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!