Temple of Healing

VOLUME 1 , ISSUE 6, NOVEMBER-DECEMBER, 2018

COVER STORY

ANTIBIOTICs - USE THEM JUDICIOUSLY

By Dr. MANASI KORDE, Department of Internal Medicine, SSSIHMS, Prasanthigram

Around 750,000 people die every year due to antibiotic resistance and this figure is expected to grow to 1 crore a year by the year 2050*. Therefore each one of us has a role to play in this fight against antibiotic resistance.

But let us first understand what are antibiotics and how they act and the concept of antibiotic resistance.

The History

It wasn’t until the late 19th century that scientists began to observe antibacterial chemicals in action. Paul Ehrlich, a German physician, noted that certain chemical dyes coloured some bacterial cells but not others. The word 'antibiotics' was first used over 30 years later by the Ukrainian-American inventor and microbiologist Selman Waksman, who in his lifetime discovered over 20 antibiotics. Alexander Fleming was, it seems, a bit disorderly in his work and accidentally discovered penicillin. Upon returning from a holiday in Suffolk in 1928, he noticed that a fungus, Penicillium notatum, had contaminated a culture plate of Staphylococcus bacteria he had accidentally left uncovered. The fungus had created bacteria-free zones wherever it grew on the plate. Fleming isolated and grew the mould in pure culture. He found that P. notatum proved extremely effective even at very low concentrations, preventing Staphylococcus growth even when diluted 800 times, and was less toxic than the disinfectants used at the time.

Following a fire in Boston, Massachusetts, USA, in which nearly 500 people died, many survivors received skin grafts which were liable to infection by Staphylococcus. Treatment with penicillin was hugely successful, and the US government began supporting the mass production of the drug. By the end of World War II, penicillin was nicknamed 'the wonder drug' and had saved many, many lives.



Image source: National Institute of Allergy and Infectious Diseases. https://www.niaid.nih.gov/ . Modified to show the action of antibiotics.

How do antibiotics act

Any substance that inhibits the growth and replication of a bacterium or kills it outright could be called an antibiotic. Antibiotics are a type of antimicrobial designed to target bacterial infections within (or on) the body. This makes antibiotics subtly different from the other main kinds of antimicrobials widely used today:

  • “Antiseptics” are used to sterilise surfaces of living tissue when the risk of infection is high, such as during surgery.
  • “Disinfectants” are non-selective antimicrobials, killing a wide range of micro-organisms including bacteria. They are used on non-living surfaces, for example in hospitals.

There are two main ways in which antibiotics target bacteria. They either prevent the reproduction of bacteria, or they kill the bacteria, for example by stopping the mechanism responsible for building their cell walls.

Of course, bacteria are not the only microbes that can be harmful to us. Fungi and viruses can also be a danger to humans, and they are targeted by antifungals and antivirals, respectively. Only substances that target bacteria are called antibiotics. Thus we need not use antibiotics in all types of fever. It can be decided by undergoing some investigations like complete blood counts to confirm the type of infection.

Most antibiotics used today are produced in laboratories, but they are often based on compounds scientists have found in nature. Some microbes, for example, produce substances specifically to kill other nearby bacteria in order to gain an advantage when competing for food, water or other limited resources. However, some microbes only produce antibiotics in the laboratory.

Antibiotics may be recommended for people who are more vulnerable to the harmful effects of infection. Antibiotics are sometimes given as a precaution to prevent, rather than treat, an infection. This is known as antibiotic prophylaxis.

Antibiotic prophylaxis is normally recommended if you're having surgery on a certain part of the body which carries a high risk of infection or where infection could lead to devastating effects.There are several medical conditions that make people particularly vulnerable to infection, making antibiotic prophylaxis necessary. For example, the spleen plays an important role in filtering out harmful bacteria from the blood. People who have had their spleen removed, people having chemotherapy for cancer, or those with the blood disorder sickle cell anaemia, where their spleen doesn't work properly, should take antibiotics to prevent infection. In some cases, antibiotic prophylaxis is prescribed for people who experience a recurring infection that's causing distress or an increased risk of complications.

Antibiotic Resistance

Antibiotic resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow. Infections caused by antibiotic-resistant germs are difficult, and sometimes impossible to cure. In most cases, antibiotic-resistant infections require extended hospital stays, additional follow-up doctor visits, and costly and toxic alternatives. Some bacteria are naturally resistant to certain types of antibiotics. However, bacteria may also become resistant in two ways: 1) by a genetic mutation or 2) by acquiring resistance from another bacterium.

Antibiotic resistance does not mean the body is becoming resistant to antibiotics; it is that bacteria have become resistant to the antibiotics designed to kill them. Antibiotic resistance has the potential to affect people at any stage of life, as well as the healthcare, veterinary, and agriculture industries, making it one of the world’s most urgent public health problems. Genetically, antibiotic resistance spreads through bacteria populations both "vertically," when new generations inherit antibiotic resistance genes, and "horizontally," when bacteria share or exchange sections of genetic material they also transfer resistance to other bacteria. Horizontal gene transfer can even occur between different bacterial species. Environmentally, antibiotic resistance spreads as bacteria themselves move from place to place; bacteria can travel via airplane, water and wind. People can pass the resistant bacteria to others; for example, by coughing or contact with unwashed hands. No one can completely avoid the risk of resistant infections, but some people are at greater risk than others (for example, people with chronic illnesses). If antibiotics lose their effectiveness, then we lose the ability to treat infections and control public health threats.

Indian Government on its national health portal mentions the following guidelines for wise use of antibiotics**:

  • Before taking any antibiotic ask your physician if it is required and beneficial
  • Always take antibiotics as prescribed by the physician
  • Take antibiotics to treat only bacterial infections
  • Do not take antibiotics in viral infections such as cold, cough, or flu
  • Do not repeat the same antibiotic for the next time you get sick
  • Do not stop antibiotic before complete prescribed course of treatment
  • Do not skip doses
  • Do not copy the antibiotic with the same diseases, which is prescribed for someone else.
  • Educate yourself and talk to your physician about antibiotic resistance

Many medical advances are dependent on the ability to fight infections using antibiotics, including joint replacements, organ transplants, cancer therapy, and treatment of chronic diseases like diabetes, asthma, and rheumatoid arthritis.

To Conclude

Antibiotics have proven to be an important means of fighting microbial infections and have saved countless lives over the last century. However, they should be used judiciously, scientifically and only when necessary. Irrational use of antibiotics can give rise to dangerous antibiotic-resistant microbial species and leave the patients defenceless against life threatening infections.