Scitech | Invisible war against bacteria

The rise of antibiotic resistance

“We are fighting evolution… and we are losing.” These are the stark words of Bob McDonald, the host of CBC Radio One’s weekly science news program Quirks and Quarks, as he starts off his show featuring “Beyond Antibiotics” in 2014. Within the 25-minute segment, listeners heard what many would consider utterly frightening. A majority of scientists and healthcare professionals believe humans are at the cusp of an era where antibiotic use will be a thing of the past for the human race. Some even believe we already are in that ‘post-antibiotic’ era.

Antibiotics are specific antimicrobial biological molecules that target bacteria and help us fight infections. In 1928, Alexander Fleming serendipitously discovered the first antibiotic, penicillin, which is a molecule secreted by a particular species of fungi that he grew in a petri dish. This was a hallmark moment for humanity. Soldiers in World War II were able to survive bacterial infections that were once lethal. The postwar fifties and sixties brought the ‘golden age’ of antibiotics as new molecules were discovered at an astounding rate. But it was Fleming himself, the pioneer of antimicrobials, who was concerned about this new precious resource. He noted in his own research that complacence, overuse of antibiotics, and the use of less-than-adequate doses to kill the bacteria in infections would lead to bacteria building a tolerance.

A realistic future without antibiotics would severely affect modern medicine. Everything from organ transplant surgery, to cancer therapy, joint replacement, and childbirth would be very difficult endeavours without the aid of antibiotics.

Society has failed once again to adequately manage and preserve a vital resource, such as antibiotics. We are now facing the consequences.
In 2012, the Canadian Institutes of Health Research claimed that 8,000 people had succumbed to infections they picked up during their hospital stay. That figure is equivalent to the number of deaths in Canada annually from breast cancer, AIDS, and traffic accidents combined. Methicillin-resistant staphylococcus aureus (MRSA), Carbapenem-resistant enterobacteriaceae (CRE), and Vancomycin-resistant enterococci (VRE) are just a few ‘superbugs’ that are giving many hospitals an extraordinarily difficult time in trying to contain their spread to patients. Further, these superbugs are strains of bacteria which are resistant to several types of antibiotics, making them very difficult to treat, if not impossible.

A realistic future without antibiotics would severely affect modern medicine. Everything from organ transplant surgery, to cancer therapy, joint replacement, and childbirth would be very difficult endeavours without the aid of antibiotics. At first, scientists and doctors were always a step ahead of these bacteria, but now they no longer have the upper hand. With increasing exposure bacteria have evolved faster than the rate at which new antibiotics were found. To defeat this imminent crisis, a new and smarter approach is needed. Researchers are taking a look at history and going back to the drawing board to find solutions. Many scientists believe that we have exhausted all the possible paths to search for compounds known as broad-spectrum antibiotics, which were once readily available during the sixties. These are molecules that have the power to kill a wide range of different pathogenic bacteria. They were especially convenient since doctors could simply prescribe them to patients suffering from infections without knowing what specific pathogen was the culprit at work.

Now, even these broad-spectrum molecules are becoming increasingly futile as their circulated use in society has exposed many microbes to their presence. As a result, they have evolved to resist the drugs’ bacteria-killing mechanisms. Some experts believe that there is a need for a more targeted, narrow-spectrum approach when it comes to antibiotic use. There have been many advancements in medical diagnostic machinery, and perhaps in the near future scientists will be able to use genomic diagnostic machinery to detect individual pathogens causing the infection through DNA analysis. A doctor could then prescribe an antibiotic geared toward that specific species of bacteria. This would be a more responsible and effective use of antibiotics and would hinder resistance.

Alternatively, there are also scientists who believe the future of antibiotics involves looking into the wonders of nature to find new antimicrobial molecules through bio-prospecting. This means scientists must go and investigate life on this planet to find molecules naturally developed by living organisms that allow them to fight infection. These defence mechanisms could then be exploited to create new antibiotics. This has been done in the past, as most antibiotics are derived from bacteria themselves. However, future work will mean having to look in novel places. Others feel the best course of action is to pursue entirely different mechanisms for killing pathogens, of which host defence peptides and bacteriophages are just some examples.

It is going to take a lot of willpower for humanity to succeed, and many changes need to be made to the mindset used in research. Governments need to step in and help with policy decisions, and alternative methods for funding antimicrobial research are a necessity, since antibiotics offer very little return on investment for pharmaceutical companies. Unlike long-term prescription drugs used to treat psychiatric conditions, when people have infections, they take an antibiotic only for a ten-day period and then they no longer require the drug.

Not to mention the fact that many new antibiotics that reach the market become useless within a few years of due to antibiotic resistance. This makes pharmaceutical companies dread pursuing drug discovery in that area even more. Pharmaceutical companies are much more interested in funding drugs targeted toward long-term conditions, such as high blood pressure and high cholesterol.

Until scientists are able to find a viable alternative to the currently diminishing supply of antibiotics, or another mechanism to prevent antibiotic resistance, governments will need to intervene and incentivize pharmaceutical companies to produce novel antibiotics. There has to be a ‘delinkage model’ that recognizes that return on investment from volume of sales is inappropriate when it comes to antibiotics. Presently, pharmaceutical companies are only rewarded for the amount of sales they make, but this is a conflict of interest, as the overuse of antibiotics directly fuels antibiotic resistance. This leaves doctors rationing what few antibiotics that still work. New alternatives need to be found quickly. The reality is that many lives are at risk due to the careless management of antibiotics and it will only get worse until a new system is adopted.