Antibiotics are probably the drugs that have transformed modern medicine the most. Thanks to them, deadly diseases of the past, such as leprosy, cholera, bubonic plague, pneumonia or tuberculosis, are now cured.
In addition, these drugs have become essential “therapeutic tools” for treatments that tend to weaken the patient’s immune system, what we would commonly call “our defenses”.
For example, in people undergoing chemotherapy for cancer, dialysis for kidney failure, transplant, or general surgery. In these cases, antibiotics help resolve infectious conditions, that is, complications that these patients often suffer from and which compromise their health and, with it, their recovery.
Since the discovery of the first antibiotics in 1940, and as a result of the success achieved later with their use, the misconception that they were “miracle drugs”, with “powers” capable of curing anything, has spread.
This has led to their misuse and, in many cases, inappropriate use in medicine, veterinary medicine and agriculture, even to treat diseases not caused by bacteria. This behavior has encouraged the emergence and worldwide spread of “superbugs”.
They are not new microorganisms, but “improved”, that is, they have evolved and adapted to survive the attack of the enemy, antibiotics.
Fight against bacterial resistance
“Superbugs” are very dangerous for hospital patients or those with weakened immune systems, as they have become strong against even the strongest or last resort antibiotics, such as colistin.
Bacterial resistance to antibiotics is a natural phenomenon that we cannot avoid. This is how bacteria survive when exposed to a hostile environment.
However, it is important to remember that we are very responsible for the resistance levels currently achieved and that it has become one of the most serious public health problems today.
Despite the fact that society is becoming more and more responsible in its use, thanks to health controls and numerous awareness-raising and awareness campaigns, there is still a lot to be done in this fight, especially in the veterinary field.
Of particular concern is the impact of bacterial resistance to antibiotics on the growing elderly population, hospital patients or those with weakened immune systems. In these cases, treatment options are increasingly limited or non-existent.
Towards global awareness
The resistance of bacteria to antibiotics has a huge economic impact on health systems and society. The European Center for Disease Prevention and Control (ECDC) estimates that around 25,000 Europeans die each year from direct multi-drug resistant infections.
This represents an expenditure of 1.5 billion euros ($ 1,777) in additional patient care costs. To this, we add the improvements obtained in the management of chronic diseases, as well as the progressive aging of the population.
Yet antibiotic resistance is reaching levels so dangerous that the World Health Organization (WHO) estimates that by 2050, deaths from bacterial infections resistant to antibiotics will exceed those caused by cancer.
If this continues like this, in thirty years some 10 million people could die from this problem each year. This has led to bacterial resistance to antibiotics being viewed as one of the three greatest threats to human health in the decades to come.
Covid-19, a worsening of the problem
Although it is still too early to assess its full impact, the crisis generated by Covid-19 seems to exacerbate the problem of bacterial resistance to antibiotics.
Since the start of the pandemic, studies carried out in different hospitals have revealed high rates of prescription of antibiotics in patients with covid-19.
Perhaps what was experienced during the 1918 influenza pandemic (influenza), and its devastating consequences, has led us to speculate that patients may have pneumonia due to secondary bacterial infection, in addition viral infection.
The 1918 pandemic (known as the Spanish Flu) stood out because it lasted for over a year, infected around a third of the world’s population, and killed over 50 million people. There is ample evidence to show that the majority of deaths from the 1918 flu were attributed to secondary bacterial pneumonia.
Although antibiotics do not treat viruses like SARS-CoV-2, patients with Covid-19, and in general any type of general influenza virus, become very susceptible to a secondary bacterial infection, which does not can be treated. with antibiotics.
This happens because viruses alter the innate and adaptive defenses of the host. Therefore, bacteria such as Streptococcus pneumoniae, Staphylococcus aureus or other colonizers take advantage of this temporary “weakness” to cause secondary bacterial pneumonias.
It is estimated that between 10 and 30% of patients with influenza virus will suffer from this type of problem. The heavy use of antibiotics that we have been forced into in recent months by the covid-19 pandemic could further exacerbate the problem of antibiotic resistance from which we already suffer. Especially in the most affected parts of the world.
SARS-CoV-2 has shown that it is not possible to develop a cure for tomorrow and reflected the terrible cost of not being prepared against microorganisms. Antibiotic resistance progresses more slowly, but its course is relentless
* Professor of the Department of Organic Chemistry, Principal Investigator of the Singular Center for Research in Biological Chemistry and Molecular Materials (CIQUS), University of Santiago de Compostela