What if antibiotics stop working?
Following my post yesterday - #scicomm reviews: Michael Mosley vs the Superbugs - I wanted to take a closer look at the potential alternatives currently being researched to combat antibiotic resistance. What might we be using when we run out of antibiotics?
So let's take a step back for a minute - What are antibiotics and why is antibiotic resistance such a problem?
Antibiotics are drugs that kill bacteria or prevent them from reproducing or spreading - treating or preventing bacterial infections. Most people first take antibiotics but antibiotics are used for much more than helping those at the GP surgery. Modern medicine would be unrecognisable without antibiotics - they are used to prevent bacterial infections to keep surgery and transplantation safe as well as for immunocompromised people who cannot fight infections themselves, such as cancer patients who are treated with chemotherapy or radiotherapy or patients with autoimmune diseases who take immunosuppressive drugs. So you can start to imagine how many treatments and hospital procedures could be affected if antibiotics are no longer effective.
Antibiotic resistance is a big problem because bacteria have a unique way of sharing genetic information with each other - and therefore when some bacteria develop resistance, they can pass that property onto potentially all the surrounding bacteria. This is because of horizontal transfer, a type of genetic inheritance that does not occur from reproduction (from your parents). Via horizontal transfer, bacteria can share antibiotic resistance between their neighbours.
The problem is - no new antibiotics have been discovered in over 30 years. Therefore, researchers are looking for new ways to target bacteria and aim to find alternative ways to prevent bacterial infection.
1. Searching for new antibiotic targets
Most antibiotics have been found and developed to exploit the mechanisms that bacteria naturally use to fight each other. Bacteria, just like animals and plants, are in competition for resources - food and a safe place to grow. Bacteria either need to protect themselves against destruction and/or be able to kill any competing bacteria in order to dominate in their chosen environment. So by studying bacteria present in some of the most extreme environments on Earth, we might begin to find new anti-microbial agents - for example, ocean beds and deep oceans, caves and Antarctica.
2. Develop better detection and diagnosis of bacterial infections
In yesterday's post I asked you to step into the shoes of the doctors and GPs, and think about how it must be really tricky for them to assess a patient's symptoms and diagnose an infection. Especially when the symptoms of different infections can be very similar. So by developing new diagnostic tools, doctors will be able to choose the most appropriate and targeted narrow spectrum antibiotics to just deal with the bacteria causing all the problems, instead of the broad spectrum ones which just attack all bacteria (including the good ones living harmoniously = microbiota). With genetic testing technology developing and becoming more accessible, it could even be possible to take a sample from a patient and genetically sequence the bacteria to identify what it is and what drugs it is already resistant to.
3. Resistance breakers
With research currently struggling to find new types of antibiotics, one option of could be to develop so-called 'resistance breakers' = agents targeting the bacteria's method of resistance and reversing the resistance. This way you'd be able to use the normal 'traditional' antibiotics plus the resistance breaker. One of these resistance breakers is an inhibitor for efflux pumps. Efflux pumps are a way for bacteria to literally pump out the antibiotic agents that
4. Bacteriophages
Bacteriophages are a natural virus that infects bacteria - there are a natural parasite against bacteria, and although they may not be able to completely obliterate the bacterial infection, they will be able to lower the bacterial load enough to help the immune system deal with the remainder and 'take the pressure off'. The other advantage is that these bacteriophages may be specific to certain bacteria - meaning they are a targeted treatment so they won't target the normal and safe microbiota.
In the UK, research into bacteriophages is still relatively new, but in other parts of the world, particularly eastern Europe, have seen promising results in clinical trials.
For more information, I'd recommend:
Nature open access article: http://www.nature.com/news/antibiotic-alternatives-rev-up-bacterial-arms-race-1.17621
This fantastic blog by fellow Newcastle university student: https://scishot.wordpress.com/2017/05/12/the-antibiotic-apocalypse/
And check out the BBC programme I mentioned earlier (Michael Mosley vs the Superbugs) which is still available on BBC iPlayer for 12 more days (UK only): http://www.bbc.co.uk/iplayer/episode/b08qkz77/michael-mosley-vs-the-superbugs?suggid=b08qkz77
So let's take a step back for a minute - What are antibiotics and why is antibiotic resistance such a problem?
