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!

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