Monday, November 28, 2022

How Have Antibiotics Changed Society

Working Against Our Evolution

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Besides the issue of resistance, there is also the ethical dilemma posed by antibiotics in our society. In theory, not only are bacteria evolving , but so are humans from generation to generation. The difference between the two is that human evolution is not readily apparent because of the relatively long time span between generations. Research has shown that humans host a natural flora of bacteria that can help act as a barrier to pathogenic ones . Throughout our evolution, humans developed not only these bacterial relationships, but also an immune system to protect the human body from pathogenic bacteria. The use of antibiotics prevents the human body from building up an acquired immunity to certain pathogens. This means the immune system of a particular individual is not given the chance to build up resistance to a pathogen as effectively when antibiotics are used. Rather, the individual becomes dependent upon antibiotics in the event that he is exposed to the same pathogen. The case of acquired immunity will only affect that particular generation, and in no way is passed on to the next generation genetically.

Golden Era Of Antibiotics

The introduction of penicillin and streptomycin in 1928 and 1943, respectively, presaged the time when antibiotics became a dominant component of medical care for infectious diseases. By 19501960 several more antimicrobials had been discovered . Indeed, 19301962 was often considered as the golden age of antimicrobial inventions as 20 different novel classes of antimicrobials were invented and developed rapidly within these two decades. Many of these went on to serve mankind for another 60 years .

A valuable introduction was the first aminoglycoside, streptomycin. This highly effective, broad-spectrum antimicrobials with a mechanism of action through inhibition of microbial protein synthesis was developed by the US scientists Waksman, Schatz, and Bugie from Streptomyces griseusand clinically first used in 1944 .

How Antibiotics Are Used

Today there are literally hundreds of different antibiotics that may be prescribed based upon the type of infection and suspected bacteria. For serious/severe infections, a broad-spectrum antibiotic is used initially. A narrow spectrum antibiotic may then be used once the infecting bacterium has been identified.9,10

In addition to treating an infection, antibiotics may be prescribed prophylactically to prevent infections in the case of high risk. For example HIV/AIDS or otherwise immunosuppressed patients may be prescribed antibiotics to prevent secondary bacterial infections.11 This is also true in the case of cancer patients with suppressed immune systems, patients about to undergo high risk surgeries, as well as dental patients at risk for bacterial endocarditis.12

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What Does The Future Hold For Antibiotics

The future of antibiotics is quite uncertain. While the experts are taking the necessary steps to ensure that there will not be an imminent crisis in antibiotic resistance we really do not know for sure if these efforts will prevent such an outcome at some point in the future.

More research must continue on this front and stricter regulations regarding the use and disposal of antibiotics so we can retain their effectiveness when we need antibiotics the most. The discovery of penicillin revolutionized medicine, but people need to take care lest the same happens with other antibiotics, or else humanity might face its biggest challenge yet surviving without effective drugs against once trivial infections, like strep throat or common skin wounds.

Despite all efforts by pharmaceutical companies, there are still no effective antibiotics available for some resistant bacteria. One of the reasons is that research and development on new drugs have been discontinued or slowed down because there is little profit for these products. However, this may be slowly changing because increasing antibiotic resistance becomes more apparent every day, but it could take years, if not decades, before there is any significant progress toward developing new classes of antibiotics.

World Antimicrobial Awareness Week

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Held annually since 2015, WAAW is a global campaign that aims to increase awareness of antimicrobial resistance worldwide and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of drug-resistant infections. Antimicrobials are critical tools in helping to fight diseases in humans, animals and plants. They include antibiotics, antivirals, antifungals and antiprotozoa. WAAW takes place every year from 18 to 24 November. The slogan has previously been, Antibiotics: Handle with Care but changed to Antimicrobials: Handle with Care in 2020 to reflect the broadening scope of drug resistant infections.

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Who Can I Ask About Side Effects

If youre concerned that you or someone in your care may have had side effects related to a medicine, seek medical advice.

People with questions about their medicines or seeking general information about side effects can also call the NPS Medicines Line on 1300 633 424 .

To report possible side effects call the Adverse Medicine Events line on 1300 134 237 from anywhere in Australia .

Find out more about medicine side effects and interactions

What Is The Significance Of Antibiotic Resistance

What is antibiotic resistance and why is it such an important public health issue? Antibiotics are one of mankinds most important discoveries. They allow us to survive serious bacterial infections. When bacteria become resistant to an antibiotic, it means that the antibiotic can no longer kill that bacteria.

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How Did Antibiotics Change Over Time

There was always a new antibiotic being developed to combat them. But, by the end of the 1960s, new classes of antibiotics were no longer being developed. Instead, most work involved slightly altering existing antibiotics to reduce toxicity and to revive drugs rendered ineffective by the emergence of resistance.

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When Are Antibiotics Not Needed Can They Really Be Overused

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Antibiotic resistance is natural, but happens faster when antibiotics are misused or overused. For example, antibiotics do not work against diseases caused by viruses but sometimes are prescribed and taken to treat viral illnesses. Every time a person takes antibiotics, sensitive bacteria are killed but resistant bacteria may grow and multiply. Treating viral illnesses with antibiotics is a problem because it can lead to the development of resistant bacteria.

