May 11, 2018

By: Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Why does antibiotic resistance happen? Most antibiotics come from mold or fungi. Mold or fungi have been fighting for space and food with bacteria for millions of years. For example, imagine to protect its food, a mold produces an antibiotic that kills off all the bacteria in the area. To get back into that area and get at the food, the bacteria must evolve a way to protect themselves from the mold's chemical weapon. The bacteria evolves antibiotic resistance. It is a microscopic arms race. Bacteria and mold have been engaged in chemical warfare for as long as there have been bacteria and mold. Antibiotic resistance isn't a new phenomenon.

Humans stumbled into this chemical arms race with Sir Alexander Fleming. He 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 he'd 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!

How do bacteria in humans become resistant to an antibiotic? There are different ways but it often happens when the bacteria are exposed to a small dose of an antibiotic. This dose is either too small to kill them or given for too short a time to kill them. For example, let's 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 won't work anymore. You have created an antibiotic resistant infection!

The bacteria have yet another sneaky trick up their microscopic sleeves. They are called plasmids. You can only pass genetic traits like height onto your children. If you were a bacterium, things would be different. Let's say you are 6'8" and your neighbor who is 5'2" is trying out for a basketball team. Your neighbor says, "Hey, I'd love to have your height!". You say, "No problem!" and hand them some DNA. Suddenly you neighbor grows up to 6'8" and makes the team. That is sort of what plasmids are like. One bacterium that has developed a resistance to an antibiotic can hand a package of DNA, called a plasmid, to a non-related bacterium, and suddenly that neighbor bacterium and all her offspring are resistant to that antibiotic.

What are Drug Sanctuaries, and how might they fight antibiotic resistance? The idea is that in a place like a hospital, certain wards would have a certain antibiotic banned. For example let's say no ciprofloxacin or cipro on the maternity ward. In the experiments by Rees Kassen and his team they found that cipro-sensitive bacteria grew faster and cipro-resistant bacteria grew slower. So in a cipro-free area like our theoretical cipro-free maternity ward, cipro-sensitive bacteria would out compete the slow growing cipro-resistant bacteria. So the cipro-free maternity ward would be a pocket or sanctuary of bacteria that wasn't resistant to the antibiotic. Using things like drug sanctuaries wouldn't stop antibiotic resistance. But it is a strategy that might slow the spread of antibiotic resistance a bit.

What can individuals 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 infections. Listen to your doctor when she says you don't need an antibiotic for your cough. Treating a viral infection with an antibiotic won't 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 don't cause resistance.

Giving sanctuary to bacteria that make us sick may not be an obvious solution to antibiotic resistance. But every little bit helps. And for goodness sake, don't spit on each other. That should be obvious. Our we will Red Card you and toss you from the game.

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.

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As always if you have any questions or concerns about these or other products, ask your pharmacist.

Drug sanctuaries offer hope for a post-antibiotic world -

World Economic Forum The Dangers of Hubris on Human Health -

World Health Organization Antimicrobial Resistance -

United Nations General Assembly Antimicrobial Resistance -

Review on Antimicrobial Resistance -

Maryn McKennan's article on a Post Antibiotic Future -


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