Are we prescribing our species to death?
Antibiotics are one of the greatest achievements of the human race in the 20th century. The ability to battle infections is deemed responsible for the elongation of human life expectancy by almost two decades. Medicinal practices like organ transplantation, chemotherapy, major surgery, and treatment of newborns would not be possible without the ability to battle bacterial infections effectively.
The undeniable effectiveness of antibiotics along with their safe use has led to overuse that could lead to a number of issues.
The most important one is that bacteria have developed resistance to antibiotics. This resistance is the result of the selection pressure applied by the use of antibiotics, that favors the multiplication of those bacteria that can survive. The antibiotics resistance is enhanced by suboptimal dosages, as is often the case with unprescribed use.
Even in his Nobel Prize acceptance speech, Alexander Fleming underlined the potential danger of antibiotics due to their misuse. The example he used was one that maybe everyone can refer to from his daily life. When an infection is treated with antibiotics, we tend to stop the use of the medicine as soon as the symptoms recede. However, this practice means that we do not kill the whole population of the bacteria, but instead “teach” them how to be resistant to the antibiotic used. This means that a person that stops the administration of antibiotics before the bacteria are eliminated simply becomes an asymptomatic host of an infection that is potentially resistant to treatment with antibiotics.
One important aspect of the antibiotics resistance is that it is not limited to the bacteria population that first developed it, but it can be transferred through a mechanism known as horizontal gene transfer. As a result, a suboptimal dosage as described above can create a new strain of antibiotic-resistant bacteria.
The suboptimal dosage application is not the only mechanism, though. Every application of antibiotics creates this selection pressure that can potentially lead to the creation of antibiotic-resistant bacteria. This means that the use of antibiotics in cases where it is not needed, such as viral infections and self-limiting infections is an aggravating factor for the phenomenon.
But why are antibiotics used in unnecessary cases then? Well, the answer lies to the nature of the for-profit economy. Doctors tend to easily prescribe antibiotics, due to their relative safety for the patient and the fact that they get compensations from pharmaceutical companies for the gross volume of medicine they give to their patients.
Also, the use of antibiotics to animals has been shown to benefit weight gain, especially when the administration starts from an early age. In other words, we continue to spread antibiotics to the environment and create the conditions for them to be rendered useless because it is profitable.
I do not think I can underline this fact enough. We create the conditions for a potential worldwide anthropogenic epidemic because it makes money.
And the fact that this is anthropogenic is undeniable. Two examples can clarify this.
Quinolones are a class of antibiotics that is completely artificial. However, in just thirty years they are being used, there are already strains of bacteria that are resistant to them. Also, the drug-resistant bacteria are encountered around human settlements, while no trace of them was found in research made to polar bears.
So, is there a solution? There could be, but it involves political action, community awareness, research and of course funding.
Political action involves policies for the rational use of antibiotics in hospitals and by the general public. This could include the cease of over-the-counter sales of antibiotics and the stewardship of antibiotics in hospitals. Also, the mitigation of antibiotics use in agriculture is essential, since the larger portion of them is used there.
Community awareness means an informed public about the correct use of antibiotics. For example, it has to be made clear that antibiotics have no effect on infections caused by viruses. Also, the importance of proper hygiene cannot be stressed enough towards the goal of preventing infections in the first place.
Research at the moment has a double goal. The first is to create new classes of antibiotics that can serve as a second-line defense against drug-resistant bacteria. The second is to discover alternate ways of dealing with infections. Some of them include phage therapy and methods to stop plasmid replication or overcome the resistance of bacteria to antibiotics like efflux pump inhibitors. The phage therapy is a method that showed great potential as a limiting factor for infections during the 1920s, especially in the Soviet Union, but was abandoned after the discovery of antibiotics. However, there are two complications with this method. On one hand, it requires extensive research which the pharmaceutical companies do not seem willing to fund since the patenting of this kind of therapy is not easy and the regulatory requirements are challenging. On the other hand, to make matters worse, phage therapy is not suited for potentially life-threatening situations.
We can understand from the above that at this point there is no valid alternative for the use of antibiotics for overcoming infections. So, safeguarding their effectiveness is imperative if we are to avoid a post-antibiotic era. All in all, antibiotics should be considered a common good and not a commodity. Their usefulness is far too great to be regulated in terms of financial profit and loss. The impact that they have had on the improvement of everyday life transcends the sphere of economy or medicine alone. It is a matter of survival.
Concluding, the overuse of antibiotics has brought us in a path where action needs to be taken, or we may come face to face with a post-antibiotic era, with immeasurable consequences for human society.