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Penicillin Wwii And Commercial Production

The increasingly obvious value of penicillin in the war effort led the War Production Board in 1943 to take responsibility for increased production of the drug. The WPB investigated more than 175 companies before selecting 21 to participate in a penicillin program under the direction of Albert Elder in addition to Lederle, Merck, Pfizer and Squibb, Abbott Laboratories was one of the first companies to begin large-scale production. These firms received top priority on construction materials and other supplies necessary to meet the production goals. The WPB controlled the disposition of all of the penicillin produced.

One of the major goals was to have an adequate supply of the drug on hand for the proposed D-Day invasion of Europe. Feelings of wartime patriotism greatly stimulated work on penicillin in the United Kingdom and the United States. For example, Albert Elder wrote to manufacturers in 1943: “You are urged to impress upon every worker in your plant that penicillin produced today will be saving the life of someone in a few days or curing the disease of someone now incapacitated. Put up slogans in your plant! Place notices in pay envelopes! Create an enthusiasm for the job down to the lowest worker in your plant.”

As publicity concerning this new “miracle drug” began to reach the public, the demand for penicillin increased. But supplies at first were limited, and priority was given to military use.

Current Most Dangerous Pathogenic Microbes

In 2017 WHO first published the list of antimicrobial-resistant priority pathogensa directory of 12 families of microbes that pose the most extreme public health risks around the globe . In 2019 the Center for Disease Control and Prevention classified 18 antimicrobial-resistant bacteria and fungi into three classes by level of public health issues of urgency, severity, morbidity, and mortality .

Table 3. WHO priority list: infectious micro-organisms for research and development of novel antimicrobials.

Table 4. CDC threats to public health.

One estimate is that development of a new antimicrobials molecule takes some 1520 years and financial support of over US$ 2.6 billion . Another study estimated this at a minimum of 10-years and needs over £1.5 billion . Most long-standing groups of antimicrobials have considerable resistance problems, and new approaches are needed .

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Pneumonia And Other Respiratory Infections

Looking at mortality data from the USA in 1928, respiratory tract infections such as pneumonia and tuberculosis caused 18% of all deaths. Without access to efficient antibiotics, pneumonia is a killer with efficient antibiotics, community acquired pneumonia is generally cured within a week or two.

Similarly tuberculosis has been almost eradicated in high income countries thanks to antibiotics. But it is still a major scourge in low- and middle income countries claiming the lives of more than a million people every year.

What Causes Antibiotic Resistance

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Antibiotic resistance is a natural process – stronger bacteria survive and multiply.

Unfortunately, the problem of antibiotic resistance is made worse when antibiotics are not used correctly or are used when they are not needed. This can happen with animals as well as people. Antibiotic overuse, and misuse, can create the conditions for the development of antibiotic resistant bacteria. Millions of treatments with antibiotics are prescribed each year when not needed. Overuse of antibiotics in children is of particular concern because the highest rates of antibiotic use occur among children. Fortunately, patients and doctors can work together to reduce antibiotic resistance.

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Side Effects Of Penicillin

Though penicillin has saved many lives, it isn’t always helpful for everyone. For example, some people have penicillin allergies that can cause a rash, hives, itching, skin swelling, anaphylaxis and other symptoms.

Beyond allergies, penicillin is becoming less effective over time, as bacteria have become resistant to the antibiotics designed to kill them. Each year, at least 2 million people in the United States develop a bacterial infection that is resistant to antibiotics and at least 23,000 people die as a result, according to the Centers for Disease Control and Prevention .

The overuse and misuse of antibiotics contribute to the development of antibiotic resistance, according to the Mayo Clinic. Every time a person takes antibiotics, most bacteria are killed, but a few drug-resistant bacteria strains are left to grow and multiply. This means that regular antibiotic use may increase the number of drug-resistant bacteria in the body.

For this reason, antibiotics should only be used to treat bacterial infections and should not be prescribed for viral infections, such as colds, flu, most sore throats, bronchitis and many types of sinus and ear infections, according to the CDC.

Nonetheless, many sore throats and upper respiratory infections that are caused by viruses are often treated with antibiotics because it is a perceived quick fix, said Dr. Saul R. Hymes, medical director for Pediatric Antimicrobial Stewardship at Stony Brook Children’s Hospital in New York.

The Situation In Developed Countries

The Greek physician and earliest anatomist Herophilus mentioned that medicines are nothing in themselves but are the very hands of God if employed with reason and prudence, indicating that the notion of the rational use of medicines is a few thousand years old . The judicious or rational use of medicine was defined by WHO in 1985 as Patients receive medications appropriate to their clinical needs, in doses that meet their requirements, for an adequate period, and at the lowest cost to them and their community . The World Bank has also defined RUM in two tiers: the utilization of medicines based on scientific data regarding drug efficacy, safety, and compliance and the need to maximize the benefit of medicine in the resource-limited health system to ensure cost-efficacy . RUM has been considered as the strategic issue in providing effective and quality healthcare .

