Microbiologist from KFU: 'Too many antibiotics have been used in COVID-19 pandemic'

Introduction

Until the first half of the 20th century, the main cause of death in the world was viral or bacterial infections. Vaccines helped in the fight against the first, and antibiotics sharply reduced the mortality rate from the second. But, as Alexander Fleming, the English microbiologist, Nobel Prize winner, warned, since they started using penicillin, bacteria have begun to adapt to this and mutate — after all, their goal is also to survive.

Today, antibiotic resistance is a threat that is growing every day, and which experts have been warning about for a long time. Every year, about 700,000 people die from infections caused by bacteria resistant to available medicines. It is expected that this number will gradually increase in the coming years. The situation has especially worsened with the beginning of the COVID-19 pandemic, during which the uncontrolled use of antibiotics has jumped to heavenly heights.

“Antibiotics do not work against viral and fungal infections”

Let's remind our readers of the basics. What are antibiotics and what is the principle of their action?

Antibiotics are drugs used to treat bacterial infections. Antibiotics do not work against viral and fungal infections. The first antibiotics were natural — English microbiologist Alexander Fleming isolated penicillin from mold fungi, which suppressed the growth of pathogenic bacteria. Initially, these substances are synthesised by bacteria and fungi as tools of competition for a place under the sun. Currently, in addition to natural antibiotics, synthetic and semi-synthetic ones are used, which are the product of modification of natural compounds.

By the way, in modern science, the name “antibiotic” is not used — it is more correct to say “antimicrobial drugs”. The mechanism of action of antimicrobial drugs is based on the fact that these substances very selectively bind to the cellular structures of bacteria, suppressing their activity.

“An antibiotic for COVID-19 is prescribed to avoid complications”

Why are antibiotics effective only against bacterial infections, but they do not work against viruses, including influenza?

The selectivity of the action of antibiotics is based on the fact that many cell structures of bacteria are radically different from the cells of eukaryotes, that is, we are with you. That is why antibiotics are absolutely useless against diseases caused by viruses and protozoa — they simply do not have such structures that could become a target for antimicrobial drugs. The antibiotic must contact a specific target, which only bacteria have. And after it binds to it, this bacterium dies.

Then antibiotics should not be effective in the fight against Covid-19, given that it is also a viral infection?

The virus, including SARS CoV-2, multiplies in the cells of the person himself. That is, we must kill the infected cells of the person himself in order to stop the development of the virus, and antibiotics, of course, cannot do this, because they work only on bacteria. Therefore, an antibiotic will be useless against the virus — it simply does not have a target for this.

Then why do some people take antibiotics for viral infections?

An antibiotic for influenza (and coronavirus) is prescribed in order to simply avoid complications. When a person gets sick with a viral infection, his immune system gets hooked. And the bacteria that we have can cause the development of a bacterial infection in this case.

Is it possible to use antibiotics for prevention?

This is the prevention of bacterial complications against the background of viral infections. This is justified if we are talking about a severe form of the disease. If the disease is mild, it is better not to start self-medication, taking the first available antibiotic. In any case, you need to consult a doctor about this. The recommendation on the need to take antibiotics must be given only by a doctor — he proceeds from the recommendations prescribed by the Ministry of Healthcare.

“During coronavirus pandemic, the consumption of antibiotics has gone up”

Even before the COVID-19 pandemic, they began to talk about the danger of uncontrolled consumption of antibiotics. What does this threaten on a global scale?

Back in 2016, a report commissioned by the British authorities on the problem of antibiotic resistance to bacteria was presented. Economist Jim O'Neill, who led the team of experts, modelled how events are going to develop. According to O'Neill's calculations, if humanity does not start fighting the resistance of microorganisms to antibiotics, then by 2050 the world economy will lose $100 trillion, and superbugs will begin to claim 10 million lives annually. This problem was called the problem of 2050.

That is, if urgent measures are not taken, by 2050, someone on our planet will die every 3 seconds from superbugs that are resistant to existing antibiotics. This will significantly exceed the number of people dying from cancer. By the way, the process has already begun: right now, 500-700 thousand people die every year from diseases caused by bacteria resistant to most antibiotics.

