The Apocalypse: Coming of the Post Antibiotic Era
The discovery of penicillin, the first antibiotic, redefined medical parameters and paradigms. This ‘medical miracle’ significantly reduced deaths in WWII and cured previously fatal infections, soon becoming a pivotal pillar of modern medicine.
The Rise of Antibiotic Resistance:As the use of penicillin became widespread, it was reported that some bacteria had started to elude antibiotics which previously cured infections – the bacteria developed resistance by changing their genetic structure through mutations, rendering them immune to antibiotics. Also this resistance is transferable, not only to similar bacteria but to other species as well. The progeny of these resistant bacteria can further mutate. Fortunately, newer antibiotics were effective against these resistant bacteria, like vancomycin against methicillin-resistant staphylococcus aureus or MRSA (the superbug).
Bacteria however, have constantly evolved to endure our antibiotic assault and resistance to vancomycin is well documented.Bacteria continue to develop resistance and pan drug-resistant (PDR) organisms resistant to all antibiotics, including the ones used as a last resort, are being reported. According to the Centers for Disease Control and Prevention in the United States, bacteria known as carbapenem-resistant Enterobacteriaceae (CRE), dubbed as “nightmare bacteria”, have become much more common in the last decade. The emergence and spread of NDM-1 (New Delhi metallo-beta-lactamase 1) gene is a recent event.
Similarly, the WHO warns that multi-drug resistant and extremely-drug resistant tuberculosis is a growing problem worldwide. Dr Margaret Chan, Director-General of WHO, speaking at a conference of infectious disease experts, warned that bacteria were starting to become so resistant to common antibiotics that it could bring about “the end of modern medicine as we know it.” Earlier this year, the British Chief Medical Officer, Professor Dame Sally Davies, compared growing antibiotic resistance to climate change and terrorism. She describes the problem as a ‘ticking time bomb’.
The Discovery Dormancy
There have been no antibiotic discoveries since 1987 when lipopeptides were discovered. This discovery void inter alia has financial underpinnings. Drug development is a lengthy and expensive process and the potential profits from antibiotic development are not luring. Research and development in drugs for common chronic diseases like diabetes and hypertension are more likely to convince companies of returns on investment, for there is no issue of resistance with these drugs, unlike antibiotics. Moreover, these drugs for chronic diseases are used for life whereas antibiotics are likely to be used as a last resort for a limited period of time.
A World without Antibiotics – The Post Antibiotic Era
This increasing antibiotics resistance with no new antibiotics in the pipeline is what is being feared as the ‘antibiotic apocalypse’ or the coming of the ‘post-antibiotic era’. A world without antibiotics is not going to be very different from a sci-fi movie. It is set to induce a paradigm shift in modern-day medical practices. Imagine a world where a scratch can plunge a soul into the jaws of death or a trivial infection may turn out to be fatal.
It will be a world where tuberculosis is treated with fresh air in sanatoriums. Poor countries will be affected the most, given their poor sanitation, lack of portable water, malnutrition, HIV, overcrowded urban areas and other factors. Surgeons use antibiotics before and after surgery to avoid infectious complications. In the absence of antibiotics, routine surgeries will carry significant morbidity and mortality, reversing us back to the pre-antibiotic era.
Transplantation will cease to be a possibility anymore. Transplantation of organs requires that the immune system is suppressed by drugs so as to avoid rejection of the transplant by the body. In the absence of antibiotics, a transplant patient would most probably die from an infection. Similarly, chemotherapy for cancer patient suppresses the immune system. Chemotherapy will no longer remain feasible.
Resistance verses Rationality
After about 85 years since the discovery of penicillin, our battle with these microbes is fiercer than ever before and our anti-microbial arsenal has been outclassed. This colossal challenge can be countered by rational and appropriate use of antibiotics, particularly in primary health care settings. A renewed commitment to discovery and development of antibiotics is the need of the hour.
This reminds one of what Dr Joshua Lederberg wrote, “The future of humanity and microbes likely will unfold as episodes of a suspense thriller that could be titled Our Wits Versus Their Genes.” He won the 1958 Nobel Prize in Physiology/Medicine for discovering that bacteria exchange genes.
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