At the beginning of September I fell ill with a severe sore throat. An otolaryngologist took a throat swab to determine antibiotic sensitivity. And in the analysis, against one of the drugs, the result was “I” (Intermediate, “moderately stable”). What do these tests mean? Is only a microbe that a particular person has been infected with at the moment immune to the drug? Or will this antibiotic never help the patient with any disease? How does antimicrobial resistance, that is, the insensitivity of bacteria to drugs, actually occur? Is it true that because of this, in the near future, people may be at risk of becoming extinct due to invincible infections, or are fears exaggerated?
To get answers to all these questions, from everyday to global, we turn to a biotechnologist who has a deep understanding of the development, action of drugs and the possible consequences of their use. Our expert is Doctor of Pharmaceutical Sciences, Chief. Department of Pharmaceutical Technology with a Medical Biotechnology course of the Pyatigorsk Medical and Pharmaceutical Institute, a branch of the Dmitry Kompantsev Volgograd State Medical University.
WHAT THE TESTS SHOW
– Dmitry, at the height of the covid pandemic, antibiotics flowed like a river. As a result, experts say, resistance to antimicrobial drugs has skyrocketed. Therefore, sensitivity tests to them are very important. What exactly do these tests show?
– First of all you have to understand: it is not the person himself who becomes insensitive to antibiotics. And certain bacteria are pathogens against which antimicrobial drugs are intended.
At the same time, two situations occur most frequently in everyday life. The first is acute infections, when the patient becomes ill due to a microbe that has entered the body from the outside. It is usually a serious condition, with high fever and threat of complications. There is often no time to perform antibiotic sensitivity tests, as in routine practice at least several days are needed. Therefore, the doctor, as a rule, immediately prescribes a broad-spectrum antibacterial drug.
The second situation is when diseases are caused by our coexisting bacteria (often called opportunistic microflora). These microbes are always present in our body, but they are under control. However, if immunity “gives way”, local, for example, in the throat during hypothermia, or if the immune system as a whole suffers (with HIV, cancer and other serious diseases), opportunistic bacteria begin to actively multiply. And the person gets sick. This is possible whenever there is an immunological failure, that is, we are talking about chronic infections. These can be pharyngitis, tonsillitis (tonsillitis), sinusitis, cystitis, bronchitis, etc. In such situations, antibiotic sensitivity testing is most relevant. Because we are talking about microbes that are constantly present in humans.
– To know the reaction of the bacteria that coexist with the main classes of antibiotics, is it enough to perform a test once?
– No. Microorganisms, like all living beings, evolve, confirming Darwin’s theory. If a person frequently takes certain antibiotics, the bacteria adapt to them. That is, you are actually training your opportunistic microflora to become insensitive to this drug.
Editor’s note: Therefore, it is recommended that people suffering from chronic infections undergo antibiotic sensitivity testing regularly. The doctor determines the time.
IS IT TRUE THAT HOSPITALS ARE A HOT OF RESISTANCE TO ANTIMICROBIALS?
So, by relying on antibiotics, each person can “grow” their own microbes that are not susceptible to drugs. On the other hand, you can become infected with resistant bacteria from other people.
“This happens in acute infections, which we started with,” says Dmitry Kompantsev. – In this case, it is possible that the patient himself has never abused antibiotics. But someone else gave him a bacteria with antimicrobial resistance.
– It is believed that the real haunt of microbes that do not respond to most antibiotics are hospitals. There, antibacterial drugs are prescribed left and right, which means that pathogens have an easier time adapting. That’s why some people wait until the last minute to avoid ending up in a hospital ward.
– This is an extremely controversial topic. I assure you: if all sanitary and hygienic standards, isolation rules, etc. are observed in a hospital, then even in the infectious diseases department there is less chance of getting infected than in the subway or in the theater. On the other hand, it must be understood that people are admitted to the hospital whose body is already weakened by the current illness. Therefore, they can activate their own opportunistic flora. And they are more easily infected by external pathogens. At the same time, medical personnel, doctors and nurses, being healthy people, do not contract bacterial infections at their workplace. Have you thought about this? Of course, except in cases where healthcare workers ignore compliance with the necessary regulations. That is, the human factor plays a very important role.
WHAT IS DANGEROUS ABOUT SELF-MEDICATION: FROM SEVERE COMPLICATIONS TO THE THREAT OF CANCER
Last year, a study was carried out in our country on the population’s attitude towards antibiotics. It turned out that almost half of Russians (49%) take antibacterial tablets like vitamins. That is, they buy them without a prescription and treat them literally with every sneeze. “In two-thirds of the cases (72.5%), patients took antibiotics unjustifiably,” the alarmed experts concluded.
By relying on antibiotics, each person can “grow” their own microbes that are not susceptible to drugs.
Photo: Shutterstock.
What are the risks of such self-medication?
1. All antibacterial drugs are toxic, emphasizes Dmitry Kompantsev. When there are medical indications, the benefit outweighs the harm. But if a person takes antibiotics without a doctor’s prescription, he can cause harm to his body (read about side effects in the instructions!), without receiving the slightest therapeutic effect.
