The antibiotic apocalypse is a big exaggeration
"It's our own fault"
The clinical pharmacologist commented on the information of foreign media
about the "decline of the era of antibiotics"Denis Nizhegorodtsev, "Vzglyad", 28.01.2013
"Antibiotics should not be used in small doses. We used to think how not to harm. And in this case, we are harming this patient by "growing" infections," Alexandra Burbello, MD, professor at Northwestern Medical University, told the newspaper VIEW.
British scientists, represented by the chief physician of England, Sally Davis, announced the end of the era of antibiotics. According to her, bacteria resistant to most existing antibiotics are increasingly found in the world, they pose a threat no less than global warming, and it is becoming increasingly difficult to find new drugs against them.
"It is obvious that global warming is not the main threat to humanity," Davis said. "The apocalypse may come in 20 years, when, say, hip replacement surgery can lead to death, since we simply will not have antibiotics."
The newspaper VZGLYAD asked Alexandra Burbello, MD, Professor of the Department of Therapy and Clinical Pharmacology of the I.I. Mechnikov Northwestern State Medical University, how serious these concerns are.
VIEW: Alexandra Timofeevna, how real a threat is the "decline of the era of antibiotics"?
Alexandra Burbello: There is some truth in the words of the Englishwoman. Indeed, the number of pathogens that are not sensitive to antibiotics is increasing. But at the same time we have completely new antibiotics, new classes, with a different chemical structure, with a different mechanism of action, which requires a different approach to use, etc. Therefore, it is impossible to say that the "era of antibiotics" is ending. In any case, it is premature to say so today. Because almost every year, every five years for sure, completely new drugs appear. Now we have antibiotics on the way, the action of which is aimed specifically at resistant strains, that is, at insensitive ones, on which the "old" antibacterial agents no longer act.
VIEW: So the fears that hip replacement surgery will lead to death in 20 years are groundless?
A. B.: At least in the next 20 years, I think this situation will not come. And then, after the withdrawal of an antibiotic that has been used for a long time, and after we do not use it for several years, sensitivity to it is restored. We are starting to use it again, and with no less efficiency. Maybe only the doses change a little bit, they get bigger. But this is the same antibiotic that was abandoned some time ago.
Another thing is that now we are forced to take a more strict approach to the selection of an antibiotic, the choice has become much more targeted, there are much more restrictions. As a clinical pharmacologist, I often tell doctors that when using an antibiotic, there should be strictly defined doses. These are not cardiovascular drugs that can be started with small doses and gradually increased, choosing the dose individually for the patient. This approach is irrational here. When using antibiotics, it is necessary to strictly observe the doses, intervals between doses, and duration of treatment. This is what makes it possible to slow down the development of resistance, that is, the appearance of microorganisms that the drug does not act on.
And the population would like to say the same. It is impossible for the patient to go to the pharmacy himself and buy what he wants. And then he took antibiotics not the way he should, but the way he thinks he should take them.
VIEW: You said that the number of bacteria immune to antibiotics is increasing. Why is this happening?
A. B.: The answer lies on the surface. Because, as I have already said, we use antibiotics in the wrong doses, violate the terms of treatment, etc. A simple example. So they prescribed a person to "take" an antibiotic for several days. And then two days later the patient got better, and he stopped taking the drug, that is, interrupted the course of treatment. But the flora did not completely die, the microorganisms remained. Yes, some antibiotics cause the death of microorganisms, but many only stop their growth and reproduction. And if a person "took" the medicine for two days, and then abandoned it, the microorganisms began to multiply again, in addition, they changed, became different, that is, insensitive to this antibiotic.
VIEW: The English doctor also said that there is a serious problem caused by the ineffective use of antibiotic drugs around the world. "We "grow" resistant infections ourselves, too often resorting to the use of standard types of antibiotics," she said.
A. B.: That's where I agree with her. Just wouldn't talk about "standard" types. Naturally, we use "standard" drugs. If, for example, we treat pneumonia, we tell the patient that, both before and now, penicillins are the most effective for this disease. For other diseases – other groups of antibiotics.
As I have already said, we ourselves are to some extent to blame for the fact that there are more and more resistant, drug-insensitive strains of bacteria. Because we use antibiotics in small doses. We used to think how not to harm. And in this case, we are harming this patient by "growing" infections. Antibiotics should not be used in small doses.
And then, we forget that the drug unevenly penetrates into various tissues and organs, and therefore the concentration of the drug, including the antibiotic, in different organs of the body will be different: in the lungs it is one, in the kidneys – another, in the skin - the third. The effectiveness of antibiotics on microorganisms depends on their concentration in the tissues, that is, in the affected organ. The dose should depend on where the disease is localized.
VIEW: Can we say that now the problem with the fact that bacteria have adapted to antibiotics has become much more acute than 20, 50 years ago?
A. B.: Naturally. When the first antibiotics appeared, there was no such problem. But after 30-40 years, we saw that strains that are insensitive to penicillin and less sensitive to other antibiotics appear. That is, there was this problem. But every year it gets sharper.
Today there are about 127 known antibacterial drugs-antibiotics. It's getting harder to make a choice. But if you know the specifics of the action and use of antibiotics well, I think the "decline of the era of antibiotics" will happen very soon.
view: And if you still imagine that doctors will refuse antibiotics, even if not in 20, but in 30-40 years, how will people be treated then?
A. B.: Science is changing so fast, searches are constantly being conducted. In place of antibiotics, simply other antibacterial drugs will come. Antiseptics will come. Or our approach to the use of existing drugs will change in some way. Now the search is underway for "transporters" – substances that will deliver the medicine as intended to a certain organ, etc.
view: Do you have a prescription for what you need to do now so that the "era of antibiotics" does not end?
A. B.: It is impossible to completely solve this problem, because immune microorganisms will appear, even if we do everything right. There is a so-called naturally insensitive flora to this or that antibiotic. And she can transmit this natural insensitivity to other microorganisms that are sensitive.
This problem will remain, but how quickly what you are talking about will come, and whether it will come at all, largely depends on us.
view: And what can you say about it? The chief therapist of Russia, Alexander Chuchalin, said yesterday that the mass outflow of Russians from Arab countries, where there is unrest now, could cause an epidemic of viral infections in Russia. Among the dangerous viruses from that region, in particular, he named coronavirus.
A. B.: As for coronaviruses, the disease caused by them resembles a rhinovirus infection or influenza. If this is the case, then now, during the winter exacerbation of upper respiratory tract infections (ARVI) and influenza, we may not even identify it.
Portal "Eternal youth" http://vechnayamolodost.ru30.01.2013