By now, most Canadians are aware there is a problem with antibiotic resistance. Researchers and public health officials have sounded the alarm and the world taken notice. Both the World Health Organization and the United Nations have declared this phenomenon a crisis and asked all countries to work together to prevent the looming post-antibiotic era.
For anyone who is aware of chronic illnesses, such as diabetes, cancer, or heart disease, this may all sound a little familiar. Similar announcements have been made regarding these human-related conditions as well as pledges to fight and conquer these problems. Yet, there is a difference between the nature of these diseases and antibiotic resistance.
For the most part, chronic diseases are abnormal and should be eliminated through prevention.
However, antibiotic resistance cannot be stopped because it is a natural part of bacterial life. For them, what we call resistance is actually a form of tolerance. It is needed to deal with potentially harmful chemicals in the environment.
The concept of tolerance isn't relevant only in the microbial world. All biological life has the ability to tolerate, including humans. A perfect example of this phenomenon occurs in those able to eat hot, spicy foods. You might think they are simply born with stronger tongues. But that isn't the case. Instead, in most cases, a biochemical modification has occurred in one of the proteins found on the tongue.
The molecule is called the transient receptor potential vanilloid subfamily member 1, but usually abbreviated to TRPV1. It's highly sensitive to capsaicin, which is the chemical involved in causing heat and pain. But if continuous exposure occurs, over time, a very small change in the structure of this protein may occur. This modification desensitizes the tongue. As the levels of capsaicin increase, so will tolerance until finally, a person can enjoy those hot curries or suicide chicken wings.
In bacteria, antibiotics are akin to a deadly form of capsaicin. Depending on the type of drug used, a different aspect of microbial life is targeted. If a high enough concentration is used, all cells die. But if the concentration is lower - known as a sub-lethal level - then some of the bacteria may survive and evolve. Much like the change to TRPV1 in spice lovers, the evolution may lead to desensitization. Over time, this new found tolerance enables the bacterium to survive regardless of the concentration of the drug.
When bacterial tolerance was first identified in the 1940s, it wasn't considered to be a significant problem. If an antibiotic stopped working, there were plenty others around to do the job. But researchers soon realized this approach was flawed. In the 1950s, a feat known as multi-drug resistance was observed. As the name implies, some bacteria were able to resist more than one antibiotic.
This revelation sparked concern in public health officials who wondered if bacteria could become tolerant of all antibiotics, gaining what is known as pan-resistance. It took 50 years but eventually this phenomenon was seen. For the first time, researchers realized the post-antibiotic era was no longer just a figment of imagination; it was real.
Although the number of pan-resistant bacterial strains is still small, there is little doubt the trend will continue without some type of change in the way antibiotics are used. Currently, large-scale projects are underway across the globe to learn more about resistance and how to stop it. But for the most part, these do not involve the public.
Yet, this does not mean all individuals, including Canadians, can help. We can find ways to reduce the use of antibiotics so there is less chance bacteria will become exposed to those sub-lethal levels. If we all play a role, we may be able to hold off the post-antibiotic era indefinitely.
As for what we can do to help, there are five specific ways to improve the situation. They are easy tasks requiring little effort although they do suggest a change in our behaviour. However, if we all agree to adopt these actions, we may be doing a world of good.
1. Maintain hand hygiene. The best way to prevent antibiotic use is to simply avoid infection. Handwashing and the use of alcohol hand sanitizers may be able to significantly reduce the chances of infection.
2. Properly prepare foods. Many infections come from undercooked meats and improperly washed fruits and vegetables. Be sure to cook meats to at least 71 degrees Celsius and rinse off any fruits and vegetables, particularly imported varieties.
3. Buy meats from animals raised without antibiotics. Most of the antibiotics used today are used in agriculture and in particular livestock. By purchasing meats raised on farms eschewing antibiotics and frequenting restaurants using meat from animals raised without antibiotics, we can put pressure on the industry to move to antibiotic abstinence.
4. If you do get sick, don't ask for an antibiotic. Studies on antibiotic use in medicine have shown at least half to two-thirds of patients may expect an antibiotic, even if it is not necessary. This request affects a doctor's choice and may lead to an unneeded prescription. If there is a concern, ask instead for a test as it will reveal whether or not drugs are needed.
5. Spread the word, not the bacteria. When we get sick, we may want to push through the pneumonia or struggle with the strep. This may end up spreading the infection to others. If you happen to fall ill, take the time needed to rest and recover. If you do find the infection isn't getting better, go see the doctor. Granted, it may mean an antibiotic is needed but at least it will be for a good cause.
We all must work together to slow or even stop the arrival of the post-antibiotic era. These actions can complement the work being done by public health officials and researchers worldwide. These actions in the present will also help to preserve the usefulness of these drugs so whenever we get sick -- and we will -- we will still have easy options instead of continually facing a life or death situation.
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