Antibiotic Resistance Crisis P3: Ugly fights, ugly truths

After the basics and history of Antibiotics, it is finally time to look at what’s going on right now. Why are we about to lose the biggest battle against infectious diseases of all time? And can we come up with new – or better; old – ideas to end the War?

Ugly Fights
A simplified explanation about the fighting skills of antibiotics is as ugly as Weinstein’s pick-up lines. When antibiotics target bacteria, they attach to it like a tree hugger dipped in supper glue and spray their loads of antibiotic snot into the bacteria. This kills the bacteria. They die, maybe because of disgust and shame, probably because their cell walls are destroyed, and all their mini-intestines are bursting out.

However, it appears that bacteria had found multiple ways to defend themselves against our antibiotics. One of which is that, when we bomb them, only the bacteria in the bomb shelters will survive. Well, these clever families had an aha-moment and told their kids to get bomb shelters as well. And not only that, no, they also told their neighbors about the shelters. In fact, they’re telling everyone that gets into close contact with them. So all information about getting resistant are being shared constantly.

Ugly truths

In every war mistakes are made. And for some it might be difficult to admit: in the Antibiotic War it is no different. We, humans (well most of you are), are to blame.

In the first Article on this topic I mentioned that Antibiotics kill bacteria and bacteria only. But still many people and doctor want to treat viruses and/or parasites with antibiotics. It doesn’t help the war, on the contrary, it provides bacteria the opportunity to practice their fighting skills and create bomb shelters.

We are also making mistakes in this War, by practices in an area which doesn’t seem to be linked to this War: the Meat Industry. As a species we eat meat and want a lot of it. To keep up with demand, farmers made a growth cocktail for their stock to make them grow faster and fatter. In this cocktail they put, you guessed it, antibiotics. The same kind as we use to treat diseases are being used for perfectly healthy animals to make them grow. Now this is a problem in two ways:

1. directly: when we eat the meat of the cow with so many antibiotics in them, we also eat the resistant bacteria that’s in the meat. And they are planning to stay.
2. indirectly: more stock with resistant bacteria ensure resistant bacteria all around them. They tell the bacteria from the farmer the tricks of resistance. And the fertilizer made from the dungs of these cows contains the resistant bacteria which we are spreading over the fields where our vegetables grow, we drive past it, we touch it. You get the picture.

The new, but also old Superhero? Bacteriophages

It’s like we had a battleplan and showed our entire arsenal to the enemy years before actually attacking them and then keep showing it to their families in the hope they won’t tell or act on it. Well, of course they will and of course they did.

What can we do? Well, I’m an infectious disease specialist and if I want to kill a lot of terrorists in a short time and I know where they’re hiding, I’ll might just throw some Ebola on their heads. That will get rid of them. Can we do this with bacteria? Yes, we can. Do we need Obama? Well, maybe, but for this war we need a “disease” that can actually kill bacteria. Its name; Bacteriophage. Discovered in 1919 and severely neglected since the rise of antibiotics. But it has potential people, really. It’s being used already in some countries to treat local wound infections. It’s not developed yet to survive the whole complexity of a human. In my view we need to spend some of our scientific budget to explore this option. We can throw away our original battle plan and attack the bacteria in a way they never saw coming. And who knows, maybe we’ll find Viral-“phages” and Parasito-“phages” as well.

In the meanwhile: some advice to survive the War

We all know how long it takes for a new idea to get to the public. So, in the meanwhile let’s try this:

1. Don’t take antibiotics if you don’t need to! People specialized in this – ID specialist like me or medical microbiologists – should be consulted if there is any doubt on this point. I expect a lot of calls!
2. For doctors: Take cultures before starting antibiotics and change to a sniper as soon as possible
3. For doctors: Stop antibiotics if a different cause is proven as the source of the infection
4. For governments: demand a stop on antibiotic use for growth of stock.
5. Eat other things than just meat and think about what kind of meat you’re eating
6. Wash your hands before you eat, like really, wash them, no kidding.

Do this, and we might stand a chance against this crisis until we implement our bacteriophages.

Good luck everyone, see you on the other side!

