ANTIBIOTIC RESISTANCE - Bacteria are prone to DNA mutations. This is part of their natural evolution and allows them to constantly adapt their genetic makeup. What if nothing happens the next time you pop one of those little bug-busting pills? Your life could be in serious danger. The WHO call antibiotic resistance ‘one of the biggest threats to global health.’ Bacteria are an integral part of our ecosystem and we share our bodies with many of these tiny creatures. However, they can be the root of serious health problems. There are roughly as many human cells as bacterial cells in our bodies, and our microscopic passengers pay their way by helping our immune system and contributing to our metabolism. But bacteria come in all manner of guises. Some can turn from friend to foe, while others are just plain nasty and will make us sick at any chance they get. Since their discovery in the 1920s and their introduction into mainstream medicine after World War Two, we’ve been relying on antibiotics to keep pathogenic bacteria at bay. Antibacterial resistance is on the rise, however. Bacteria are prone to DNA mutations. This is part of their natural evolution and allows them to constantly adapt their genetic makeup. When one bug naturally becomes resistant to a drug, it survives when all others are killed. Now it’s a race against the clock.

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Antibiotic Resistance

What causes antibiotic resistance?

Bacteria are prone to DNA mutations. This is part of their natural evolution and allows them to constantly adapt their genetic makeup - when one bug naturally becomes resistant to a drug, it survives when all others are killed

Written by Yella Hewings-Martin, Ph.D.

Fact checked by Jasmin Collier

Most of us will have taken antibiotics at some point in our lives.

But what if nothing happens the next time you pop one of those little bug-busting pills? Your life could be in serious danger.

The WHO call antibiotic resistance ‘one of the biggest threats to global health.’

Bacteria are an integral part of our ecosystem and we share our bodies with many of these tiny creatures. However, they can be the root of serious health problems.

There are roughly as many human cells as bacterial cells in our bodies, and our microscopic passengers pay their way by helping our immune system and contributing to our metabolism.

But bacteria come in all manner of guises. Some can turn from friend to foe, while others are just plain nasty and will make us sick at any chance they get.

Since their discovery in the 1920s and their introduction into mainstream medicine after World War Two, we’ve been relying on antibiotics to keep pathogenic bacteria at bay.

Antibacterial resistance is on the rise, however.

According to the Centers for Disease Control and Prevention (CDC), each year in the United States, at least 2,049,442 illnesses are caused by resistance to medicines prescribed to treat bacterial or fungal infections.

What is more, 23,000 people die each year when these drugs fail to work.

So, why have our once reliable antibacterials stopped working, and how do the pesky bugs manage to outfox us? It’s all about mutations.

Mutations, a ‘natural phenomenon’

Bacteria are prone to DNA mutations. This is part of their natural evolution and allows them to constantly adapt their genetic makeup.

When one bug naturally becomes resistant to a drug, it survives when all others are killed.

Now it’s a race against the clock.

How quickly can this one bacterium adapt to the new mutation, and how quickly can it replicate in the face of species eradication?

If the bug comes on out top, it’s bad news for the infected individual and bad news for society at large: the drug-resistant bacterium will likely spread.

Not only has it evaded the grim reaper, but it can also now spread the love by passing the resistance to its numerous offspring, who will soon be the dominant species on the block.

Bacteria are also able to pass genes to other bacteria. This is known as horizontal gene transfer, or “bacterial sex.”

While this process is actually quite rare, bacteria are highly mobile creatures, which gives them plenty of opportunity to come into contact with other microbes and pass on their mutated genes.

But how do genetic mutations equip bacteria with the skills to outsmart antibiotics?

Combating antibiotics

A study recently published in Nature Communications sheds new light on how Echerichia coli and other members of the Enterobacteria family fight off commonly used antibiotics.

A gene called mar is commonly shared by family members.

Some of the proteins encoded in this gene can switch on other genes, explain researchers from the University of Birmingham’s Institute of Microbiology and Infection in the United Kingdom.

“We found two completely unexpected mechanisms,” says senior study author Prof. David Grainger, “that bacteria use to protect themselves from antibiotics. One protected their DNA from the harmful effects of fluoroquinolone antibiotics, and the other prevented doxycyline getting inside bacteria.”

But finding out how Enterobacteria combat antibiotics is only the first step in this decade-long research project.

First study author Prateek Sharma, Ph.D., says that “the resistance mechanisms that we identified are found in many different species of bacteria therefore, our research could lead to the discovery of molecules that could be developed into new drugs that can treat bacterial infections.”

The World Health Organization (WHO) call antibiotic resistance “one of the biggest threats to global health, food security, and development today.”

The need for new drugs is great.

‘Overuse and underuse’ of antibiotics

This week is World Antibiotic Awareness Week. The WHO aim to warn people that inappropriate use of antimicrobials makes drug resistance worse. This includes both overuse and underuse.

This year, they urge everyone to “[s]eek advice from a qualified healthcare professional before taking antibiotics.”

