AsianScientist (Jul. 12, 2016) – I wrote an editorial a while ago on antibiotic resistance, which indelibly left a dent on my conscience.
Doctors and scientists have described the development of superbugs as the end of the modern antibiotic era. In my head, I picture an Independence Day-esque bacteria hovering over us all and shooting destructive laser beams at us. Maybe that’s preferable?
A few weeks ago, news broke that a drug-resistant strain of bacteria E. coli finally hit American shores. This strain is resistant to colistin, the antibiotics of the ‘last resort’ nature for gram-negative bacteria. Colistin is Plan Z for a type of superbug called Carbapenem-resistant Enterobacteriaceae (CRE), of which some strains have incidentally also become resistant to several antibiotics.
The authors wrote that this event “heralds the emergence of a truly pan-drug resistant bacteria.”
One strain of bacteria that hasn’t gone away since the dawn of human civilization is tuberculosis. According to the Global TB report, although multidrug-resistant tuberculosis (MDR-TB) accounts for only five percent of all global tuberculosis cases, some countries in Eastern Europe and Central Asia have had to deal with serious MDR-TB epidemics.
Some strains of tuberculosis have also become extensively drug resistant (XDR-TB), meaning that they are resistant to isoniazid and rifampin plus fluoroquinolone and at least one of three injectable second-line drugs. On average, it was found that nine percent of all MDR-TB cases were XDR-TB.
Staphylococcus aureus has also developed a resistance to the antibiotic methicillin, which is extremely worrying—especially in a healthcare setting such as a hospital—given that it can cause bloodstream infections, pneumonia and sepsis.
Disconcerting, but inevitable?
Careless use of antibiotics in agriculture and among patients with bacterial infections has led to a phenomenon called natural selection, where the bacteria that survive are the ones with genes that code to exclude or destroy the antibiotic.
Approximately 80 percent of antibiotics sold in the United States are used in animals to promote growth and prevent infections. However, it is slightly unfair to put all the blame on humans for antibiotic misuse and overuse; microbes have had about three billion years of adaptation ‘experience’ compared to humans.
The question that remains is: where do we go from here? Equally important, how did we get to this point?
Looking back some 5,000 years in history, it has been documented that the Egyptians and ancient Chinese managed bacterial infections quite adeptly. In modern times, however, the age of antibiotic as we know it truly began when Sir Alexander Fleming discovered penicillin in 1928. Diseases such as syphilis could be cured with the administration of penicillin. Penicillin also was used aggressively during World War II, which ultimately led to penicillin resistance by the 1950’s.
Since then, most strains of bacteria have developed some form of resistance to antibiotics. However, this spike in antibiotic resistance was mostly negated by new antibiotics founded by pharmaceutical companies throughout the 1980’s. Antibiotic research has waned since then.
The way forward appears to be paved with: 1) increased monitoring of antibiotic resistance, specifically in Francophone Africa and India where data is severely lacking; 2) advocating against the abuse of antibiotics in agriculture and in humans; 3) improved sanitation; and last but not least, 4) further research into bacterial infections. Scientific, economic and regulatory barriers to antibiotic market failure must also be addressed for knowledge to be put into action.
Overcoming antibiotic resistance is akin to how impossible it seemed to kill the alien mothership in the movie Independence Day. However, if all of us rally in the same fashion as Bill Pullman and folks did when it came to taking down the nasty aliens, only then can we even hope to overcome antibiotic resistance. Though it certainly doesn’t help that unlike aliens, bacteria are invisible.
This article is from a monthly column called Our Small World. Click here to see the other articles in this series.
Copyright: Asian Scientist Magazine; Photo: Shutterstock.
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