Treating+infection+in+a+Post-Antibiotic+World

Antibiotic Resistance dangerously affects everyone in our world. Antibiotic resistance is the phenomenon wherein the microbes responsible for bacterial infection in living organisms quickly evolve through natural selection to be immune to treatment via certain Antibacterial Drugs. This rise in resistance to our best method of fighting infection has been described my many experts as the greatest threat humanity will face in the coming years. In recent years, we have seen a resurgence in patient deaths from what used to be easily treated diseases such as Tuberculosis and Salmonella. Antibacterial drugs have been the standard way of treating bacterial infection since Alexander Fleming’s discovery of Penicillin started being used clinically in 1942. After that, these drugs were mankind’s greatest tool against bacterial infection until the mid-1990s, when [|Harold Neu] published an article in //Science// magazine[1] bringing up the idea of “Antibiotic Resistance”. Neu was an expert on infectious disease and the chief of Columbia University’s College of Physicians and Surgeons. Neu’s article on Antibiotic Resistance struck a chord with the scientific community and the dangers were recognized, but the pharmaceutical and medical industries did not see it as enough of a threat to improve their own practices. In 2009, the Center for Disease Control issued a statement[2] that involved recommendations from the Federal Tuberculosis Task Force on how to fight “Extensively Drug-Resistant Tuberculosis.” After that, it became the general consensus that something must be done to combat Antibiotic Resistance. The best option is to develop new Antibiotic drugs that do not aid in the natural selection that occurs when Antibiotics are used. These drugs take a long time to develop, so the human population must figure out how to treat infection until viable new drugs are on the market. While each have their own pros and cons, the two currently realistic solutions are to either use stronger drugs or to treat infection with surgery, as it was done long before the first Antibiotics were developed.
 * __Introduction__**


 * __Contents:__**
 * Antibiotics**
 * Overuse and Misuse**
 * Drugs That Don’t Contribute to Antibiotic Resistance**
 * Use of Stronger Antibiotics**
 * Surgical Removal of Infection**
 * Conclusion**
 * References**

Antibiotics are drugs used to treat bacterial infection. These are very different from drugs used to treat viruses such as cold or flu. Between the use of Antibiotics and [|vaccines], many diseases that were once leading causes of human death are now a nonissue. Antibiotics work by rupturing bacterial walls and disrupting vital cell functions. The Antibiotic ruptures the bacterial cell by attacking enzyme sites, which is why different antibiotics work for different infectious bacteria.
 * __Antibiotics__**

Since their introduction, Antibiotics have been excessively and inappropriately used all over the world. Between 2000 and 2010, worldwide Antibiotic use has increased 36%.[3] This is due to a combination of doctors prescribing too many Antibiotics than are needed to stop an infection, prescribing the wrong Antibiotics, and prescribing Antibiotics to treat viral diseases. The misuse of Antibiotics has become so bad that the [|Center for Disease Control] launched a campaign[4] to educate doctors on the correct and incorrect uses for Antibiotics. They offered classes and posters to hang in doctor’s offices. Overuse and misuse of Antibiotics has led to a staggering increase in the number of bacteria resistant to the Antibiotics that are appropriate to prescribe.
 * __Overuse and Misuse__**

The clear solution to the Antibiotic Resistance issue is to use drugs that do not leave behind a bacterial populous comprised of only cells that are resistant to the drug used. The problem is that these kinds of drugs are not easy, cheap, or quick to produce. In addition to those issues, once they are developed, they need to be made safe, tested in the lab, tested on patients, and approved by the FDA before they can be prescribed by doctors to treat infection. It can take several years to complete this process. While it is a slow process, progress is being made in this vital field. Two main antibacterial drugs are under development currently; Teixobactin[5] and Ceftazidime[6]. Ceftazidime was even approved by the FDA. Ceftazidime has much lower rates of resistance than most Antibiotics and has fewer negative side effects as well.
 * __Drugs That Don’t Contribute to Antibiotic Resistance__**

