The Case for Less Sanitizing
I could line up the counter with the antibiotics I have, replied the pharmacist.
The pharmacy was barely a 10-by-10 room yet the number of antibiotics outnumbered all the other drugs combined. Home, Sierra Leone, is a small country on the west coast of West Africa with a population of approximately seven million people. Yet, like every other country, the use of antibiotics is skyrocketing because the demand is increasing and the prices are decreasing.
This summer was the first time I had a bacterial infection. The most interesting part was that I didn’t even know what the symptoms of a bacterial infection were and how to manage them. My first thought was that I was getting sick from something I ate or because of the jet lag from flying for over 24 hours. I was unable to stand for long hours because of the fever and exhaustion and all I wanted to do was lie down. Then it dawned on me that I might be suffering from a bacterial infection.
I was home, in Sierra Leone, a place that I had lived for the first 18 years of my life. At 18, I left to study at a United World College in Hong Kong before coming to Middlebury College, Vermont, USA. Yet I find myself in a position where I was no longer immune to the bacteria that colonized my home. Humans have evolved with trillions of microbes (tiny organisms) that colonize our bodies, creating very complex and important systems. The reality today, however, is that the increased use of anti-bacterial in hand soaps, detergents, and animal feeds is significantly reducing this ecosystem and replacing it with ones that are rarer and more virulent.
We are at the point in our evolution where we have never been more prone to bacterial infections and antibiotic-resistant bacteria than ever before and we might not be prepared.
The first antibiotic, penicillin, was developed by Alexander Fleming in 1928. It was only in 1959 that the first penicillin-resistant bacteria appeared. Today, bacteria resistant to antibiotics appear within two to five years after discovery.
For example, Daptomycin, an antibiotic used to treat post-surgical infections developed in 2003 had bacteria resistant to it evolving in 2004/5! Despite this increase in resistance from bacteria, we are yet to fully engage with the idea that we need to simultaneously develop novel antibiotics and cut down on our antibiotic use to win this race. Microbes colonize our bodies; one might even argue that they are our bodies. There are about 100 trillion cells in the human body yet microbes outnumber our cells by ten-to-one. These organisms including fungi, bacteria, and viruses colonize areas such as our mouth, nose, skin, and guts.
Bacteria are developing resistance at an unprecedented rate
As I left home, my diet changed, my environment changed and the bacteria that I was coming in contact with also changed. Successful bacteria that colonize your body are less resistant to change but that means that they might not resemble the bacteria of your immediate environment, at least not for a while. During my time away, I was no longer exposed to the bacteria that colonize Sierra Leone’s atmosphere, thus, my body did not recognize them as part of my microbiome anymore and they became infective to me.
Millions of people suffer from bacterial infections daily. This could be from Helicobacter pylori, which causes anything from ulcer to methicillin-resistant Staphylococcus aureus (MRSA), an infection, which is resistant to almost every kind of antibiotic known to man. But these are only infective because they are foreign to our body. As I walked into the pharmacy to get myself some over the counter antibiotics, I asked the lady what kinds she had, and she said: “they could line up the whole counter!” I was shocked because this just highlighted the ubiquity of antibiotics. I did not know which one I wanted and which antibiotic was specific for which bacterial infection as this is not common knowledge.
Microbes colonize almost every inch of our bodies
Overwhelmed by the choices available to me, I decided to consult a close friend who is a doctor to ask for their advice. But it is important to realize that not many people have access to these resources or even know about the rising antibiotic resistance globally. Humans have co-evolved with many microbes that colonies almost every inch of our body. we occupy only a tiny fraction of the animal domain, while bacteria, viruses, and fungi have a more extensive domain. This means that each human being has a microbiome that is unique to them and the microbes on that human being are personalized to that person. This might make very anal people very uncomfortable. But we do live with bacteria (pathogenic and nonpathogenic) They help us digest our food, filter our air and increase the disease barrier on our skin.
Bacteria from the same family tend to function in the same way. Thus, when we use one antibiotic, we might be destroying an entire family of bacteria. Despite the diversity between and within our microbiomes, we run the risk of killing a huge percent of the helpful bacteria. Yet, there are millions, if not billions of bacteria that we do not come in close contact with and these all have their own specific mode of action. But one thing is true, we do not know yet how to fight them. Therefore, we heavily rely on the mechanisms of organisms that have been involved in this arms race to fight bacteria. These personal bacteria are so adapted to our bodies that they cannot be grown in the lab. The change in the bodies microbiota affects the immune and digestive system of children. Our personal bacteria are usually effective in our guts even before we are born and has significant consequences on our lives as we grow up. A baby born with cesarean section is 26 percent more likely to be overweight and 22 percent more likely to be obese as an adult than those born vaginally.