To what extent can the COVID-19 pandemic further worsen the situation?

Now they say that there is an even greater spread of bacterial resistance to antibiotics due to the coronavirus, because too many antibiotics have been taken. This has greatly increased the spread of antibiotic-resistant strains. The problem of 2050, according to which by 2050 more people will die from superbugs in the world than from cancer, in principle, has shifted, by my standards, by 10 years — that is, by 2040. But this is my personal, subjective assessment. But the fact that the deadlines have shifted from 2050 is for sure. All because during the coronavirus pandemic, the consumption of antibiotics has gone up.

For example, azithromycin is recommended and prescribed to people with a suspicion for Covid-19. With such consumption, we simply force the bacteria to develop resistance to it. The same streptococci that cause complications in Asian countries are already 70 percent resistant to this antibiotic.

“There are already a lot of superbugs that have developed immunity to antibiotics”

What is the chain of formation of resistance to antibiotics after their widespread use?

The main mechanism is that when antibiotics are taken uncontrollably and they do not complete the course of treatment to the end, as it should be according to the instructions, the bacterium is in sublethal conditions. This means that the concentration of the antibiotic is not enough for the bacteria to die, but it is sufficient to teach them to develop a mechanism of protection and escape from it. Therefore, the main danger is not so much in uncontrolled use, but in the fact that the wrong dosage is used, and patients do not finish the treatment cycle.

Are there any bacteria that have already developed immunity to antibiotics?

Yes, and there are plenty of them. Basically, these are superinfections, which are usually common in hospitals, because there are patients there who are fed with antibiotics. On the website antibiotic.ru, it is possible to study which bacteria are sensitive to which antibiotics, and to which they are resistant.

If we take, for example, staphylococcus aureus, then almost all its strains have already received resistance to levofloxacin, that is, this drug is useless. But if you take vancomycin, then so far it does not have staphylococcus-resistant strains. Meanwhile, staphylococcus aureus is one of the bacteria that leads to sepsis.

Microbes adapt to new antibiotics faster than we synthesise them

Does it mean that humanity is losing the battle with bacterial infections?

To answer this question, I can give statistics. It takes 7-8 years to develop and produce a fundamentally new antibiotic. That is, every 7-8 years, a fundamentally new antibiotic enters the market, and not analogues. And bacteria need 4-5 years to develop a strain resistant to it. That is, we spend 7 years to come up with a new antibiotic, and in 5 years microbes will be able to develop resistance to it. It is not difficult to model how many years we will lose absolutely all the tools for fighting bacteria.

In your opinion, how can the problem be solved?

The task of pharmaceutical companies and scientists is to develop new antimicrobial drugs and approaches to overcoming resistance. But it is difficult to invent something fundamentally new. Therefore, the direction of combining antibiotics is relevant. A good way is to combine them with substances that increase their activity. It is also possible to include in drugs the inhibitors of enzymes that destroy antibiotics: that is, substances that prevent bacteria from fighting the antibiotic molecules. The best example is amoxiclav, which contains amoxicillin, an antibiotic, and clavulanic acid, which suppresses the activity of bacterial enzymes that can destroy this antibiotic.

On the other hand, we can help solve the problem ourselves. First, you can not finish the course of taking antibiotics before we are cured. This is necessary in order for all pathogenic bacteria to die. If we see that the antibiotic does not work, it should be changed. If we constantly use the same drug, there is a high probability that we will have a strain of microorganisms resistant to it.

Therefore, the correct strategy is to test the bacteria for sensitivity to antibiotics before prescribing the drug. Unfortunately, sometimes there is no time for this test, which takes up to 2-3 days, and therefore they prescribe treatment with those drugs that usually help. After all, in the absence of treatment, the patient may die before the results of the analysis are ready.

It is also important to strengthen the immune system — this allows us to defeat the infection with natural tools that nature has given us, even without the use of antibiotics. It is necessary to change the consciousness of people so that they do not take the same remedy and bring the course to the end. This is not so difficult and really works. But we need a mass propaganda campaign, and we don't see that yet.