Teixobactin is much newer, and is still in testing, only developed in 2015. Teixobactin is part of a new class of Antibiotics. Old Antibiotics fight bacteria by binding to enzyme sites on the bacteria to disrupt vital cell functions. The reason bacteria easily become resistant to these Antibiotics is that with a slightly misshapen enzyme site, which is a common mutation for bacteria to have, the Antibiotic can no longer block that enzyme from binding, and the bacteria lives on. As part of the new wave of Antibiotics, Teixobactin instead binds to lipid II and lipid III in a developing bacterium. These lipids are necessary for the formation of the bacterium’s cell wall, which is what protects the bacterium and allows it to perform important tasks that keep the bacterium alive. Teixobactin binds to generic lipids in the early stages of a bacterium’s life, making it much harder for the bacteria to evolve in a way that renders the Teixobactin useless. In a recent test of Teixobactin, no resistant bacteria were left post-treatment.

When patients complete their first round of Antibiotics for a bacterial infection and are not cured, many doctors will prescribe a “second-round” Antibiotics. Second-round Antibiotics are stronger than the drugs usually first prescribed. They typically attack more enzyme sites, giving a better chance of killing the bacteria. These stronger drugs may work better; however, they still contribute to Antibiotic Resistance, albeit at a lower rate. In a study done at a tertiary care hospital in New Delhi, India, it was found that even being educated on the dangers of Antibacterial Resistant bacteria, the prescription of stronger Antibiotics increased.[7] In addition to still increasing the number of resistant bacteria, these resistant bacteria are resistant to even stronger medications. Second-round Antibiotics, like all antibiotics, not only kill harmful bacteria in a patient, but also do quite a bit of damage to healthy [|gut flora] that are essential to healthy human life.[8] Luckily these healthy bacteria can be replaced, but the temporary damage can lead to the patient having difficulty digesting food and fighting additional diseases. There are also many positive aspects to using stronger Antibiotics. All of the positives that were associated with Antibiotics when they were first used still hold true. First off, Antibiotics are extremely antiinvasive. Even the most invasive Antibiotics are only injected intravenously, and most are taken in pill form by mouth. Also, while some Antibiotics reduce the strength of tendons, in rare cases aiding in tears and the formation scar tissue, the vast majority of the damage done by Antibiotics is temporary and treatable through reforming healthy bacteria colonies via a probiotic heavy diet. The use of stronger Antibiotics is currently a viable option, but it does not help stim the growing resistant bacterial population.
 * __Use of Stronger Antibiotics__**

Surgical removal is currently another option for treating bacterial infection, and keeps in mind the growth of Antibiotic Resistance around the world. Surgical removal is the preferred method of treatment for patients with abscesses[9], as the use of Antibiotics can severely harm the recovering abscess once the infection is cleared up. Surgery allows the doctor to seal the internal wound, whereas it remains open if the patient is treated with common Antibiotics. A U.S. National Library of Medicine study found that post-operation infection was much lower when the surgical site of operation was manually cleared of infection due to the lack of resistant bacteria.[10] In addition to being better for internal wounds with bacterial infections, surgery does not contribute to a constantly growing resistant bacterial population. No bacterium can evolve to the point where it is immune to surgical removal. There are many downsides to using surgery to combat bacterial infection. Surgery is quite invasive. Even the simplest of surgeries can be quite painful for the patient. Often, the patient must be put under using Anesthesia, adding another dimension of danger. Once the surgery is complete, the patient then must undergo recovery. Recovery from surgery can be painful and extensive. The patient is at greater risk for additional infections and may not be able to perform basic functions for a period of time. Scar tissue formation is another problem with performing surgery, and the patient may be forever changed by the effects of the surgery. The medical and scientific communities must collectively decide if the negative effects of surgical removal of infection is worth stimming the rise in Antibiotic Resistance it comes with.
 * __Surgical Removal of Infection__**

