Antibiotic Resistance

Jan 21, 2019

By: Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

He whines when he has to get out of bed. He whines when he has to go to bed. He whines when he has to stop playing video games to eat. He whines when he is playing video games and can't find anything to eat. The life of a thirteen year old boy is so very very hard. I wish he'd just grow up and stop whining about how hard everything is. The other night Eric had to leave go to Neepawa to play a hockey game. I agreed to finish off the last third of his paper route. I mean, how hard could it be if a thirteen year old boy can do it.

It will be hard for everyone when the world moves into a Post-Antibiotic Era! This headline might not be as exaggerated as you would think. And this warning isn't just coming from health groups the World Health Organization. The World Economic Forum, and the United Nations General Assembly -issued this grave warning to the world. When antibiotics don't work, we get sicker more often. We stay sicker longer. This will hurt the economy because sick people don't work.

Why do we care that antibiotic won't work anymore? There is the obvious problem of people dying of infections like pneumonia. But there are the less obvious health care implications. Without antibiotics things like gut surgery, caesarean sections, joint replacements and cancer chemotherapy would be too dangerous to perform. But first let's talk about what we are up against.

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 bacteriophages, and how might they fight antibiotic resistance? Bacteriophages or phages for short are viruses that attack bacteria. Picture a number with a "1" and then 31 zero's behind it. That is how many phages there are on Earth. There are more phages on Earth than every other living thing, including bacteria, combined. There have been phages probably as long as there have been bacteria, so probably billions of years. Virus, like bacteriophages, are very specific. They only attack bacteria. If fact, each virus only attacks certain type bacteria. That means phages do not attack human cells. That has led some scientists to try using phages to treat antibiotic resistant bacteria. Dr. Benjamin Chan is a phage researcher at Yale University. His phages attack a part of the bacteria that makes them antibiotic resistant. That means the only bacteria that survive the phage attack are the ones that can be killed by conventional antibiotics. CBC's Quirks and Quarks did a nice segment on how Dr. Chan's phages saved a young woman in Texas. Paige Rogers has Cystic Fibrosis and after years of antibiotics to treat recurrent lung infections had led to an antibiotic resistant lung infection. Dr. Chan's phages made Paige's infection able to be killed by regular antibiotics again. Alexander Belcredi did a nice TED Talk about a woman with an antibiotic resistant post surgical infection in her leg. Since the infection couldn't be cleared, normally the leg would have to be cut off. But in this case the patient didn't have to get the leg amputated because of phage therapy. Why am I talking about individual cases instead of huge trials with thousands of patients? Because phage therapy is exciting, but still experimental. It might be part of the solution to antibiotic resistance, but it isn't ready for prime time yet.

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.

I started delivering The Herald at the end of Brown Ave. It wasn't so bad. Then my pen froze, and I couldn't tick off which houses I had delivered to. I went to the truck and found a pencil. I wonder how Eric does this without a truck. I did a few more houses, but then I couldn't find a house number. I asked a lady getting out of her car. Apparently, a large guy dressed all in black appearing out of the shadows scared the Holy Ghost out of her. Then my fingers started going numb. And I was taking way longer than Eric does. And I was starting to whine to myself. I guess I might have to give Eric some credit about how hard it is to be a 13 year old.


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