Miracle Drug Paradox

Since the discovery of penicillin in 1929, fatal bacterial infections were not recurrent as they once were. Subsequent discovery and production optimization of penicillin had a positive effect on World War II, by reducing the number of casualties resulting from infected wounds. Particularly, the drug was used to alleviate medical complications arising from bacterial infections in the interim period prior to surgery. Beyond this, the expansion of antibiotics and their usage has aided in infection control and limiting the number of human deaths . Therefore, penicillin and other antibiotics were named as “miracle drugs” based on their potent ability to cure diseases which were previously fatal.

Evidently, the use of antibiotics has been enormously useful, upon correct prescription and rational use. The modes of action for these drugs are diverse; they are able to inhibit imperative biological functions such as protein synthesis, DNA replication, cell wall synthesis and metabolism. Presently, the miraculous drug category of antibiotics have lost their potency arguably, due to the misuse of humans coupled with the genetic adaptability of bacteria. Paradoxically, these miracle drugs have created superbugs (Bacterial strains with multi-drug resistance) which were tamed easily in the past. The seemingly increasing antibiotic resistance of bacterial strains is being considered as a massive medical and economic burden.

Why should we care about antibiotic resistance?

Antibiotic resistance has an omnipotent effect on many things which means that measures should be taken to address this issue.

Antibiotic resistance,

  • Increases healthcare costs while threatening healthcare gains within a society.
  • Hinders the control of infectious diseases.
  • Result in increased casualties.
  • Directly threatens health security which can impair the global economy and trade

Antibiotic Resistant Bacteria

Accodring to the Centre for Diseases Control and Prevention (CDC), there are imminent threats as well as threats which should be taken in to serious consideration as a result of antibiotic resistance. The table below was formulated according to given data by the CDC along with a several other sources.

This article will now discuss some of the key issues which has influenced antibiotic resistance.

Declining Antibiotic Development

An important contributor for superbugs and associated antibiotic resistance is the discovery void of novel antibiotics.

The above schematic adequately depicts the diminishing rate of novel antibiotic approvals by the Food and Drug administration. This also means that the ones which have already been approved are being used to continuously for a long period of time.

“It is time to close the book on infectious diseases and declare the war against pestilence won” – William Stewart, (1960)

The past there decades have evidently demonstrated how inaccurate the above statement is. Now it is said that the golden era of antibiotics has come to an end.

Disconnection between medical need and market needs – Money matters

Physicians practicing infectious diseases medicine demonstrate an increasing need for novel antibiotics, yet the R&D biotech companies tend to be reluctant on attending such needs. Among many reasons, the very nature of antibiotics and its limited capacity to provide profitability have made biotech companies to be reluctant on making efforts on R&D. (Antibiotics are typically efficient and show results rapidly, an antibiotic course is short lived in comparison to an anti-cancer drug course). The discussed phenomenon is also influenced by the lengthy and risky process of novel antibiotic production, clinical trials and FDA approval.

Misuse of antibiotics – Human use

Human misuse of antibiotics accelerates and favors the selection and emergence of resistant bacterial strains.

  • Inappropriate prescription by healthcare providers. (At the request of patients, use of incomplete and imperfect diagnosis as guidelines for prescription etc.)
  • Use of antibiotics for viral infections such as colds and flues.
  • Extensive use in critical care health patients in hospitals which favors nosocomial resistant strain spread over time.

Misuse of antibiotics – Agricultural applications

Supply demands in poultry and agricultural industries mandates the need for intensive breading of farm animals in larger quantities. To avert deaths resulting from infections and subsequent spreading, farmers have customed a habit of using large quantities of antibiotics. The repercussions of this act is the generation of resistant bacterial strains through selection. Antibiotic resistance via human intervention proceeds and behaves as a cycle.

Agricultural use of antibiotics and the emergence and dissemination of resistant bacterial strains.

Bacteria – High adaptability, advantages genetic factors

In the presence of antibiotics, bacteria are challenged to a point where they are killed or even to survive in harsh conditions. The bacterial strains which survive tend to possess a genetic advantage of having resistant genes. In such instances, the survivors replicate giving a stronger offspring. Given the fact that bacteria reproduce often (few hours), they evolve and adapt quickly to the new conditions. During reproduction, genetic mutations by chance occur , while some of which proves to be beneficial to the organism. Additionally, bacterial cells are able to transfer genetic material by others means between distant relatives (horizontal gene transfer).

Antibiotic Resistance Cycle


A graphical representation of antibiotic resistance phenomenon and its progressive stages which contributes to the cycle. (Source – drugdevelopment-technology)

Strategies

Alternative therapy for infectious diseases

Research and development of alternative drugs and compounds to treat infections has been a point of focus due the increasing antibiotic resistance. Therapies as such include bacteriophage and associated product application. Bacteriophages are viruses which specifically target and attack bacteria. This strategy has a similar effect as antibiotics due to its propensity to generate phage-resistant bacterial strains after prolonged use of bacteriophages. Due to improvement and advancement of life science techniques such as genome sequencing, scientists have already began to study individual bacterial genes in order to search for information which may provide clues for therapeutic formulation. Studies as such have revealed and encouraged scientists to device new therapeutics such asAdhesion inhibitors which impairs the ability of bacterial cells to interact and attach to specific host cells in order to replicate and mount an infection.

