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Antibiotic resistance and the COVID-19 pandemic: how much are we exacerbating the problem?
In a little over 30 years, antibiotic-resistant bacteria could become more deadly than cancer worldwide. In America alone, about 23,000 people die each year from the effects of an antibiotic-resistant infection, and some experts estimate that there may be more.
Antibiotic resistance is often referred to today as a "silent pandemic", and refers to the phenomenon that many pathogenic bacteria acquire resistance to existing antibiotics. The World Health Organization has declared this phenomenon one of the 10 greatest threats to humanity, a problem that must be addressed urgently. Antimicrobial resistance - AMR - that is, "antibiotic resistance" occurs as a result of the evolution of bacteria that gives them resistance to the hitherto known drugs that destroy bacteria in various ways. Such bacteria, which have drug resistance, are called "superbugs". . We do not have new antibiotics and little is being invested in finding new antibiotics, so now the only way to fight is the rational use of existing drugs.
Some of the diseases caused by bacteria are tuberculosis, whooping cough, tetanus, a number of bacterial sexually transmitted diseases and plague. Today, there are already several types of tuberculosis agents that are resistant to antibiotics, and this disease is becoming increasingly difficult to treat. Tuberculosis, but also some other diseases such as diphtheria and whooping cough, can be prevented with vaccines, but while the diphtheria vaccine is quite effective, the tuberculosis vaccine mostly protects children and prevents more severe forms of the disease, but it does not prevent infection.
Bacterial disease vaccines help reduce the risk of antibiotic resistance
The whooping cough vaccine also protects children, but its effectiveness declines after a few years, and in our country there is no possibility of vaccination ("boost" doses) of adults. Therefore, it is not uncommon for whooping cough to circulate in the elderly population. There are also infections caused by antibiotic-resistant Staphylococcus aureus (MRSA), pneumococcal and meningococcal infections. However, there are vaccines against both pneumococci and meningococci, and in fact vaccines partially reduce the problem of antibiotic resistance.
How antibiotic resistance develops
Until recently, we were able to successfully treat bacterial infections with various antibiotics, however, the intensive and improper use of these drugs has led to some bacteria gaining resistance. The evolution of bacteria happens much faster than the evolution of more complex living beings, and bacteria that acquire mutations that make them resistant to antibiotics survive therapies and form new colonies.
Namely, during cell divisions, random mutations and changes in the genetic code can occur in bacteria. Many of these mutations do not change the characteristics of bacteria, but sometimes there are mutations that give bacteria an advantage for survival, which is the essence of evolution. One such advantage is antibiotic resistance, and those bacterial cells that have that resistance survive therapies and continue to divide, transmitting this property to those cells that arise in division.
One of the sources of this phenomenon is the excessive use of antibiotics in livestock and poultry. Some of the antibiotics used in veterinary and medical practice can be diluted through sewage into natural streams. In this way, bacteria living in these ecosystems are naturally exposed to a very small and dilute amount of antibiotics, to which they can form resistance. Practically - we "immunize" bacteria on our drugs.
image source: shutterstock
Sometimes the bacteria are exposed to a lower dose of antibiotics or the person does not complete the listed therapy. In this way, instead of destroying bacteria, we actually "train" them to become resistant. This can also happen if we take an antibiotic from someone else on our own or if we have not spent the previous therapy, and on some occasion we take the antibiotics that we have left.
Antibiotics are not supplements, nor can they be taken to prevent bacterial infection. However, especially in our country, they are given to patients even before the finding arrives. This happens in gynecological practice in family medicine and many other branches.
The WHO emphasizes that the priorities in the fight against this problem are the rational use of antibiotics, only when necessary, and hygiene and increased access to clean water and adequate sanitation, which is usually not the case in many parts of the world. Let's not forget that in our country there are places where there is no running water and sewage. Also, experts emphasize the need for better sanitation and hygiene in hospitals.
The cost of antibiotic resistance is significant for the economy. In addition to mortality and disability, long-term illness also results in longer hospital stays, the need for more expensive medications, and financial challenges for those affected.
The WHO emphasizes that there is a problem that pharmaceutical companies do not invest in research and development of new antibiotics, because it is not so profitable for them and therefore no new antibiotic has been created for almost 30 years.
WHO position on the treatment of patients with COVID-19 antibiotics
At the session of the World Health Organization, experts were asked about the practice of giving antibiotics to patients treated with COVID-19. In the world, especially in our region, it has become common for almost all patients with COVID-19, including those on home treatment, to receive antibiotics. Sometimes people manage to get this broad-spectrum antibiotic on their own without a prescription and have it as a "reserve" in the house in case they get sick. We have often had the practice of sharing therapy tips via social media, and these tips also mention taking antibiotics.
This is not the first time we have encountered this problem, that antibiotics are used in the treatment of viral infections in order to treat secondary bacterial infections.
This practice should be limited to hospitalized patients, if there is a risk of bacterial infection and antibiotics should not be taken by those on home treatment.
Doctors often complain that they do not have time to assess whether a patient has a single bacterial infection that needs to be treated, and even with proven viral infections, they blindly give antibiotics to prevent the spread of a potential but unproven bacterial infection. It seems that work will still have to be done to strengthen the capacity of health systems to effectively detect bacterial infections and to educate doctors about what antibiotic resistance really means for the health system, in order to make better decisions. The WHO insists on the careful use of antibiotics in the therapy of COVID-19.
If the existing antibiotics become completely ineffective, it brings into question surgical procedures, childbirth, as well as cancer therapy and many other medical procedures. In other words - we would go back to medicine from a hundred years ago.