THE SECOND COMING OF THE PRE-ANTIBIOTIC ERA: HOW READY ARE WE?


The word “antibiotics” is a term derived from the Greek word anti (against) and biotikos (concerning life), which refers to substances produced by microorganisms that act against another microorganism. Thus, for a substance to qualify as an antibiotic, it must not be synthetic (e.g. quinolones), semi-synthetic (e.g amoxicillin) produced by plants (e.g alkaloids) or animals (e.g lysozyme).

Antibiotics are probably one of the most successful forms of chemotherapy in the history of medicine. Over the years of discovery and commercial use, many lives have been saved and significant contributions have been made to the control of infectious diseases that were the leading causes of human morbidity and mortality. Regrettably, the use of these wonder drugs has been accompanied by the rapid appearance of resistant strains. Medical pundits are now warning of a return to the pre-antibiotic era; a recent publication by the World Health Organization about Gonorrhea getting to the verge of being untreatable is one of many -yet to come- effects of antibiotics resistance. This calls for adequate concerns and a surge into action not just by medically inclined individuals but everyone with love for humanity.

In the case of antibiotics, the complexity of the processes that contribute to emergence and transmission of resistance cannot be overemphasized, and the lack of basic knowledge on these topics is one of the primary reasons that there has been so little significant achievement in the effective prevention and control of resistance development. Thus, to tackle this occurrence, we first need to understand the cause(s) and how we can play our part in its reduction (as elimination is near impossible). Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth; in other words, the bacteria are "resistant" and continue to multiply in the presence of therapeutic levels of the said antibiotic. 
A wide range of biochemical and physiological mechanisms (such as genetic mutation/acquired resistance) may be responsible for resistance but the one channel that requires extensive monitoring is resistance due to anthropogenic activities. The predominant role of human activities in the generation of environmental reservoirs of antibiotic resistance cannot be disputed. Since the 1940s, ever-increasing amounts of antibiotics designated for human applications have been manufactured, used clinically, released into the environment, and widely disseminated, thus providing constant selection and maintenance pressure for populations of resistant strains in all environments. The main problem we are facing with antibiotic therapy is that after a new antibiotic is introduced, resistance to it will, sooner or later, arise. This scenario has been seen on multiple occasions, therefore, there exists a continuing race between the discovery and development of new antibiotics and the bacteria that will respond to this selective pressure by the emergence of resistance mechanisms.

So how do we protect the power of these wonder drugs and extend their lifespan? Very easy, we require strict controls on antibiotic use by humans and this includes accurate prescriptions (no use of antibiotics to treat colds/flu and other viral infections), compliance with drug use regimen, no delivery of antibiotics without a doctor’s prescription (reducing needless use of antibiotics), controlled therapeutic use in animal husbandry/agriculture and restricted discharge of hospital and pharmaceutical wastes which serve as a major reservoir of antibiotics.

Achieving this feat in the field of antibiotics resistance and chemotherapy is certainly not limited to clinical microbiology as it was in the early years of the antibiotic era. Thus, it is no longer a single grand challenge but a complex problem requiring concerted efforts of microbiologists, ecologists, health care specialists, educationalists, policy makers, legislative bodies, agricultural and pharmaceutical industry workers, and the public to deal with. Conscious efforts need to be put into handling antibiotics as more than mere drugs and we can together delay the emergence of the pre-antibiotic era.