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Antibiotic Resistance Crisis P2: The Battle

My previous article was about the basics of antibiotic use and that it is an Art to fight the Antibiotics War against bacteria. How we can use Nuclear bombs, but probably hurt innocent bacteria. That we want snipers that know where and how to kill them. And that we were lucky in 1928: the first antibiotic literally flew into our lives to save us from these tiny terrorists, his name: Cillin, Penicillin. 

In this second article about Antibiotic Resistance we will focus on the actual Battle.

Intra-Bellum

When did this Battle start, I hear you asking? You might think it started close to 1928. That we started curing people almost immediately, right? Well, no. Humanity wouldn’t be humanity if we didn’t wait for 15 years to introduce Penicillin. Three years after the first bacteria became resistant to it. Already 0-1 behind.
Researchers from Oxford were working hard to make a working, safe and producible medicine of Penicillin, but it wasn’t easy. After years of research, they eventually had to reach out to the corn farmers from USA to help them bottle the precious mold juice that was the Antibiotic. Around 1941 the production started on a small scale. Like the BBC said in 1942: “Good science is not often quick in getting results.”

Mankind finally kicked back with Penicillin during a genuine real-life battle. The year was 1943, it was World War II. You probably heard about it, it was a pretty big war. What you probably did not hear before is that during the War soldiers could die from a simple splinter. While fighting a World War, we were still losing the Small Wars inside our body.

Fake news? Who cares!

It was probably thanks to some fake news and proper propaganda Penicillin came to the allied forces in 1944. And it involved Churchill. You know, 69 years old, overweight, heavy smoker, avid drinker. Well, he got a pneumonia in December 1943 and got pretty sick. Aaah. But he got saved. Yeah. So far, this is true. But then came the propaganda for Penicillin in the newspapers, here we go:

1. When Churchill was a boy (true, he once was a boy),
2. a man had saved him from drowning (not true)
3. Churchill’s father was so grateful that he paid for the hero’s son to attend medical school (also not true, never met him in his life).
4. That son, Alexander Fleming, discovered Penicillin that saved Churchill’s life (also, sorry, not true, he didn’t even get Penicillin).
5. And Churchill lived happily ever after (Well, he died in 1965, so not true).

And even though Churchill may not really have been helped by Penicillin, the propaganda helped the industry to get a move on things. In March 1944, 18 months after the BBC had reminded its listeners that good science goes slow, a factory began pouring out penicillin. 

Sex on the beach (well, probably after getting of the beach)

If you realize that in WW I 50,000 soldiers died from infectious diseases versus 1,265 during WW II where twice as many people fought, you understand why Penicillin was called a Wonder Drug. On June 6, 1944, allied soldiers carried that Penicillin with them onto the beaches of Normandy, benefitting 100,000 or so soldiers from that day.
And wow, that was a good call. After getting of the beach, the soldiers had a little bit too much trauma-relief-sex at the time. They got infected with Syphilis and Gonorrhea and yes, these could be cured by Penicillin. There were actual discussions going on where to introduce the antibiotic first, on the battlefield or in the bordello.
German soldiers probably experienced similar levels of sexual transmitted infections, but they had no remedy. Some theories go that the resulting advantage in troop strength may have tipped the balance of the war in favor of Allied forces during key engagements late in the war. Yeah, I know, but I did say it was a theory…

Introducing the beta lactam family
After the war ended, when everyone that was not dead or heavily traumatized returned to their homes, scientists were able to proof that the medicine was safe and working. Not all bacteria could be killed by the Penicillin, so they started their research on broadening the spectrum by adding stuff on Penicillin making it stronger and able to kill other bacteria as well. Think of The Incredibles meets Fantastic Four.  A whole family of Penicillin cored antibiotics emerged called: beta-lactam antibiotics. A Super Hero family that changed our lives for years.
A family however, that is also under severe threat by a Super Intelligent Army that chances the Rules of the War against Terrorist Bacteria: Antibiotic Resistance.

Next week, in the last episode of the Antibiotic Resistance crisis, Part 3:  Ugly fights, ugly truths.