We currently know a lot about Antibiotic Resistance, except for the important things. We know how it works, how quickly it can happen, and what will happen if it is not stopped. We do not know how to stop it, if it can even be stopped, or what to do before it is. It is known that the first step is to prescribe fewer Antibiotics. This requires education to doctors, especially in developing countries, on what Antibiotic Resistance is, and how they can help to stop it. This will be quite a process. Hospitals in New Delhi are implementing small clinics and classes to doctors on these matters, and it is helping. Prescription levels in New Delhi are still very high, but are starting to drop without noticeable increases in patient death. This is a good step, but everywhere people must recognize the danger Antibiotic Resistance means for us all. The pharmaceutical industry is working to bring us drugs that will not contribute to Antibiotic Resistance, but that task is not quick or easy. In the meantime, we all must do our part to seek treatment that will not add to the problem, even if it seems worse in the short term. There is still much work to be done to both bring in new drugs and treat infection currently, but the problem is clearly known by most professionals in the medical industry, and we are far ahead of where we used to be.
 * __Conclusion__**

[1] Neu, Harold C. "The crisis in antibiotic resistance." //Science//, vol. 257, no. 5073, 1992, p. 1064+. //Academic OneFile//, Accessed 7 Oct. 2017. [2] Lobue, Phillip. “Plan to Combat Extensively Drug-Resistant Tuberculosis Recommendations of the Federal Tuberculosis Task Force.” //Centers for Disease Control and Prevention//, Centers for Disease Control and Prevention, 13 Feb. 2009, [|www.cdc.gov/mmwr/preview/mmwrhtml/rr5803a1.htm]. [3] Plump, Wendy. “Study Shows Significant Increase in Antibiotic Use across the World.” //Princeton University//, The Trustees of Princeton University, 10 July 2014, www.princeton.edu/news/2014/07/10/study-shows-significant-increase-antibiotic-use-across-world. [4] “CDC Features.” //Centers for Disease Control and Prevention//, Centers for Disease Control and Prevention, 13 Nov. 2017, www.cdc.gov/features/antibioticuse/index.html. [5] Ling, Losee L. “A New Antibiotic Kills Pathogens without Detectable Resistance.” //Nature.com//, Nature.com, 22 Jan. 2015, [|www.nature.com/nature/journal/v517/n7535/full/nature14098.html] . [6] “Ceftazidime/Avibactam (Avycaz) -- a New Intraveneous Antibiotic.” //Ceftazidime/Avibactam+(Avycaz)+-+A+New+Intravenous+Antibiotic | The Medical Letter, Inc.//, The Medical Letter, 25 May 2015, secure.medicalletter.org/article-share?a=1469c&p=tml&title=Ceftazidime%2FAvibactam%2B%28Avycaz%29%2B-%2BA%2BNew%2BIntravenous%2BAntibiotic&cannotaccesstitle=1. [7] Wattal, C, and S Khanna. “Antimicrobial Prescribing Patterns of Surgical Speciality in a Tertiary Care Hospital in India: Role of Persuasive Intervention for Changing Antibiotic Prescription Behaviour.” //Indian Journal of Medical Microbiology.//, U.S. National Library of Medicine, July 2017 [8] Levy, Stewart B. “The Challenge of Antibiotic Resistance.” //Scientific American//, Mar. 1998, schimizzi.cmswiki.wikispaces.net/file/view/antibiotic%20resistance.pdf/493751958/antibiotic%20resistance.pdf. [9]  Ackerman, Anne Lenore, et al. “Diagnosis and Treatment of Patients with Prostatic Abscess in the Post ‐ Antibiotic Era.” //International Journal of Urology//, Japanese Urological Association, 24 Sept. 2017, onlinelibrary.wiley.com/doi/10.1111/iju.13451/full.
 * References**

[10] Klinger, A L, and H Green. “The Role of Bowel Preparation in Colorectal Surgery: Results of the 2012-2015 ACS-NSQIP Data.” //Annals of Surgery.//, U.S. National Library of Medicine, Oct. 2017