Medical professional’s wits against the genes of bacteria
One million people have died from superbug infections since 2014.
The Review on Antimicrobial Resistance in the UK says that superbugs that are resistant to drugs will cause fatal infections and kill one person every three seconds by 2050, according to BBC health news.
According to a report by UK economist, Lord O’Neill, on the 19 May, there will be more people dying from antimicrobial resistance in the future than people dying of cancer.
The reason? Many antibiotics that were used to cure infectious diseases are no longer effective.
The world’s newest threat, antibiotic resistant bugs, with the unaffectionate sobriquet ‘superbugs,’ are getting the better of the medical and pharmaceutical fraternity.
The World Health Organisation (WHO) has already warned that superbugs – resistant to antibiotics is set to become the new epidemic.
The first antibiotic, Penicillin, was discovered by Alexander Fleming in 1928 and more than 100 compounds have been found since, but no new class of antibiotics has been found since 1987.
“Antibiotics, also known as antibacterials, are types of medications that destroy or slow down the growth of bacteria,” says Bonitas Medical Fund.
“Bacteridical antibiotics interfere with the formation of the bacterium’s cell wall and bacteriostatic antibiotics which stops the bacteria from multiplying.”
But bacteria have a will to live. It’s called evolutionary pressure and survival. So, how do they do it? Either by genetic mutation or by acquiring resistance from another bacterium.
Some bacteria are naturally resistant to certain types of antibiotics. They may produce potent enzymes that inactivate the antibiotic while others eliminate the cell target that the antibiotics attack.
They can close their entry ports or like a ruthless bouncer eject the antibiotics with efflux pumps just when it thinks it has slipped through undetected.
They also spread their bad will by ‘conjugation’ transferring genetic material encoded with antibiotic resistance.
Over time they gather resistances and develop multiple resistance traits which is why there is a need for a superdrug.
The resistance appears to be in part self-inflicted. “Misuse of antibiotics is the biggest culprit,” says Bonitas Medical Fund.
“Our natural antibodies will fight the infection in most cases naturally by the bacterium being engulfed by special immune cells called granulocytes.
“But we are impatient and immediately go on to antiobiotics. The ‘hygiene hypothesis’ is becoming more and more evident. If we all got a little grubbier our immune systems would be tougher.
“However one must not under-estimate the need for antibiotics in cases of severe infections such as septicaemia or TB. In those cases we cannot sit and wait for the immune system to kick in.”
Twelve years ago, Nobel Laureate Dr. Joshua Lederberg wrote that “The future of humanity and microbes will likely evolve…as episodes of our wits versus their genes.”
Since writing this it appears medical science has not won in the battle of their wits against the genes of bacteria.
What is needed is ‘out the box thinking’ and an antibiotic that uses a completely different modus operandi to outsmart even the most obdurate bacteria.
The superbugs are here so it’s a case of “medical professional’s wits against those of bacterial DNA.”
Unfortunately the bacteria are winning. It’s hardly surprising when no new classes of antibiotics have been developed for 40 years and bacteria appear to be getting smarter and more savvy.
So why have pharmaceutical companies stopped using their wits to keep up with the bacteria?
Apparently the ‘low hanging fruit has already been picked’ ie the agents easily identified.
The more complex discovery and development is expensive and more time consuming.
It’s also about the bottom line. Antibiotics have a poor return relative to investment.
Why spend millions of dollars on a tablet that is for acute use (short term) therapy when you could be developing for example a blood pressure tablet that needs to be used for the rest of the person’s life?
There is the added red tape and difficulty in getting antibiotic approval from health authorities.
It makes sense but does not address the exponential growth and associated problems of the superbug invasion.
Lord O Neill suggestion to overcome the problem in the UK is to force the pharmaceutical industry to pay or play ie either research and develop new antibiotics or be prepared to fund other companies to do so.
The second is to ban doctors from prescribing antibiotics until they have used a rapid diagnostic test to prove the infection is bacterial.
There does not seem to be an incentive though to develop such a diagnostic test and South Africa is a long way from using such a proactive and developed diagnostic tool.
The other solution is for everyone to stop treating antibiotics like sweets, let your immune system do what it is designed to do.
“Remember taking antibiotics when you have a virus will not help and in some cases do more harm than good. Antibiotics only work on a bacterial infection,” says Bonitas.
“If you take them when they are not needed your risk of developing an infection that is antibiotic resistant is increased.”
It is also absolutely imperative that you finish your course of antibiotics, he says, even if you are feeling better.
“Non-compliance with antibiotics is a major contributor to the development of superbugs.”
Acknowledging the pivotal role antibiotics play in controlling bacterial infections, one must remember they are not the panacea for all infections.
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