Antibiotic Resistance Crisis P1: The Art of Antibiotic Warfare by Sun Tzu Bierhoff

This is the first article in the trilogy of antibiotic resistance. Let’s take a look at some basic rules of Antibiotics, how to use them and how we got them in the first place.

Fact 1: Antibiotics kill bacteria! Not viruses (like flu), not parasites (like your ex-wife or ex-husband), just bacteria.

Super simple and easy to understand. Well, not in practice, not in the daily healthcare. An example:

The common cold and the flu are caused by viruses. Are they killed by antibiotics? … (did you shout it out?) Indeed, NO! Many people ´suffering’ from these viruses visit their doctors and demand antibiotics. Or in some countries they just go to a pharmacy to buy some themselves. Kudos for their assertiveness, major penalty points for their solution. It won’t help. In fact, it can cause a lot of damage in both the short term – their own health is at risk – and the long term: antibiotic resistance.

Fact 2: You, yes you, carry millions of bacteria in your body and that’s ok, you need them.

When they stay in their designated places, bacteria are fine. It is only when they travel that they can cause problems. For instance, bacteria from your bowels can cause urinary tract infections and bacteria from your mouth causes pneumonia. So, some of the “bad bacteria” are also “good bacteria”, all at the same time. And we never want to kill the good guys, right?
This is where the struggle begins in Antibiotic warfare.

Nuke’m or shoot’m

Picture a bacterial infection as having a group of terrorists in a certain part of your body, let’s say in your urinary tract. To kill the terrorists, we can use a nuclear bomb. It will probably kill the terrorists but it will also cause a lot of collateral damage. In this example: the bad bacteria in the urinary tract, were the good guys in your bowels. Because we’ve nuked them and all other bacteria in your body, now you have diarrhea, leading to bad infections, and so on, and in the end, you may die. Sorry about that.

We’d rather use a sniper, a specific antibiotic, to kill the terrorist. To use a sniper, we need to know a couple of things.
1. Where are the bacteria hiding?
We need to choose an antibiotic that can shoot at the right place, at the right time. Not all snipers can go into every dark place of your body (no, not even there).

2. Which bacteria usually cause that particular kind of infection?
The bacteria causing of urinary tract infections are rarely the cause of pneumonia. So, these different bacteria need a different sniper, they need different antibiotics.

So, let’s continue with the example of the urinary tract infection. We need to establish first whether the terrorists are hiding in your left kidney (Middle East region) or your bladder (Western Europe). Then we need to culture your urine so we can see what bacteria is attacking us. This culture can take often five days, so we start a war using antibiotics based on the usual suspects (not a nuclear bomb but still a big bomb). As soon as we know the exact bacteria and what it’s susceptible for, we stop our bombing and bring in the sniper.

My name is Cillin, Penicillin

The James Bond of Antibiotic Warfare is Penicillin. Penicillin is probably the most snipery sniper, the top of all top-secret agents, if it was up to me I would call Penicillin Daniel Craig. It kills, when you need something killed, using his blue eyes and his perfect body…
It was born in 1928 (what …?) after a Scottish Microbiologist (oh, a history intermezzo) was conducting research on bacteria. He was doing this with the windows open and the fungus Penicillium, pretty common in nature, flew in. On the places where this fungus had landed, his bacteria didn’t grow. And so, Penicillin was discovered, still the corner stone of our antibiotics.

The scariest of bacteria, however, the bacteria that nowadays really kill you, are resistant to Penicillin. Even James Bond cannot save us. After 90 years, we still didn’t find a cure as effective as Penicillin.

Is the pharmaceutical industry not interested? Do we need to open our windows more and hope nature will solve our problem once more? Anyhow, something needs to happen: otherwise we will end up in an Antibiotic Resistance crisis.

Next time, Antibiotic Resistance crisis part 2, the BATTLE!

Antibiotic Resistance Crisis

Recently, a crisis of emerging antibiotic resistance gets more attention in the news. And it’s about time: the threat is more serious than diseases like swine flu or Ebola and could be deadlier than anything we’ve seen before (although, we have seen it before…).

