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Published On: Tuesday May 30, 2017
Sniffles or sore throat, every home has a plastic box overflowing with medicines to the rescue. Today, apart from painkillers, antibiotics are the most common self-prescribed drug. Their use and misuse have triggered numerous discussions in the medical fraternity. If there was ever a term that consolidated into daily vernacular from an exhaustive list of prescribed drugs, it would be ‘antibiotic’. What does it imply? what makes this particular medicine so unique? how does it work? Can its unmonitored use be dangerous? Read on to find out.
The wonder drug
Antibiotics took center stage around 1929 with the inadvertent discovery of Penicillin by Sir Alexander Fleming. But this was not the first time they had been used in healthcare. Nearly three thousand years ago, the Chinese treated skin diseases by applying mouldy curd on it. Ancient Ayurveda suggested the use of Chaulmoogra oil for treating leprosy. The discovery of microorganisms (1665 – 83) replaced this empirical use with more researched compounds containing arsenic dyes (Ehrlich’s phase). It was only by the 1940s that clinical use of penicillin commenced. These miracle drugs took the market by storm. They were unique in that they could cure the cause of the disease and not merely its symptoms. Present day scenario might render it trivial but for the millions of lives saved from tuberculosis, typhoid, tetanus, and other deadly infectious diseases, antibiotics were indeed wonder-working drugs.
How do they work?
Microbes are a normal part of the human body. They are said to constitute approximately 1-3% of total body mass. Essential for a variety of functions, they are maintained in a state of ‘equilibrium’. Most of these bacteria are harmless but under conducive environments ( such as reduced immunity) can turn pathogenic. Disease-causing bacteria like M. Tuberculosis or C. Diphtheriae, on the other hand, are dangerous even to a healthy individual. An infection occurs when pathogenic microorganisms invade and multiply within body tissues.
Antibiotics are used to combat a bacterial infection. They destroy the microorganisms without affecting the recipient. Categorized under “antimicrobials”, they are classified into, Broad spectrum – those that act on most of the microbes and Narrow spectrum – those that act on the specific group of microbes. The method of action varies from group to group, with an ultimate goal of destroying the targeted microbes by either killing them or stopping them from growing/multiplying. Depending on the characteristics of the causative organism, a suitable drug is chosen. Antibiotics act on bacteria and are useless in viral infections such as common cold.
When a physician treats an infection HE/SHE takes into account a myriad of things such as signs/symptoms, age & weight of patient, extent,and site of disease, the lifecycle of bacteria etc. After careful consideration of these factors, a suitable dose of AMA (antimicrobial agent) is determined for the ailing patient. The treatment specifies exactly which drug is to be used, in what amount and for how long. It is explained to the patient that the drugs must be taken on time and for the precise number of days so that all resistant bacteria are destroyed. This schedule is designed to completely eliminate the disease-causing bacteria from the body. If not strictly adhered to, there is a chance of microbes becoming unresponsive or tolerant to the given drug. Highlighting the fact that ill-informed self-prescription of antibiotics can be dangerous.
The dangers are not merely limited to antibiotic resistance. Administering AMAs to an individual who is allergic to them can be life threatening. Prescribing them without considering the age, weight and medical status of the recipient, can lead to severe organ damage or even death. Some antibiotics when consumed during pregnancy can cause developmental diseases in the child. Thus, the importance of medical consultation before ‘popping a pill’ cannot be emphasised enough.
what do you mean by resistant microbes?
Microorganisms rapidly adapt to their changing environment. As discussed earlier, each AMA has a specific mode of action. For e.g. Penicillin damages the cell walls of bacteria, causing them to die. Soon, the bacteria are able to interpret the threat posed by this drug and evolve necessary defense mechanisms against it. Over a period of time, the AMA becomes ineffective and obsolete. This is known as antibiotic resistance.
The twentieth century made ‘Amoxy’, ‘Ciplox’ and ‘Azithro’ common household names. Sir Fleming warned against this in his ominous prediction in 1945, saying “public will demand [the drug and] … then will begin an era … of abuses.” After it’s miraculous contribution to war medicine, antibiotics began to be overused, misused and globally overprescribed. Soon, these drugs were no longer effective. By 2013 Centre for Disease Control (CDC) declared that the human race was in the “post-antibiotic era”. WHO, in 2014, warned that this crisis was becoming dire. Advances in research for the development of new and effective antibiotics seemed sluggish compared to the pace at which resistant strains of microbes evolved.
What happens now?
The crisis faced by modern medicine brought about a global alliance to investigate possible solutions. It was found that public awareness and education were the top priority at this stage, accompanied with accelerated research in drug therapy and strict pharmacological regulations. Scientists are constantly at work trying to find more effective antibiotic regimens. Synthetic compounds are being crafted to curb the resistance. Genetics, microbiology and medicine are collaborating to create a smart drug that evolves in its attack MOA concomitant with the evolution of defense by bacteria. These advances might offer respite for future generations. Meanwhile, it is in the hands of the general public to control the outcome.
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Content Credit: Dr.Nikita Pande, Pune