In the developed world antimicrobials are almost without exception legally defined as prescription-only medicines. However, a recent Norwegian study has shown how frequently travelers are able to buy antibiotics over the counter, even in EU countries .

Awareness of the consequences of irrational and imprudent prescriptions in raising utilization of antimicrobials with a consequential higher rate of AMR , has led to many initiatives to make antimicrobial prescribing more careful and selective . Careful, rational prescribing, can be seen as a quality marker for healthcare .

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How Have Antibiotics Improved Human Health

Antibiotics are a class of medicines used to prevent or treat bacterial infections. Antibiotic drugs have been around for decades, but they only started being widely prescribed in the 1950s and 1960s. Their discovery was through research on microorganisms. This led to antibiotic development by pharmaceutical companies and public health organizations, like the Centers for Disease Control and Prevention in the U.S.

The discovery of antibiotics has drastically changed the medical world since they allowed physicians to fight diseases that doctors could not cure before, such as pneumonia and syphilis. In addition, surgical procedures would become nearly impossible without having medications that target bacteria or more dangerous because there would be no way to reduce the risk of infection after surgery except sterilizing instruments before operations.

Their impact was enormous since it was now possible for surgeons to perform complicated and delicate surgeries, such as heart transplantation or neurosurgery. Most people died from bacterial infections without any cure for them, which led to high death rates during surgical operations. There was also a risk that patients would die after being operated on due to infection.

Antimicrobial Prescribing Kap Among Medical Practitioners

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Studies across the world demonstrate that there are serious KAP deficiencies amongst prescribers. We select here four examples: one each from Malaysia, India, China, and Baltimore USA.

The Malaysian study, conducted in a public hospital, looked primarily at knowledge. Medical officers scored moderately well on knowledge, reflecting the fact that 62.0% of the research respondents expressed confidence in prescribing antibiotics. However, despite their lack of confidence, only 18% of the respondents actually discussed the therapeutic options with a colleague before prescribing antibiotics or other medicines .

The Indian study conducted in tertiary hospitals revealed that was statistically significantly related to the periodic updates on bacterial resistance patterns improved medical doctors’ knowledge levels, as did internal and external antibiotic-related courses. More senior doctors with 11 years’ average experience were more likely to have a scientific and rational basis for antimicrobial utilization. The study also highlighted that 40% of the study respondents reported that their institute did not have a formulary or an infection control policy .

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The History Of Antibiotics

Antibiotics have been used for millennia to treat infections, although until the last century or so people did not know the infections were caused by bacteria. Various moulds and plant extracts were used to treat infections by some of the earliest civilisations the ancient Egyptians, for example, applied mouldy bread to infected wounds. Nevertheless, until the 20th century, infections that we now consider straightforward to treat such as pneumonia and diarrhoea that are caused by bacteria, were the number one cause of human death in the developed world.

It wasnt until the late 19th century that scientists began to observe antibacterial chemicals in action. Paul Ehrlich, a German physician, noted that certain chemical dyes coloured some bacterial cells but not others. He concluded that, according to this principle, it must be possible to create substances that can kill certain bacteria selectively without harming other cells. In 1909, he discovered that a chemical called arsphenamine was an effective treatment for syphilis. This became the first modern antibiotic, although Ehrlich himself referred to his discovery as ‘chemotherapy’ the use of a chemical to treat a disease. The word ‘antibiotics’ was first used over 30 years later by the Ukrainian-American inventor and microbiologist Selman Waksman, who in his lifetime discovered over 20 antibiotics.

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Scientific And Economic Challenges For Antimicrobial Development

If the flow of antimicrobials through the pipeline of development seems to have slowed, one suggested reason is that giant pharmaceutical companies have deprioritized funding antibiotics research, because the development of medications utilized in lifestyle-related sicknesses generates much more substantial financial gain . The invention of a new antimicrobial agent or a new class of antimicrobials in the last 35 years has been difficult, time-consuming, and problematic because of many issues . In addition, it is taking longer for new antimicrobials to obtain approval from drug regulatory bodies, and hence new agents are coming onto the clinical market too slowly and too infrequently to combat current alarming levels of AMR . Despite pharmaceutical industry and academic institute sponsored research, the development of innovative antimicrobial agents for clinical use has dwindled.

The principal approaches to combating AMR remain in two significant areas, Firstly, the accurate identification of molecular targets that are not predisposed to quick development resistance mechanisms is a priority . Secondly, in order to overcome current limitations on treatment of contagious diseases, there is an urgent need to move past the current well-known five principal core mechanisms of antimicrobial action .

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Can I Help Prevent Antibiotic Resistance

Australia has one of the highest rates of antibiotic consumption in the developed world, but the good news is that there are steps you can take to prevent the spread of antibiotic resistance.

  • Understand that colds and flu are caused by viruses, and that antibiotics treat bacterial infections, not viruses
  • Tell your doctor you only want an antibiotic if it is really necessary
  • Take the right dose of your antibiotic at the right time, as prescribed by your doctor
  • Take your antibiotic for as long as your doctor tells you to
  • Take the pledge to fight antibiotic resistance and encourage your friends and family to as well.

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