Without antibiotics – or without the healing power of antibiotics – you, yes you, will die. Bam! Scary stuff, huh? Even the most common infections like pneumonia or urinary tract infections can not be treated without antibiotics, and you, yes you, will suffer.
Luckily, we still have antibiotics that work. But if we don’t use them properly, bacteria will learn how to defend themselves and will become resistant to all the drugs we have. 

We might get our crisis and experience life without them.

In the coming weeks I will post three articles on Antibiotics and the Resistance Crisis. In the first article I will explain the basics of Antibiotic warfare. The next will go into the details of the battle, in the third and last one is about the emerging crisis of antibiotics resistance. Have fun!

The Black Death

The Plague, aka the black death, aka bad news, is a disease most people only know from their history lessons and the Middle Ages. But it is also hitting the news right now. In Madagascar, last month 30 persons died of the plague, more than 200 are infected. With Dr Eric Bertherat, a WHO epidemiologist in our mind saying “You can become contaminated in the morning and be dead by the evening.” It makes you wonder: is history going to repeat itself?

Today, the plague can be avoided with the right hygienic measures and, if prevention fails, easily treated when diagnosed in time. In Madagascar both are lacking right now. The cause is probably the overcrowded and unhygienic prisons infested with rats and remote rural areas with rats that come out during rain season. And don’t think the prison walls can hold this infection inside. And definitely don’t think those straw-roofed houses can truly keep the rats outside.

So while the health care officials do all they can in Madagascar and try to solve it, let’s understand first what the deal is with this disease and why it is so infamous (by the way, don’t think the plague only shows up in remote African countries. Here is a map of affected regions in 2012).

The disease is transmitted through the bite of a flea from a rat. It can also be transmitted from human to human via contaminated fluids, tissue or droplets to fly through the air like kamikaze pilots. Although, the disease is scary, not to mention the fluids, fleas and rats, the plague is actually a “normal” bacterial infection, just like Chlamydia. It is caused by the bacterium Yersinia pestis, causing the bubonic plague and the plague of the lungs (90% mortality rate of that one). But wait, I hear you think, bacterium, the world has antibiotics to treat those!

Well, not in the late Middle Ages.

In those days, people dreaded the plague even more than people fear Simon Cowell’s verdict these days. Between 1347-1351, the plague was responsible for the death of nearly one third of the entire population of Europe. If this would happen today in Europe, you could drive from the Netherlands – where I was born – to Spain – where we would spend the occasional holiday – without ever seeing a living person. Well, I like to have some peace and quiet, but this was too much. It was the mother of epidemics.

Not only the rats and their fleas were to blame though.

The whole thing supposedly started with the Mongols (from the land Mongolia). They had used the disease to their advantage in 1346 when they wanted to invade the city of Kaffa (Ukraine). During the fight they would shoot the dead bodies of plague victims over the walls of the city using catapults, thus infecting the inhabitants. They must have been some real Angry Birds. The surviving inhabitants of Kaffa fled back to their daddies and mommies who still lived Italy. Through Italy the disease could spread further in Europe.

Venice had a fantastic plan to stop infections after the death of almost half the Venetians during the first half of the outbreak. They implemented the rule that all ships had to remain in the harbor without docking for 40 days. Probably from the 40 days of fasting from the bible. After those 40 days of quarantine, they could step on land.

Quick party conversation “fun”-fact: quarantine derives from the Italian word for 40 which is “quaranta”.

In the meanwhile, the medical school jumped to the opportunity to train the so-called plague doctors. These doctors didn’t wear the classical white coat, but they wore an ankle length black overcoat, black hat (quite stylish I must say) and a beaked mask. This beak was very smart to prevent infection (sure…) but also to eliminate the horrible smell coming from their patients. In the end of the beak they would put herbs and flowers to prevent them from gagging at their patient’s side, because that just isn’t professional.

So, the mask a lot of people wear during carnivals is actually a plague mask. Makes you look slightly different at the crowd, doesn’t it? Or what about the “Eyes Wide Shut” orgy scene? Maybe in 500 years a remake will be made with the future Tom Cruise and Nicole Kidman with the gear we wear today: white coats, chalked gloves and properly sealed mouth caps.

Strange world we will live in.