Microbes form the vast majority of earth’s biodiversity
There is more diversity between the microbes that occupy different parts of our body that the microbes of same parts across individuals (for example, it is more likely for the skin microbes between two people that live in the same community to be the same than for the bacteria in the oral cavity and the skin of the same person to be the same). Other microbes found in our bodies include viruses and fungi. Despite the pathogenicity of these domains, they are still represented in “healthy” populations. There are at least 1,000 different species of bacteria, fungi, viruses and other microbes which live on the skin. Most of which are harmless or even beneficial to the human host. The competition between bacteria and fungi for space on our skin is what keeps pathogenic microbes at bay but when we interrupt this arms race, we risk fighting a battle that was not ours, to begin with. Not only do we have different bacteria and fungi that make up our skin and gut environments, but we also have different viruses that make up our unique virome.
Significant increase in antibiotic use especially in low and middle-income countries. Developed countries are slowly reversing their trend of antibiotic resistance
One of the most important human immune responses is the development of T-Cells. When we get attacked by a microbe, our immune systems have phages that engulf these microbes and after they have been attacked, the chemical markers of the microbes are displayed on the surface such that the next time something similar attacks, our response will be faster. In this way, our personal microbiome educates our immune system and reduces our infection rate. By killing these microbes, we are reducing our immunity. Initial microbial colonization of the gut in infants appears to be dependent on whether the baby was delivered vaginally or through cesarean section. Studies have shown that babies delivered vaginally acquire microbiota similar to those of their mother’s vagina and babies delivered via cesarean section acquire microbiota similar to those typically associated with the skin. There are also differences between the gut microbiota of formula-fed and breastfed infants. By the end of the first year of life, the microbial profile is distinct for each infant. It is found that by the age of 2.5 years, the microbiota fully resembles the microbiota of an adult in terms of composition.
Antibiotics such as penicillin, streptomycin, and chloramphenicol are usually selected from specific organisms like fungi. We are beginning to observe is that these antibiotics have a high rediscovery rate because they more or less act the same way. The aim now is to find new antibiotics that act differently from the ones important human pathogens are already used to.
The answer to these questions lies not in the shortage of antibiotics but in the proper use of them. Brady team experiment demonstrated is that there are many conspicuous sources of antibiotics that are yet to be discovered and the best way to find more is to keep exploring. Culturing bacteria in the lab can be time-consuming and might not yield new products. Developing antibiotics can take decades and every step might backfire.
The answer to this problem is not more antibiotics. The role of these microbes on our skin is yet to be fully understood yet it is a common consensus that they are critical to our health. Certain microbes perform specific tasks known to be useful to the human host. Scientists are convinced that modern trends of diet, excessive use of antibiotics, obsession with cleanliness, cesarean deliveries, to name a few are disrupting the delicate balance contributing to some of the most perplexing ailments including asthma, allergies, obesity, diabetes, autoimmune diseases, cancer and perhaps even autism. The bacteria that colonize our systems are so important to our digestion, metabolism, immunity and physical appearance. What we need right now is the cautious use of antibiotics that have a very narrow spectrum targeting very specific bacteria without killing the useful ones.
CITATIONS
“Dramatic Rise Seen in Antibiotic Use.” Nature News, Nature Publishing Group, www.nature.com/news/dramatic-rise-seen-in-antibiotic-use-1.18383.
FutureLearn. “Antibiotic Use in Humans — Antibiotic Resistance.” FutureLearn, www.futurelearn.com/courses/antibiotic-resistance/0/steps/19875.
Kumar, Anil, and Nikita Chordia. “Role of Microbes in Human Health.” Applied Microbiology: Open Access, vol. 03, no. 02, 2017, doi:10.4172/2471–9315.1000131.
Linaman, Chris. “A MRSA Infection Cost Me $300,000-and Nearly Killed Me.” Time, Time, 1 June 2017, time.com/4797815/mrsa-superbug-bacteria/.
Lloyd-Price, Jason, et al. “The Healthy Human Microbiome.” Genome Medicine, vol. 8, no. 1, 2016, doi:10.1186/s13073–016–0307-y.
“National Science Foundation — Where Discoveries Begin.” Multimedia Gallery — A Tree of Life Based on Genetic Analyses; the Small Black Line Is the Ancestor of All Life on Earth. | NSF — National Science Foundation, www.nsf.gov/news/mmg/mmg_disp.jsp?med_id=72586&from.
