Tag Archives: Antiobiotics

WHEN BACTERIA DECIDE TO FIGHT BACK

By Edidiong Michael

UDOFA, 300Level, Faculty of pharmacy

Before the dreaded effects of global warming or the apocalypse, lays a more life threatening doom- ANTIBIOTIC RESISTANCE. This means that in anticipation of effects that would befall mankind when the ozone layer finally gives way, a whole lot of humans would suffer and eventually die from diseases as insignificant as boils , urinary tract infections or even sore throat.

Alexander Fleming in his Nobel Prize acceptance speech in 1945 said:

“The time will come when penicillin can be bought by anyone in the shop. Then there is the danger that the ignorant man may easily underdose himself and by exposing these microbes to nonlethal quantities of the drug, make them resistant.” As predicted 71 years ago by the man who first discovered antibiotics, drug resistance is upon us.

What is antibiotic resistance?

Antibiotic resistance, simply put, is the effect seen when bacteria decide to fight all medical efforts to terminate them. It is the ability of microorganisms to withstand the effect of antibiotics.                                   

The first global report on antibiotic resistance by the World Health Organization (WHO) shows alarming resistant levels of bacteria like pneumonia, diarrhea, urinary tract infection, gonorrhea and sepsis to drug treatment in 114 countries with some areas already out of treatment options for common infections.

KEY FACTS:

    • Antimicrobial resistance threatens the effective prevention of treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.
    • A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).
    • Treatment failures due to resistance to treatment of last resort for gonorrhea have been reported in 10 countries.
    • Resistance to one of the most widely used antibacterial drug for the treatment of urinary tract infection- fluoroquinolone- is very widespread.

How did the world let it get this far?

A new study suggests that antibiotic resistant bacteria may be tougher superbugs than previously thought: not only are they harder to treat, they appear ‘fitter’ in general by causing more deadly infections.

With respect to Mother Nature, antibiotic resistance arises as a result of environmental pressure. It is a consequence of evolution via natural selection. Hence the bacteria which have a mutation and survive long enough to reproduce, pass on these traits to their offspring which become a fully resistant generation. Nature being only but a secondary factor here can only achieve this with the immense help from humans.

Primarily, humans pave way for the secondary factor to kick in through:

  • Over dependence on antibiotics for modern medical benefits
  • Overuse of broad spectrum of antibiotics like the use of 2nd and 3rd generation cephalosporins
  • Incorrect diagnosis and unnecessary prescriptions; 50% of the time, antibiotics are prescribed when they are not needed like in the use of antibiotics in the treatment of viral diseases like cold and flu.
  • Improper use/abuse of antibiotics by patients through self-medication, non-compliance to dosage regimen (underdose and overdose).
  • The use of antibiotics as livestock food additives to promote growth.

When these human factors are sufficiently supplied, bacteria mutate and eventually become resistant to medical efforts in terminating them. The gravity of the situation might not be fully understood or taken as serious as required until we realize that if more bacteria become resistant, in no distant time from now:

  • Urinary tract infections might become more deadly than cancer.
  • Gonorrhea may soon become untreatable.
  • The biblical Egyptian boils might eventually become an untreatable world plague.
  • Sore throat and diarrhea will become more life incapacitating than paralysis.

Should we be scared and how can we overcome this?

Not yet. The ‘discovery’ does not mean that an otherwise healthy person with a urinary tract infection is in danger of dying from it, but the gene is mobile and can be picked up by other bugs and this can make them more resistant and untreatable. I would also say, just like the trending Nigerian epp (help) mantra; who fear don epp?

Although there is the need to be cautious and sagacious while handling antibiotics, there is no reason to fear. Newer improved drugs are being developed to fight bacteria which are resistant to the existing drugs. Still, the abuse of these newer drugs would land us in a much bigger mess and this implies the continuous loading of our bodies with stronger drugs that would overtime make the bacteria fitter. It is however, now left to us to tackle antibiotic resistance by

  • Consulting a drug expert- a pharmacist- before proceeding with any medication.
  • Taking antibiotics only when prescribed by a certified health professional.
  • Complying with prescriptions; completing the full prescription.
  • Not saving antibiotics for next illness: leftover medication should be returned to the pharmacy.
  • Practicing safer and more hygienic lifestyles to prevent bacterial infections: washing hands, cleaning our environment and employing vaccines where appropriate.
  • As healthcare professionals, only prescribe antibiotics after proper investigation of symptoms.

We are running out of time, let us join hands to tackle and win this fight against bacteria.

edisuzzy@gmail.com

ANTIBIOTIC DEVELOPMENT AND GLOBAL INTERVENTION IN COMBATING THE EMERGENCE OF ANTIBIOTIC RESISTANCE

By Adeyemi Sylvester

INTRODUCTION

Antibiotics were the wonder drugs of the 20th century because of their  ability to kill and inhibit bacterial growth. In the pre-antibiotic era, the treatment of infectious diseases in human and animals was almost impossible. Besides the use of herbal medicines, there was no way out of the death sentence. That was until 1928, which  marked the beginning of  the antibiotic era when Sir Alexander Fleming discovered penicillin from the mold penicillium. After this breakthrough in medicine, came the emergence of antibiotics.

Resistance to antibiotics could either be natural due to inherent characteristics or acquired when  bacteria undergo evolutionary changes that transform their cells. These changes that lead to bacterial resistance to antibiotics are caused by both bacterial and human factors.