Nanoparticles have also received attention at this post antibiotic era wherein diagnosis, treatment and prevention has been taken to another level. Durable and eco-friendly Nano-coating materials have already been proven to act againstClostridium difficile and other resistant bacterial strains.

Rational use of antibiotics

Antibiotics users can minimize the chances for resistance by not sharing given antibiotics and using antibiotics upon prescription by a certified professional

Healthcare providers and workers can minimize resistance by prescribing antibiotics when they are truly needed while ensuring the correct antibiotic is given according to illness.

Everyone can contribute by using antibiotics responsibly while promoting good hygiene and infection prevention.

As seen from the above facts and evidence, antibiotic resistant bacterial species are a serious threat to public health and economy. As humans, we are responsible for the paradoxical effect of the miracle drugs which resulted in resistant strains. Due to the stagnation of novel antibiotic development and increasing difficulty to treat drug resistant bacterial infections, healthcare workers, consumers and stakeholders are required to coordinate in order to find a plausible solution for this serious issue.

Please share your thoughts!

Raveen Rathnasinghe (R.Rathnasinghe@gmail.com)

Work Cited,

  • Cdc.gov, (2014). CDC – Carbapenem-resistant Enterobacteriaceae – HAI. [online] Available at: http://www.cdc.gov/hai/organisms/cre/ [Accessed 16 Sep. 2014].
  • Centre for Diseases Control adn Prevention (CDC), (2013). ANTIBIOTIC RESISTANCE THREATS in the United States, 2013. CDC.
  • Charpentier, E. and Tuomanen, E. (2000). Mechanisms of antibiotic resistance and tolerance in Streptococcus pneumoniae. Microbes and Infection, [online] 2(15), pp.1855-1864. Available at: http://dx.doi.org/10.1016/s1286-4579(00)01345-9 [Accessed 16 Sep. 2014].
  • Food and Drug Administration, (2004). Bad Bugs, No Drugs. Alexandria: Infectious Diseases Society of America.
  • Herbarium.usu.edu, (2014). Penicillin: the first miracle drug. [online] Available at: http://herbarium.usu.edu/fungi/funfacts/penicillin.htm [Accessed 16 Sep. 2014].
  • Jagusztyn-Krynicka, E. and Wyszynska, A. (2008). The decline of antibiotic era-new approaches for antibacterial drug discovery. Pol J Microbiol, 57(2), pp.91–98.
  • Khachatourians, G. (1998). Agricultural use of antibiotics and the evolution and transfer of antibiotic-resistant bacteria. Canadian Medical Association Journal, 159(9), pp.1129–1136.
  • Lifesciencesfoundation.org, (2014). War Against the Microbes. [online] Available at: http://lifesciencesfoundation.org/magazine-war_against_the_microbes.html [Accessed 16 Sep. 2014].
  • Niaid.nih.gov, (2014). Causes, Antimicrobial (Drug) Resistance. [online] Available at: http://www.niaid.nih.gov/topics/antimicrobialresistance/understanding/pages/causes.aspx [Accessed 16 Sep. 2014].

Pechere, J. (2001). Patients’ interviews and misuse of antibiotics. Clinical Infectious Diseases, 33(Supplement 3), pp.170–173.

Pharmaceuticals, S. (2014). The Threat is Real. [online] Battlingsuperbugs.com. Available at: http://www.battlingsuperbugs.com/the-threat-is-real.html [Accessed 16 Sep. 2014].

Polly, S. (1993). The Antibiotic Paradox: How Miracle Drugs Are Destroying the Miracle. JAMA, 270(3), pp.384–385.

Prescott, J. (1997). Antibiotics: miracle drugs or pig food?. The Canadian Veterinary Journal, 38(12), p.763.

Spellberg, B., Guidos, R., Gilbert, D., Bradley, J., Boucher, H., Scheld, W., Bartlett, J., Edwards, J. and others, (2008). The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clinical Infectious Diseases, 46(2), pp.155–164.

Spellberg, B., Guidos, R., Gilbert, D., Bradley, J., Boucher, H., Scheld, W., Bartlett, J., Edwards, J. and others, (2008). The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clinical Infectious Diseases, 46(2), pp.155–164.

superbugs, N. (2013). Nanotechnology solutions to combat superbugs. [online] Nanowerk.com. Available at: http://www.nanowerk.com/spotlight/spotid=32188.php [Accessed 16 Sep. 2014].

Wiley.com, (2014). Essential Biochemistry. [online] Available at: http://www.wiley.com/college/pratt/0471393878/instructor/activities/bacterial_drug_resistance/index.html [Accessed 16 Sep. 2014].