Antibiotics are drugs that kill bacteria or prevent them from reproducing or spreading - treating or preventing bacterial infections. Most people first take antibiotics but antibiotics are used for much more than helping those at the GP surgery. Modern medicine would be unrecognisable without antibiotics - they are used to prevent bacterial infections to keep surgery and transplantation safe as well as for immunocompromised people who cannot fight infections themselves, such as cancer patients who are treated with chemotherapy or radiotherapy or patients with autoimmune diseases who take immunosuppressive drugs. So you can start to imagine how many treatments and hospital procedures could be affected if antibiotics are no longer effective.
Antibiotic resistance is a big problem because bacteria have a unique way of sharing genetic information with each other - and therefore when some bacteria develop resistance, they can pass that property onto potentially all the surrounding bacteria. This is because of horizontal transfer, a type of genetic inheritance that does not occur from reproduction (from your parents). Via horizontal transfer, bacteria can share antibiotic resistance between their neighbours.
The problem is - no new antibiotics have been discovered in over 30 years. Therefore, researchers are looking for new ways to target bacteria and aim to find alternative ways to prevent bacterial infection.
1. Searching for new antibiotic targets
Most antibiotics have been found and developed to exploit the mechanisms that bacteria naturally use to fight each other. Bacteria, just like animals and plants, are in competition for resources - food and a safe place to grow. Bacteria either need to protect themselves against destruction and/or be able to kill any competing bacteria in order to dominate in their chosen environment. So by studying bacteria present in some of the most extreme environments on Earth, we might begin to find new anti-microbial agents - for example, ocean beds and deep oceans, caves and Antarctica.
2. Develop better detection and diagnosis of bacterial infections
In yesterday's post I asked you to step into the shoes of the doctors and GPs, and think about how it must be really tricky for them to assess a patient's symptoms and diagnose an infection. Especially when the symptoms of different infections can be very similar. So by developing new diagnostic tools, doctors will be able to choose the most appropriate and targeted narrow spectrum antibiotics to just deal with the bacteria causing all the problems, instead of the broad spectrum ones which just attack all bacteria (including the good ones living harmoniously = microbiota). With genetic testing technology developing and becoming more accessible, it could even be possible to take a sample from a patient and genetically sequence the bacteria to identify what it is and what drugs it is already resistant to.
3. Resistance breakers
With research currently struggling to find new types of antibiotics, one option of could be to develop so-called 'resistance breakers' = agents targeting the bacteria's method of resistance and reversing the resistance. This way you'd be able to use the normal 'traditional' antibiotics plus the resistance breaker. One of these resistance breakers is an inhibitor for efflux pumps. Efflux pumps are a way for bacteria to literally pump out the antibiotic agents that
4. Bacteriophages
Bacteriophages are a natural virus that infects bacteria - there are a natural parasite against bacteria, and although they may not be able to completely obliterate the bacterial infection, they will be able to lower the bacterial load enough to help the immune system deal with the remainder and 'take the pressure off'. The other advantage is that these bacteriophages may be specific to certain bacteria - meaning they are a targeted treatment so they won't target the normal and safe microbiota.
In the UK, research into bacteriophages is still relatively new, but in other parts of the world, particularly eastern Europe, have seen promising results in clinical trials.
For more information, I'd recommend:
Nature open access article: http://www.nature.com/news/antibiotic-alternatives-rev-up-bacterial-arms-race-1.17621
This fantastic blog by fellow Newcastle university student: https://scishot.wordpress.com/2017/05/12/the-antibiotic-apocalypse/
And check out the BBC programme I mentioned earlier (Michael Mosley vs the Superbugs) which is still available on BBC iPlayer for 12 more days (UK only): http://www.bbc.co.uk/iplayer/episode/b08qkz77/michael-mosley-vs-the-superbugs?suggid=b08qkz77
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