Antibiotics have become a daily part of our lives. According to the World Health Organization “Antibiotic resistance is one of the biggest threats to global health, food security, and development today”. Antibiotics have clearly become a double-edged sword and there is now a great need to raise awareness on the beneficial roles of bacteria and highlight alternative strategies to fight back against antibiotic resistance.
The double-edged sword of antibiotics
Antibiotics are a class of drugs that kill or inhibit the growth of bacteria, and bacteria alone. Like many great scientific discoveries, antibiotics too, were discovered by accident. In 1928, it was first postulated by Sir Alexander Fleming, that penicillin – a molecule found in the spore of penicillin fungi – could have antimicrobial properties, and since then, hundreds of antibiotics have been developed for a broad array of bacterial infections. At the time, it seemed like nothing could go wrong, it was a gateway to our happily ever after. But the fact is, we have been rapidly returning to an old nightmare we wish we never had. There is not just one culprit for this but instead a melting pot of reasons why we are in this turmoil called “antibiotic resistance”. Antibiotic resistance, simply put, is the result of bacteria no longer being susceptible to antibiotic drugs. For instance, let us imagine pathogenic bacteria as tiny houses with a specific lock to the front door. For each lock, you need a specific key to fit the key hole. Antibiotics can be seen as the key. If the correct antibiotic is used, it can fit in the lock and open the doors to allow bacterial killing. However, if a bacterium undergoes one or more mutations, it can change the type of lock and will prevent the antibiotic from doing its job. As this bacterium has survived the wrath of the antibiotic, it paves the way for replication and long-term survival. Moreover, this bacterium can be very generous and share the same lock with its neighboring bacteria. Ultimately, this feature spreads until the majority of bacteria have this altered lock where none of the keys can fit, and as a result these bacteria are protected from antibiotics and can continue to infect the host.
Unfortunately, over the years, professionals in the field have failed to properly educate people on correct antibiotic prescription, production and disposal, which have all played a part in the rise of antibiotic resistance. Scientists and researchers have understood the mechanisms and dangers of antibiotic misuse and continue to find alternative solutions, but are unable to communicate with a language that the general public can understand as a whole. As early as 1945, Fleming warned:
“There may be a danger, though, in underdosage. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
In other words, if you take antibiotics and start to feel better, do not stop taking the antibiotics until the full course is complete, because inefficient killing will allow the survivors to gain resistance.
To this day, despite several awareness programs endorsed by the World Health Organization, research institutes and health care officials alike, a large portion of the population is still under the impression that antibiotics are effective against any kind of infection including the common cold. This is not caused by bacteria, but rather viruses. To add fuel to the fire, apart from the unhealthy sanitation standards, doctors in less-developed countries frequently prescribe antibiotics to patients who have the flu because a culture exists that idealizes antibiotics as the solution to all problems. This is partly due to inadequate awareness, but also a declining healthcare system that cannot afford to prescribe costly medication to patients. Moreover, the food industry and animal waste handling in farms across the world has led to the rapid spread of antibiotic resistant bacteria.
Bacteria are essential for us
The root problem lies within a culture that does not fully understand the diverse roles bacteria play in our daily lives, and the health benefits they provide. Despite the notion that all bacteria are bad and make you sick, it has repeatedly been shown that this is not exactly true. Not only do we have more bacterial cells living within us than our own body cells, but researchers are continuously making new discoveries shedding light on the importance of the human microbiome. For instance, a clear trend can be seen with the number of probiotic supplements which are ever increasing in the fridge aisles in your local supermarkets as they have been proven to support a healthy immune system. Additionally, medical practitioners have started using fecal transplantations containing commensal bacteria from healthy patients as an alternative bacteriotherapy to treat problematic bacterial infections.
Fight Fire with Fire
With the increasing emergence of MRSA (methicillin-resistant Staphylococcus aureus), a superbug that is currently plaguing hospitals across the world, it is clear that we are the hosts of pathogenic and deadly bacteria. However, bacteria can also be the hosts of viruses called endolysins. As antibiotic resistance rages on, many researchers across the globe are looking to find another solution. What makes endolysins a possible future therapy is that they act in a very specific manner, i.e. specific endolysins are only able to kill specific bacteria, rather than killing a range of commensal and pathogenic microflora, as is the case with antibiotics (1). Although it is in the early stages, another promising approach to fight antibiotic resistance bacteria has been the recent discovery of Bdellovibrio bacteria, which can devour other pathogenic bacteria. Much research and clinical testing is required before we can use either of the two described treatments, but one thing is for sure, if we are able to raise awareness, change our habits and look outside the box for alternative treatments, we might just stand a chance against antibiotic resistance.
1. Schmelcher M. et al., “Bacteriophage endolysins as novel antimicrobials”. Future microbiology, 2012
Received: 26.9.18, Ready: 12.10.18, Editors: ST, RG.