from the “antibiotic trap” set by humanity. In fact, they’re not that clever, but we humans are without sense. The overuse and misuse of antibiotics allows bacteria to develop resistance against them (not to be confused with resistance, a term that is reserved for other phenomena). By their nature, bacteria are very flexible, thanks to this feature they were able to adapt to almost any living conditions and inhabit the entire Earth, even extreme due to the living conditions of the place. So why not microbes learn to live in the presence of the antibiotics we use over and over again?

The mechanism is painfully simple: if bacteria are exposed to an antibiotic that is too low, or too briefly, or the wrong antibiotic, those that were most sensitive to it, but survive the more resistant, will die. The resistant ones will multiply quickly and the next time the use of the same antibiotic at the same dose will be ineffective. And it was enough to simply use a higher dose of the drug (or a properly selected drug) and administer it for a longer time, so as to eliminate all bacterial cells responsible for the infection, or to give up the use of an antibiotic altogether and resort to other methods of treatment if the infection was not serious .

The situation is getting really dangerous. It is already known that there are such strains of bacteria that, horror of horror, are resistant to all antibiotics known to mankind. The spread of such bacteria around the world will mark a return to a bleak past when we were defenseless against contamination. Diseases such as tuberculosis or surgical wound infections become incurable and deadly again, as was the case before the penicillin era.

Antibiotics for bacterial infections

We must try to use rationally and wisely the arsenal of antibiotics at our disposal so as not to cause the emergence of antibiotic-resistant strains. Our biggest mistake is on the one hand overusing antibiotics and on the other hand using them the wrong way. The more often we use antibiotics, the more opportunities the bacteria have to acquire resistance to them. Therefore, it is extremely important to try to limit their use when there is no such need. Attempts to treat viral infections with antibiotics are lame. Ailments such as colds or flu are viral and viruses are not affected by antibiotics !!! In the event that the doctor determines a viral infection, the patient should be properly treated, and the antibiotic should be used only in the case of complications caused by bacterial superinfection, if the patient’s condition requires it. Flu or cold symptoms are specific and each doctor can distinguish between viral and bacterial infections. If the doctor has doubts or if he suspects a bacterial infection that requires the administration of an antibiotic, he should order a microbiological test to determine the species of bacteria causing the infection and to select a specific, effective antibiotic, i.e. an antibiotic preparation. Such microbiological tests are the only guarantee that the doctor will prescribe the right antibacterial drug, which, when properly dosed, will eliminate pathogenic bacteria and prevent the emergence of strains resistant to this antibiotic, and the patient will quickly recover. Microbiological tests are definitely too rarely used, and doctors, unfortunately, too often prescribe antibiotics “in the blind”, on the principle: if this does not help, then maybe another one will help, and so on. This is a shameful procedure and contributes to the emergence of resistant bacteria.

It is not always necessary to refer the patient to the microbiology laboratory for a swab. Patients complaining of a sore throat very often appear in the offices of family doctors or general practitioners. It is often the popular throat angina. However, if it is really angina, it is definitely caused by Streptococcus pyogenes – in this case the doctor should prescribe a specific antibiotic. However, to find out if streptococcus is in your throat, you can get a quick in-office test that will give you a response in minutes, without the need for a complete microbiological test. Such tests are available on the market, but unfortunately doctors do not want to perform them because of the additional costs. For the same reasons, they often avoid referring patients to microbiological testing. Let us also not forget about another, perhaps less important, issue; any use of an antibiotic has a negative effect on the bacteria that naturally inhabit our body and are an integral part of it, like bacteria in the digestive tract. The antibiotic destroys these bacteria and causes a feeling of indigestion at best, at worst it allows pathogenic bacteria to enter the gastrointestinal tract, which do not find natural competition in the already killed “good” bacteria.

All our omissions lead to a sad end, that is, to the return of pathogenic bacteria on a large scale, when we will again be defenseless against them. Remember, antibiotics are not candies, let’s use them wisely.

The National Antibiotic Protection Program (http://www.antybiotyki.edu.pl/program_podstawy.php) has been implemented in Poland for some time, the aim of which is to prevent the development of bacterial resistance to antibiotics.

Text: Tomasz Gosiewski, MD, PhD

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