Mar 18, 2014
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
In a world, where a scraped knee could lead to sepsis and death. When your life is no longer your own, because everything you know about infections is wrong. One man in a lab, in 1920s London, will change the worldforever. That man we now knowas.the Penicillinator! I am terrible at new super hero names, but I couldnt resist when I heard of the passing of Hal Douglas. Hal Douglas had that famous gravelly baritone in thousands of movie trainers. He did voice over work for over sixty years and passed at the age of 89. The age of In a world is over.
The age of antibiotics might be over too. I read an article in medium.com by Maryn McKennan about the world going into a post-antibiotic age. In pharmacy school we learned about antibiotic resistance. But something always sticks with you better when you witness it first-hand. Shortly after I got out of pharmacy school, the new antibiotic azithromycin came out. It was very popular because you only had to take it once a day and it stayed in the body for a long time. Because azithromycin stayed in the body for a long time at low doses, azithromycin became the first antibiotic that bacteria developed resistance to during my career. Azithromycin still works in many people for many infections, but now sometimes it doesnt.
What are antibiotics and what is antibiotic resistance? You have to go back to Alexander Fleming. Sir Alexander Fleming discovered penicillin in 1928. He was doing research on bacteria and was already known as a good researcher, but a messy lab technician. Coming back to his lab after a few days off, he found some cultures of his bacteria that hed forgotten had been spoiled by mold. Instead of just throwing out all the culture plates, he noticed a zone around some of the mold was completely free of bacteria. The mold (later named Penicillium notatum) produced a substance (now called penicillin) that killed the bacteria. Penicillin was eventually isolated and made in large quantities. When it was given to people, certain infections were cured!
Penicillin was a miraculous discovery. Bacterial infections can kill people. Before antibiotics, strept throat, sexually transmitted diseases and infected wounds often killed people. As miraculous as antibiotics are, they arent perfect. A few years after penicillin was discovered, doctors started noticing antibiotic resistance. In Maryn McKennan's article, she points out that Alexander Fleming himself warned of antibiotic resistance in his Nobel Prize speech in 1945.
How do bacteria become resistant to an antibiotic? There are different ways but it often happens when the bacteria are exposed to a small dose of the antibiotic. This dose is either too small to kill them or given for too short a time to kill them. For example, lets say you go to the doctor and insist that she give you an antibiotic for your cough. Then, you only take 2 or 3 days worth of the antibiotics and save the rest for next time. This will kill off the most of the bacteria, but it will leave some alive. The ones that are left will have a natural immunity to the antibiotic. Those bacteria will reproduce and all their offspring will have a resistance to that antibiotic. Now that original antibiotic wont work anymore. You now have an antibiotic resistant infection!
Another interesting possible source of antibiotic resistance is livestock. We routinely give livestock low doses of antibiotics to promote growth. Giving a low dose of an antibiotic for a long time is a good way to promote antibiotic resistance. There are reports that up to 80% of all antibiotics are used in livestock. It is possible that the antibiotic resistant bacteria in livestock can transfer to people, or sometimes the antibiotic resistant genes from one bacteria can leap into another bacteria. The exact scope of how antibiotic use in livestock affects people is still being debated.
Why does antibiotic resistance happen at all? Bacteria and mold have been engaged in chemical warfare for as long as there have been bacteria and mold. Antibiotic resistance isnt a new phenomenon. Gerald Wright from McMaster University and his colleagues published a paper in August 2011 in Nature that showed us how old antibiotic resistance might be. The researchers looked at Actinobacteria, which lives in soil and doesnt cause disease. They found some Actinobacteria was resistant to many antibiotics. Then the researchers looked at some frozen soil from the Yukon from 30,000 years ago. It had Actinobacteria that was resistant to penicillins, tetracyclines and vancomycin. Why are ancient bacteria resistant to modern antibiotics? Well we dont really know, but one theory goes like this. Bacteria in the soil are always competing with each other and other microbes like fungi. Fungi, like the mold that produced penicillin, create antibiotics to kill off the surrounding bacteria. The soil bacteria must evolve a way to protect themselves from the chemical weapon, so they evolve antibiotic resistance. It is kind of like a microscopic arms race. This goes to show bacteria are very capable of developing antibiotic resistance given the right conditions.
If bacteria are becoming resistant to antibiotics, why dont pharmaceutical companies just make new antibiotics? Maryn McKennas article suggests it is because there is no money in it. It takes a pharmaceutical company about 10 years and $1 billion to bring a drug to market. Bacteria seem to develop resistance to new antibiotics in about 1-2 years and doctors stop using them in about 5 years. So the pharmaceutical company only has 5 years to make back its $1 billion investment. From a financial point of view, making cholesterol and blood pressure pills makes much more sense.
Maryn McKennas article points out many unsettling facts about a possible future in which antibiotics dont work. Without antibiotics, it would be very difficult to do common procedures like caesarian sections, prostate surgery or even kidney dialysis. Infections would kill many people who had these procedures. In cancer treatment, we routinely knock down the patients immune system to treat the disease. If you do that without viable antibiotics, the cancer treatment might become as dangerous as the cancer. Even things like a cut finger, piercing your ear or getting a tattoo could put your life in danger.
What should we do so our antibiotics will work when we need them? Start with non-drug measures. Wash your hands. Coughing and sneezing into the crook of your elbow reduces the chance of spreading bacteria. Listen to your doctor when she says you dont need an antibiotic for your cough. Treating a viral infection with an antibiotic wont make you better and can promote antibiotic resistance. And if your doctor gives you an antibiotic, finish your antibiotics! Do not stop taking an antibiotic part way through the course of treatment without first discussing it with your doctor. Even if you feel better, use the entire prescription as directed to make sure that all of the bacteria are destroyed. Dead bacteria dont cause resistance.
Countries like Denmark, Norway and the Netherlands have been able to turn the tide against antibiotic resistance. They have put in place tough government regulations on the use of antibiotics in medicine and agriculture. So maybe one more stab at superhero names. The villain MRSA is back and he is more evil than ever. In a world, where The Penicillinator is on the ropes, who will save us? One woman and her name isThe Government Regulator!
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Maryn McKennan's article on a Post Antibiotic Future - https://medium.com/editors-picks/892b57499e77
Hal Douglas in Jerry Seinfelds The Comedian Trailer - https://www.youtube.com/watch?v=fVDzuT0fXro
A few more Hal Douglas Trailers because they are fun - http://www.theguardian.com/film/filmblog/2014/mar/13/hal-douglas-trailers-voiceover-six-best
This American Life and good vs bad Super Hero Names and Powers - http://www.thisamericanlife.org/radio-archives/episode/508/superpowers-2013?act=3