Controlling antibiotic resistance

Since the start of the 21st Century, there is an awareness that antibiotics don’t work as well as they used to. Bacteria are becoming increasingly resistant to their effects and we are approaching a time when many bacteria could be resistant to all the antibiotics we have. As individuals and a society as a whole, we should try to limit our use of antibiotics, substituting them with non-antibiotic bacterial killers if these are found to be effective.

Before antibiotics were used in the mid-1930s, 30 per cent of all deaths were caused by bacterial infection.

Any use of antibiotics encourages exposed bacteria to develop ways of becoming resistant. Exposing bacteria to antibiotics pressures them to adapt to the antibiotics in an “adapt or die” life and death saga. This is called selection pressure. Bacteria under threat from antibiotics eventually come up with a way of overcoming their vulnerability. They may develop thicker or more repellent membranes to stop antibiotics from getting into the bacterial cell in the first place. Bacteria may switch on or turn up pumps to expel any antibiotic that does get into the cell. These are just some of the tricks they have to become antibiotic resistant.

Antibiotic use was rising steadily in Sweden during the 1980s and 1990s, causing an increase in antibiotic resistant bacteria. A group of doctors mobilized to tackle this threat, and brought together peak bodies across pharmaceuticals, infectious diseases and other relevant areas to form a national coalition. The Swedish Strategic Programme Against Antibiotic Resistance (Strama) was founded in 1995. Since then, Strama has been working on a national and regional level to reduce antibiotic use. Between 1992 and 2016, the number of antibiotics prescriptions decreased by 43% overall. Among children under four, antibiotics prescriptions fell by 73%. By 2020, levels of antibiotic use and resistance in Sweden are among the lowest of all OECD countries, both in humans and animals.

Sweden banned non-therapeutic use of antibiotics in agriculture in 1986 and has since evolved a system of meat production that does not depend on these drugs. A 1997 World Health Organization report recommended ending the use in animal feed of all antibiotics used in human medicine. As a result the use of four antibiotics in animal feed was banned throughout Europe. In the 1970's, the US Food and Drug Administration (FDA) proposed a ban on certain uses of penicillin and other antibiotics in animal feed. The proposals met with a storm of protest from legislators representing agribusiness interests and were never made final.

While antibiotics are usually taken orally or intravenously, non-antibiotic bacteria killers are typically applied topically in the form of creams and ointments. It should be noted that regular antibiotics are only toxic to the bacteria and not to the patient, while non-antibiotic bacteria killers can be toxic if ingested.  Some non-antibiotic bacteria killers include:

• Honey: Research has found that medical-grade honey be can an effective topical antibiotic cream to stop infections developing around catheter sites of dialysis patients.
• Tea tree oil: Tea tree oil has been proven to inhibit and kill bacteria. It’s even been found to be effective against bacteria that was previously antibiotic resistant.
• Vinegar: Due to its acetic acid content, vinegar works topically to kill bacteria around an infection, specifically found in cases where patients receiving dialysis have developed difficult-to-treat catheter infections.
• Mannose: Mannose is a type of sugar, similar to glucose, which may be useful in treating urinary tract infections since it prevents bacteria from attaching to the cells of the urinary tract. It’s typically packaged as a nutritional supplement but it’s also found in many fruits and vegetables.
• Trisodium citrate: This simple salt, used in the 1990s to keep kidney dialysis patients infection-free, has now become one of the main strategies for preventing catheter-related bloodstream infections in dialysis patients. This popularisation largely occurred through the efforts of non-commercial interests.

Further studies are needed that show more evidence into the proven effectiveness of non-antibiotic bacterial killers. This work is usually funded and undertaken by companies that benefit from patenting a product and placing in the mass market. Many non-antibiotic bacterial killers cannot be patented, therefore drug companies don’t really benefit.  When these studies do occur, they do so very slowly and with limited resources.

The development of antimicrobial resistance in many pathogenic microbes poses one of the most serious problems in the control of infectious diseases.