To find out more, here is video from the WHO explaining why they think that “everyone has a role to play to help reduce antibiotic resistance.”

https://youtu.be/-ZX97bIbZBQ

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https://www.medicalnewstoday.com/articles/320070

TAKING ANTIBIOTICS - When To Take Antibiotics (And When To Avoid Them) - Antibiotic-resistant superbugs are on the rise and we're being urged to forgo antibiotics wherever possible to limit their spread. In general, a patient will be given antibiotics if her symptoms are severe (a high fever or skin rash, for instance, or inflammation spreading around an infection site); she has a higher risk of complications (such as an elderly patient with suspected pneumonia); or if the infection is persistent. To prescribe, the doctor makes an educated guess as to what may be causing the infection. This is based on knowledge of what type of bacteria are normally found in these cases and, if available, the patient's history. In the absence of an accurate diagnosis, as well as to minimise potential risk to the patient, a broad-spectrum antibiotic is used to "cover as many bases" as possible. Until we can develop point-of-care technology that can identify a bug on demand, such broad-spectrum drugs (the grenade approach to bacteria) are a better option for doctors than targeted specific drugs (a sniper against superbugs). But the latter is the better long-term option for the patient and the community, although it may not always work. One key problem with broad-spectrum "grenade" antibiotics is that they can cause collateral damage by killing a lot of good bacteria.

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Taking Antibiotics

When To Take Antibiotics (And When To Avoid Them)

Matthew Cooper

Antibiotic-resistant superbugs are on the rise and we're being urged to forgo antibiotics wherever possible to limit their spread.

But serious bacterial infections can only be dealt with effectively using these drugs. So when should you take antibiotics?

The easy answer, of course, is when your doctor tells you to. But there's more to it than that.

We know that rates of bacterial resistance track antibiotic usage rates.

So, as a community, the more we take these drugs, the more likely we are to have superbugs down the line. And Australia may face a bleak future in these terms.

Antibiotic myths and facts

The Australian government's 2015-2019 National Antimicrobial Resistance Strategy highlighted some interesting, if somewhat disturbing, facts:

A 2014 poll of Australian workers showed 65% believed taking antibiotics would help them recover faster from a cold or flu

20% of people expect antibiotics for viral infections, such as a cold or the flu

Nearly 60% of GPs surveyed would prescribe antibiotics to meet patient demands or expectations

surgical prophylaxis (giving antibiotics before or during surgery to minimise the risk of infection) is used in 41% of cases, which is much higher than the recommended best practice of less than 5%

Clearly, we still don't understand that antibiotics won't kill viruses responsible for the flu and many common colds.

And a majority of doctors take a seemingly lackadaisical approach to antibiotic stewardship. It's no surprise then that the 2013 National Antimicrobial Prescribing Survey showed 30% of antibiotic prescriptions were inappropriate.

Antibiotics are amazing drugs that can prevent serious harm and stop infections becoming fatal. They're often used for:

lung infections, which include bacterial pneumonia and pertussis (whooping cough)

urinary and genital infections, some of which are sexually transmitted

eye infections (conjunctivitis)

ear, nose and throat infections (otitis, sinusitis and pharyngitis)

skin infections (from impetigo in schoolchildren through to more serious diabetic foot ulcers)

diarrhoea and more serious gut infections, such as those caused by Clostridium difficile

In general, a patient will be given antibiotics if her symptoms are severe (a high fever or skin rash, for instance, or inflammation spreading around an infection site); she has a higher risk of complications (such as an elderly patient with suspected pneumonia); or if the infection is persistent.

Getting it right

To prescribe, the doctor makes an educated guess as to what may be causing the infection. This is based on knowledge of what type of bacteria are normally found in these cases and, if available, the patient's history.

But she doesn't know exactly what type of bug is causing the infection.

In the absence of an accurate diagnosis, as well as to minimise potential risk to the patient, a broad-spectrum antibiotic is used to "cover as many bases" as possible.

Until we can develop point-of-care technology that can identify a bug on demand, such broad-spectrum drugs (the grenade approach to bacteria) are a better option for doctors than targeted specific drugs (a sniper against superbugs).

But the latter is the better long-term option for the patient and the community, although it may not always work.

One key problem with broad-spectrum "grenade" antibiotics is that they can cause collateral damage by killing a lot of good bacteria.

We now know that we have about a kilogram and a half of good bacteria in our guts that help us digest food. They also "crowd out" potential nasty infections caused by bad bacteria.

There are cases where patients on antibiotics end up with diarrhoea, thrush (a vaginal infection caused by Candida that goes wild when protective bacteria are wiped out), or nasty infections, such as Clostridium difficile, that can lead to severe colitis.

And it gets worse: a recent Danish study that followed more than a million patients found an association between frequency of antibiotic use and Type II diabetes, generating considerable media interest.

It found people who received more than four courses of the drugs over 15 years were 53% more likely to develop diabetes.

Caveats and conclusion

Of course, there's the cause-effect corollary. People who were already heading towards the disease may simply have been less healthy, more prone to infection, and hence had more visits to the doctor to get antibiotics.

The study showed an association between antibiotics and diabetes, not causality.

So where do we stand now? Remember bacterial infections can kill, and antibiotics save lives, so if you're really feeling crook, go to your doctor and take her advice.

But also think twice. If you have a bad cold or think you have the flu, remember this may be due to a viral infection. And using antibiotics could do you more harm than good in the longer term.

The real game changer in all of this will be a "tricorder" diagnostic that can identify a bug on site. With such a technology, a doctor could prescribe the right drug, the first time, in time. So be sensible about using antibiotics and let's keep our eyes on this prize.

Matthew Cooper, Prof. Institute for Molecular Bioscience, The University of Queensland

https://www.lifehacker.com.au/2015/09/antibiotics-when-to-take-them-and-when-to-avoid/