If you follow the news, you may have seen an increase in reports and stories on the use of antibiotics and the consequences of resistance. It's due to Antibiotic Awareness Week, an initiative originated and fostered by the World Health Organization. The seven-day campaign focuses on improving public understanding of the importance of antibiotics in our lives and more importantly, how we are now in a crisis as a result of misuse and overuse.
For those with any concern for public health -- which in all honesty should be everyone -- the rise of antibiotic resistance should not be a revelation. We have known almost since the dawn of antibiotics about the phenomenon and the potential for a single bacterium to become resistant to multiple if not all drugs. The warnings of a crisis have been around for decades as have the threats of the so-called post-antibiotic era. In essence, all the attention over the last week should be considered old news.
Even if the concept of a crisis is just burgeoning as a result of the increased media attention, the continued focus on the past and present can only do so much to improve the situation. We need to look forward to determine how we can either manage resistance or, alternatively, find other means to deal with infectious bacteria without resorting to antibiotics. Unfortunately, this doesn't seem to be given particularly much attention for good reasons.
Antibiotics are complex molecules designed to hinder or stop normal biological processes. They are in effect, biological mousetraps. They target one small piece of a bacterium's necessary activities and either trap it, halt it, or kill it. The result is a dead cell and a neutered threat. Unfortunately, microbes are crafty and can develop ways to evade or block the attack. This could happen with as little as a very small change in the way the bacterium conducts its activities. More importantly, they don't become stronger as public health officials and scientists may imply; they are just evolving to stay alive.
That evolution is what is behind the crisis. Despite all the technology in academic and pharmaceutical institutions, nothing can stop a microbe from figuring out how to best an antibiotic. As such, the mood is sombre at best and apocalyptic at worst. After all, who would want to spend the millions if not billions of dollars to develop a new antibiotic if it only can be used for a few years? It's one of the reasons why the so-called 'antibiotic pipeline' has for the most part, dried up.
There is, however, a route forward by looking backwards towards a more simplified approach to treating bacterial infections. Instead of trying to develop yet another complex mousetrap, the answer lies in looking at weapons of mass microbial destruction already in use in the wild. By harnessing these options in the lab, we may be able to develop novel drugs to combat bacteria without any worry for resistance. More importantly, they may come at a reduced cost.
One of the best examples of a natural killer of microbes is alcohol. When between 62 and 70 per cent, it can wipe out bacteria in a matter of seconds. There's no chance for resistance either as it kills using a physical process rather than a biochemically complicated one. That's why the use of alcohol hand sanitizers is so important in preventing microbial spread and why these sanitizers do not contribute to resistance. But alcohol can't replace antibiotics as the liquid is equally as toxic to human cells.
A more effective means of bacterial killing is called an antimicrobial peptide or AMP. It's a string of amino acids -- they are the building blocks of proteins -- and acts essentially like a knife, puncturing the bacterial cell and causing it to bleed out. In most cases, the action is swift and merciless. Some AMPs even help out the immune system making the fight even easier.
AMPs can be made in one of two ways. The first is to make them in the lab. They are fairly easy to synthesize in the lab and are quite cost-effective in comparison to an antibiotic. The other route to AMPs is to find them in nature. All organisms produce them -- including humans -- and we can quickly identify them and put them to the test. Not all will work, mind you, but some will most definitely be useful.
The incredible potential of AMPs may lead one to wonder why this past week hasn't been devoted to looking towards the future of AMPs rather than the past failures of antibiotics. It's partly due to the fact some bacteria can resist AMPs and this could potentially lead us down the same path as antibiotics. Yet, unlike antibiotics, for which there is a limited supply, AMPs may be limitless. In fungi alone, there are enough forms of an AMP called a defensin to keep us occupied for generations. Many of these will no doubt have the activity we need to combat bacterial diseases and become the medicines of the future.
As we move on from Antibiotic Awareness Week, we can see a positive path forward. However, to ensure we get there, we have to be sure AMPs and other cost-effective, simplistic antimicrobial options (such as bacteriophages) are given the chance to shine. With increased funding towards these measures instead of the development of so-called stronger antibiotics that are destined to fail, we can move towards the post-antibiotic era in confidence knowing we will be relying on nature's simplicity rather than a chemical lab's complexity.
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