CAUSES OF ANTIBIOTIC RESISTANCE

Primary causes of antibiotic resistance include wrong dosage, inappropriate prescription, inaccurate regimen, mechanical ventilation, multiple underlying diseases, poor hand hygiene.

In animals, antibiotics are used at subtherapeutic doses to promote growth. At subtherapeutic doses, bacterial population develops resistant strains. In research studies resistant bacteria can be transmitted from animals to humans in three ways: by consuming animal products (milk, etc.) from close or direct contact with animals or other humans, or through the environment. In the first pathway, food preservation methods can help eliminate, decrease, or prevent the growth of bacteria in some food classes.

ROLE OF PHARMA SECTOR IN ANTIBIOTIC DEVELOPMENT

The pharma sector undoubtedly plays a vital role in developing newer medicines as resistance emerge. Since 1945, newer antibiotic were being discovered to compete with the evolving bacterial population. According to an article published in the journal Clinical Infectious Diseases in January 2009, only 5 of the biggest pharma companies –GlaxoSmithKline, Novartis, AstraZeneca, Merck and Pfizer still had antibacterial discovery programmes in 2008. This is because of the commercial impact it has on the companies. The return on investment is poor and treatment of bacterial infection is usually short course regimen so patronage begins to reduce as soon as the infection is cured. That’s why companies have stopped developing antibiotics.

However, the launch of every antibiotic has been and will be followed by resistance in the targeted bacteria. Therefore, there is a constant need to develop new agents to keep up with the acquisition of resistance among pathogenic bacteria.

As a way to encourage drug-development, private-public partnership should be embraced to curtail financial burden of obtaining newer antibiotics.

sylvester-blog

GLOBAL ACTION PLAN AGAINST ANTIBIOTIC RESISTANCE

There have been increasing public calls for global collective action to address the threat. In 2014 WHO released preventive strategies to tackle resistance

The public can help tackle resistance by:

  • Using antibiotics only when prescribed by a health professional
  • Completing the full prescription, even if they feel better
  • Never sharing antibiotics with others or using leftover prescriptions

Health workers, including pharmacists, can help tackle the resistance issues by:

  • Enhancing infection prevention and control
  • Only prescribing and dispensing antibiotics when they are truly needed
  • Prescribing and dispensing the right antibiotic(s) to treat the illness

Policymakers and industries can help tackle the resistance by:

  • Strengthening resistance tracking and laboratory capacity
  • Regulating and promoting appropriate use of medicines
  • Fostering innovation and research and development of new tools
  • Promoting cooperation and information sharing among all stakeholders

On March 27, 2015, the White House released a comprehensive plan to address the increasing need for agencies to combat the rise of antibiotic-resistant bacteria.

The Action Plan was developed around five goals with focus on strengthening health care, public health, veterinary medicine, agriculture, food safety and research, and manufacturing. These goals, as listed by the White House, are as follows:

  • Slow down the emergence of resistant bacteria and prevent the spread of resistant infections
  • Strengthen national One-Health surveillance efforts to combat resistance
  • Advanced development and use of rapid and innovative diagnostic tests for the identification and characterization of resistant bacteria
  • Accelerate basic and applied research and development for new antibiotics, other therapeutics, and vaccines
  • Improve international collaboration and capacities for antibiotic resistance prevention, surveillance, control and antibiotic research and development

The following are goals set to meet by 2020.

In 2015, WHO started the World Antibiotic Awareness week from 16–22 November to improve global awareness, promote rational use, and prevent further instances of resistance.

On 22nd September 2016, at the UN Meeting, collaboration between approximately 70 heads of state and ministers of health and foreign affairs demonstrated overwhelming political support to combat AMR. After the meeting, UN  decided to focus on rectifying the startling level of under-investment in AMR-related research; and a major new commitment by 13 of the world’s largest pharmaceutical companies, including giants of the generics industry, to take concrete actions to reduce the development and spread of drug resistance.

Mr. Sylvester a recent pharmacy graduate of Igbinedion University Okada, Nigeria.

adeyemisylvester1@gmail.com

REFERENCES

  1.  Pechère JC (September 2001). “Patients’ interviews and misuse of antibiotics”. Clin. Infect. Dis. 33 Suppl 3: S170–3. 
  2.  Arnold SR, Straus SE (2005). Arnold SR, ed. “Interventions to improve antibiotic prescribing practices in ambulatory care”. Cochrane Database of Systematic Reviews (4): CD003539. 
  3.  Antibiotic Resistance – Linking Human And Animal Health: Improving Food Safety Through a One Health Approach Workshop Summary. Wegener, Henrik C. Washington (DC): National Academies Press (US); 2012
  4. Todar’s online textbook of bacteriology by Kenneth Todar phD
  5. Race against time to develop new antibiotics: Bulletin of the World Health Organization 2011,89:88-89
  6. The bacterial challenge:time to react  A call to narrow the gap between multidrug-resistant bacteria in the EU and the development of new antibacterial agents
  7.  “FACT SHEET: Obama Administration Releases National Action Plan to Combat Antibiotic-Resistant Bacteria”. whitehouse.gov. Retrieved 2015-10-30.
  8. WHO AMR newsletter 2016
  9. “WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health” Retrieved 2014-05-02