Furthermore, these drugs have become essential “therapeutic tools” for those treatments that tend to weaken the patient’s immune system, what we would commonly call “our defenses.”
For example, in people undergoing chemotherapy for cancer, dialysis for kidney failure, transplants, or general surgery. In these cases, antibiotics make it possible to solve infectious conditions, that is, the complications that these patients often suffer and that compromise their health and, with it, their recovery.
Since the discovery of the first antibiotics in 1940, and as a result of the success achieved later with their use, the false idea spread that they were “miracle drugs”, with “powers” capable of curing everything.
This led to their abusive and, in many cases, inappropriate use in medicine, veterinary medicine and agriculture, even to treat diseases not caused by bacteria. This behavior has favored the appearance and worldwide spread of “superbugs”.
These are not new microorganisms, but “improved”, that is, they have evolved and adapted to survive the attack of the enemy, antibiotics.
Fight against bacterial resistance
The “superbugs” are very dangerous for hospitalized patients or those with a weak immune system, as they have become strong against antibiotics, even the most powerful or last resort, such as colistin.
Bacterial resistance to antibiotics is a natural phenomenon that we cannot avoid. It is the way that bacteria survive when exposed to a hostile environment.
However, it is important to remember that we are very responsible for the levels of resistance currently achieved and that it has become one of the most serious public health problems today.
Despite the fact that society is increasingly responsible in its use, thanks to sanitary control and numerous outreach and awareness campaigns, there is still much to do in this fight, especially in the veterinary field.
Of particular concern is the impact that bacterial resistance to antibiotics has on the growing elderly population, hospitalized patients, or those with a compromised immune system. In these cases, the treatment options are increasingly limited, or not even exist.
Towards a global awareness
The resistance of bacteria to antibiotics has a huge economic impact on health systems and society. The European Center for Disease Prevention and Control (ECDC) estimates that around 25,000 Europeans die each year as a direct consequence of multi-drug resistant infections.
This represents an expenditure of 1.5 billion euros in additional costs for patient care. To this, we add the improvements achieved in the management of chronic diseases, as well as the progressive aging of the population.
Yet antibiotic resistance is reaching such dangerous levels that resistance to World Health Organization (WHO) estimates that by 2050, deaths from antibiotic-resistant bacterial infections will exceed those caused by cancer.
If it continues like this, in thirty years some 10 million people could die each year due to this problem. This has led to considering the resistance of bacteria to antibiotics as one of the three greatest threats to human health in the coming decades.
Covid-19, an aggravation of the problem
Although it is still too early to assess its full impact, the crisis generated by COVID-19 seems to be exacerbating the problem of bacterial resistance to antibiotics.
Since the pandemic began, studies carried out in different hospital centers revealed high rates of prescription of antibiotics in patients with covid-19.
Perhaps what was experienced during the 1918 flu (influenza) pandemic, and its devastating consequences, suggested that patients could have pneumonia due to a secondary bacterial infection, in addition to the viral infection.
The 1918 pandemic (known as the Spanish flu) stood out because it lasted more than a year, infected about a third of the world’s population, and killed more than 50 million people. Numerous data show that the majority of deaths caused by the 1918 flu were attributed to secondary bacterial pneumonias.
Although antibiotics do not treat viruses like SARS-CoV-2, patients with Covid-19, and in general with any type of general flu virus, become very susceptible to contracting a secondary bacterial infection, which can only be treated with antibiotics.
This happens because viruses alter the host’s innate and adaptive defenses. Therefore, bacteria such as Streptococcus pneumoniae, Staphylococcus aureus, or other colonizers take advantage of this temporary “weakness” to cause secondary bacterial pneumonia.
It is estimated that between 10 and 30% of patients with a flu-like virus will suffer from this type of problem. The high use of antibiotics to which we have been forced in recent months by the covid-19 pandemic could further exacerbate the problem of antibiotic resistance that we already suffer. Especially in those regions of the world most affected.
SARS-CoV-2 has shown that it is not possible to develop a cure for tomorrow and has reflected the terrible cost of not being prepared against microorganisms. Antibiotic resistance progresses more slowly, but its evolution is relentless.
This article was originally published in THE CONVERSATION.
Concepción González Bello. Full Professor of the Department of Organic Chemistry, principal investigator of the Singular Research Center in Biological Chemistry and Molecular Materials (CIQUS), University of Santiago de Compostela