A major problem today is the prospect of antibiotic resistance. With growing cases of superbugs appearing and the difficulty associated with creating new antibiotics and integrating them into the market, it seems that the fight to keep up with bacteria is waning. Ayush Kumar, a professor in the department of microbiology and medical microbiology at the University of Manitoba, spoke to the Manitoban about the history of antibiotics and the problems that arise from antibiotic resistance.
Learning from the past
Kumar believes that by understanding the historical significance of antibiotics, we as a society can understand the severity of the issue confronting us today and learn from the mistakes of the past.
“People were starting to think in the 1800s that there are molecules that can selectively kill one kind of cell and not others,” said Kumar.
“This idea was coming from trying to kill cancer cells, but not killing normal cells, things like that. And that’s when people started thinking ‘well, there might be molecules that maybe bind to only bacterial cells but not to human cells.’ So one of the first antimicrobials that was being used was an arsenic-based compound to treat syphilis. But arsenic is very toxic to us as well. But they found that if administered properly […] maybe there was some benefit to it.”
Why do our bodies reject antibiotics?
Antibodies are used to either prevent bacteria from reproducing, or kill it entirely. This allows the human body’s immune system to tackle the problem more easily and decrease the magnitude of the physiological response. Bacteria are known especially for their capacity to reproduce quickly and primarily asexually through binary fission. More recently, these factors have proven to be more worrying, primarily in pathogenic bacteria.
Kumar explained that there are two underlying factors that cause resistance to antibiotics: intrinsic resistance and acquired resistance. Intrinsic resistance would be when an organism is resistant to a type of antibiotic naturally.
“If we use antibiotics irresponsibly, if we are not using the right dose, what can happen is that in a community of microorganisms, you may have one or two cells that are intrinsically resistant,” Kumar said.
“They are the ones that will survive and the other ones will die. And now [the surviving organisms] will propagate, and now you’re left with just resistant organisms. Which means that the next time you use that antibiotic, it is not going to act.”
Kumar then expanded on the second factor that causes antibiotic resistance, which is acquired resistance, or when resistance to antibodies is created and updated to keep up with antibodies.
“Microbes are very good at exchanging genetic material, so even if they don’t have intrinsic resistance to antibiotics, they can change small pieces of DNA, like plasmids, that specifically encode for resistance mechanisms for antibiotics,” said Kumar.
“That happens on a regular basis. But if you have this antibiotic selection pressure, then you are actually encouraging that genetic transfer.”
The influence of agriculture
A major contributor to antibiotic resistance today can be traced down to copious amounts of antibiotics being used within the field of agriculture as a way to maximize profit at a minimal cost. Kumar believes this is certainly a contributor to current antibiotic resistant strains but believes that there are other factors that contribute.
“Antibiotics are used as growth promoters for a lot of these animals, which means that a lot of these places, they actually use low levels of antibiotics, low concentrations, to promote growth,” he said.
“In the 1950s and 1960s, people actually found that when they fed their animals antibiotics, low levels of antibiotics, they grew faster. Which is obviously beneficial if you’re running a farm in order to sell meat. So that practice sort of became the fairly standard practice.”
Kumar added that while this may contribute to human’s resistance to antibiotics, it brings up as many questions as it answers.
“So we know that when we do something like that, it’s creating a selection pressure. But there are a lot of factors that are actually contributing to antibiotic resistance. This is just part of a big, big puzzle,” Kumar explained.
“The reality is that in the U.S. and Canada, out of all the antibiotics that are produced, 80 per cent of that is used for animals. So are these farms contributing to resistance? Well, if we are using that many antibiotics, then yes they are. But again, there are multiple factors.”
When Kumar was asked whether the often-questionable conditions of these farms where the animals are kept was the reason for the generous amount of antibiotics being used, he argued that it was more of a culture to use many antibiotics in farming rather than the conditions the animals are put through.
“There are people who are involved in farming trying to stay away from antibiotics and the reality is, I think, consumerism drives these things,” Kumar said.
“I think it’s A&W that is now claiming that their chicken is raised without antibiotics […] that means they are doing that because people are being educated. So that will sort of encourage the practice of not using antibiotics.”
Are we nearing a post-antibiotic era?
Fear that the constant over-indulgence and over-reliance on antibiotics has the potential of decreasing the effectiveness of antibiotics is a concern amongst many people. In addition, many believe it is our job to preserve what antibiotics we have left since it takes years, sometimes decades, to create an entirely new variety.
When presented with this question, Kumar once again stressed the important of understanding the history of antibiotic research and the reason for this over-indulgence.
“I think the fear is that the post-antibiotic era is already here – that somebody is going to be at the hospital, getting an infection, and [the doctors] not being able to treat the patient, and basically letting the person die,” Kumar said.
“This is happening, but there are efforts going on. Agencies like the World Health Organization have called for a lot of research and development for new antibiotic molecules so there is a lot of interest. But it is not easy.”
In response to the time-consuming efforts required for creating an antibiotic, Kumar believes that the high cost of antibiotics may be our downfall.
“Looking at the numbers from different companies it seems like in today’s world it can take anywhere from 10, to 12, to 14 years, right from finding a compound to putting it in the clinic for patients. So it’s an expensive process,” Kumar said.
“The cost of finding an antibiotic and putting it into the market is estimated to be about 1.4 billion dollars […] It’s just not a good business option, right? Economics is a big part of everything.”
This being said, Kumar also believes that there is hope in the world of antibiotic science, with new discoveries being found often.
“At the same time, there are some glimpses of hope, and there are people who have discovered some new molecules, which look very promising. So maybe they will have an impact,” Kumar said.
“But the challenge is that the reality is that we will always be playing catch-up. And we need to be smart about that. We need to be smart about how we use antibiotics.”
Some believe that antibiotics themselves are a temporary phenomenon based on the tremendously speedy rates of bacterial mutations and reproduction. When asked about this, Kumar explained he believes that the key is figuring out how to slow the process of disease down and this is closely linked with crucial changes within society.
“We know people still, [who have a] cold, go to their physician and they say ‘I need antibiotics,’ when 80 per cent of the cold is actually caused by a virus. So in 80 per cent of those cases antibiotics are useless,” Kumar said.
“A lot of physicians are actually just [going to say] go wait it out for a week, and if it doesn’t get better, then come back. So I think that’s changing, that practice is changing. Education is a big part of that. And that’s the key, basically, I think, people getting educated about this problem.”
Antibiotics are an integral component in the fields of health and research and organizations like the WHO continue to stress the importance of preserving these drugs and putting in the effort to discovers new ones. By prioritizing these issues and making subtle societal changes, perhaps playing catch-up won’t seem so impossible anymore.