2. It is very important to choose the right class of antibiotics, combination therapy (several drugs) may be needed; This will not work with self-medication. “By taking antibiotics “like this”, without the appropriate strategy, a person runs the risk of not obtaining the full therapeutic effect and developing complications. There is a risk that the infection will develop into an extremely dangerous generalized form. All this will greatly complicate treatment and can lead to serious consequences, including death,” warns Dmitry Kompantsev.
3. By abusing antibiotics, each person personally contributes to the emergence of bacteria that are not susceptible to drugs. This means that the next time you get sick, these or those pills will no longer help you. And your circle will grow.
Scientists are also currently discussing the hypothesis that the increasing use of antibiotics could be involved in the increased incidence of cancer. Especially among young people under 50 years of age, who are the most actively self-medicating. Regular use of antibacterial drugs causes serious alterations in the intestinal microflora. The functioning of the immune system largely depends on it. And its failures are fraught not only with frequent colds, but also with a deterioration in control over cancer cells that are constantly forming in each person. If the immune system is weakened, the risk increases that the tumor is not destroyed at the root and begins to develop, experts explain.
RACE FOR SURVIVAL: HOW TO RESIST THE SUPERBARGAS
This summer, the Russian government approved an action plan to combat antimicrobial resistance for the period 2025-2030. The document talks about improving the qualifications of health workers (so that antibiotics are not prescribed when they can be avoided), constant monitoring of pathogens resistant to antibacterial drugs and the development of new drugs. It is also planned to expand public education on the correct use of antibiotics, including avoiding self-medication.
In the scientific and medical community, there are three main ways to prevent bacteria from defeating humanity in the race for survival:
– compliance with the rules for the use of antimicrobial drugs (strictly according to medical indications, complete treatment, etc.);
– development of new antibiotics;
– use of drug combinations.
“I completely agree with these methods,” supports Dmitry Kompantsev. – I have a clear example of how compliance with regulations works, in particular the strict control of the dispensing of antibiotics in pharmacies. Once when I was working in the UK, I had a toothache. There was severe inflammation and the doctor prescribed an antibiotic. I was surprised: in Russia the drug belongs to the antediluvian generation and bacteria have been resisting it for a long time. The pharmacist girl at the pharmacy surprised me even more: she asked me for my passport, a prescription and spent a long time checking something and writing it on the computer. I joked: it’s probably easier to get narcotics here. And she confirmed: yes, it is. Antibiotic control is strict. And it gives results.
Today in the world there are different classifications of antibiotics, which reflect their generations (for example, five generations of cephalosporins). In our country, medicines are prescribed mainly from the 4th or 5th generation. Furthermore, microbes have already acquired resistance due to uncontrolled use of drugs, especially self-medication. And where control is very strict, antibiotics from earlier levels still work. This means doctors have a much broader arsenal of tools to treat infections.
– Dmitry, a study was recently published in the scientific journal Lancet with a terrifying prognosis: due to the ineffectiveness of antibiotics, more than 39 million people may die by 2050. And another 169 million deaths are predicted “from causes related to antimicrobial resistance. It turns out that we are still losing to superbugs that have learned to resist drugs? Some even talk about the threat of human extinction due to invincible infections.
– First of all, not a single infection can cause the death of humanity. Remember the epidemics of plague, cholera, smallpox, when there were no vaccines or chemotherapy. In any case, there is always a percentage of people who acquire immunity or are not susceptible at all to an infectious agent. Second, bacteria have a “tolerance limit.” About the same as a person: he can still lift 100kg, but he can’t lift 200kg. Furthermore, microbes have limited potential to form a protective response to antibiotics. Thanks to this, a combination therapy of several drugs can work. Additionally, if an antibiotic is not used for a long time, bacteria can lose resistance to it.
Today, one of the most promising ways is to improve existing drugs and enhance their effect, says Dmitry Kompantsev. This is simpler, cheaper and faster than creating new antibiotics, which requires enormous amounts of time and money for clinical trials and other procedures. “For example, special substances and technologies are now used that prevent microbes from protecting themselves from antibiotics. Or they trick the bacteria into “swallowing” the antibiotic and dying,” explains the expert.
IN PLACE OF EXIT
No matter how events develop in the future, bacteria are not capable of wiping out all of humanity from the face of the Earth, experts say. But resistant microbes may well reduce the quality of life or kill individual people. Science and medicine strive to improve medications and keep up in the race against infectious agents. But it also depends a lot on each of us. We can “grow” our own superbugs in our bodies that do not respond to antibiotics. And we can take antimicrobial medications strictly according to medical indications. And reduce the risks to yourself and others. By the way, under no circumstances stop taking the prescribed antibiotic treatment ahead of schedule as soon as you feel better. “Unfinished treatment is excellent training for bacteria and the shortest path to the emergence of resistant microorganisms,” warns Dmitry Kompantsev.
