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Antimicrobial resistanceAntimicrobial resistance, or AMR, is a growing trend among newly discovered viruses. The World Health Organization (WHO) identifies 30 new diseases that threaten half the world’s population, which are particularly prevalent in developing nations.

Background of Antimicrobial Resistance

Drug-resistant diseases (AMR) have grown in prevalence over the past 40 years. Many of the medicines used to treat common infections like the flu and pneumonia have been around for decades. Eventually, viruses and bacteria develop their own microbial methods of fighting back against these drugs and inevitably become fully resistant to treatments.

Perhaps the most well-known example is the virus known as pneumococcus, or streptococcus pneumoniae. Penicillin has been used to treat pneumococcus since the early 1950s, giving it plenty of time to develop a strong resistance to the drug. Now, pneumococcus is practically untreatable, killing over 300,000 children below the age of 5 annually.

The CDC explains that germs that grow resistant to medications can be almost impossible to treat, often resulting in severe illness or death. This problem is only getting worse, as the U.N. finds that while 700,000 people die every year due to AMR diseases now, by 2050 that number will skyrocket to 10 million people.

The AMR crisis has severe economic implications as well. Antimicrobial diseases affect livestock as well as humans, leaving our international agricultural sector to collapse if not dealt with. All in all, the AMR crisis is projected to cause $100 trillion worth of global economic damage by 2050, only pushing people further into poverty.

Three organizations have stepped up to address the issue of antimicrobial resistance.

The AMR Action Fund

The AMR Action Fund is a financial project created by an international group of pharmaceutical companies. It aims to bring four new antibiotics that combat AMR to the consumer market by 2030. The fund expects to invest over $1 billion into late-stage antibiotic research by the end of 2025.

The AMR Alliance

The AMR Alliance is a massive coalition of more than 100 of the most powerful pharmaceutical companies, dedicated to fighting AMR. In 2016, the AMR Alliance signed the Industry Declaration, an agreement promising the development of anti-AMR medicines.

In 2018, the AMR Alliance spent a record $1.8 billion in the war against AMR. In 2020, the  AMR Alliance released its second progress report, detailing the progress made so far. The results are promising: 84% of relevant biotechnology companies are in the late stages of research and development for AMR cures and more than 80% of them have strategies in place for releasing the drugs.

UN Food and Agriculture Organization (FAO)

The FAO is taking serious steps to battle antimicrobial resistance. These dangerous antimicrobial superbugs threaten livestock in farms throughout the world. The FAO explains that two-thirds of future antimicrobial usage will be in livestock. These AMR superbugs will only increase in danger over time, as they develop stronger resistance to medicines.

The FAO has worked to improve agricultural practices across the world, specifically in developing nations. The FAO is raising awareness about this issue with rural farmers and is providing millions of dollars in funds to combat AMR.

World Antimicrobial Awareness Week (WAAW) is an annual campaign designed to increase awareness of the issue and encourage best practices among the general public, health workers, and policymakers to avoid the further emergence and spread of drug-resistant diseases. Over the week of November 18, millions of posts are made around the globe in support of antimicrobial resistance awareness. Expanding awareness is key, as the WAAW campaign website explains that less general use of antibiotics could help to mitigate the effects of this issue.

– Abhay Acharya
Photo: Flickr

Helps Ethiopean ChildrenAfrica has the highest child mortality rate of any continent. Ethiopia sits in the middle of the child mortality ranking of countries throughout Africa with 59 out of 1,000 children dying before the age of five. While it is not as high as the rate of 76 per 1,000 children found in sub-Saharan Africa, it is much worse than many developed nations, which average around 6 deaths per 1,000 children annually. New research, however, shows that childhood mortality can be significantly lowered in Africa using an antibiotic that could help Ethiopian children prevent blindness.

Azithromycin Helps Ethiopian Children

Trachoma is the leading bacterial infection that causes blindness. In an effort to lower the number of cases of trachoma, researchers preemptively gave azithromycin, an antibiotic effective at fighting trachoma, to thousands of children under the age of nine in Ethiopia. The researchers administered these doses of azithromycin to children twice a year.

After observing the children for several years, they came to a shocking discovery: azithromycin will help Ethiopian children live longer. Not only did the bi-annual antibiotic prevent against trachoma, as the researchers believed it would, but it also protected against many other common ailments as well. For those children in the case study, the childhood mortality rate was cut in half.

The discovery seemed too good to be true, so this group of researchers tried to replicate their findings in other African nations with higher child mortality rates. Close to 200,000 children were given azithromycin in Tanzania, Malawi and Niger. While the results were not quite as impressive as cutting the child mortality rate in half, as seen with Ethiopia, the results were still high. The twice-yearly drug lowered child mortality rates between 14 to 19 percent in each country.

Research Into Other Illnesses

Research must continue before Africa will see widespread use of azithromycin for children. If approved for widespread use, this antibiotic could help prevent some of the common illnesses that lead to child mortality. These common illnesses include:

  • Pneumonia: Pneumonia kills nearly 100,000 children per year in Africa. This accounts for 16 percent of childhood death under the age of five. Currently, when children contract pneumonia, only one third are able to receive lifesaving antibiotic treatment.
  • Diarrhoeal disease: Diarrhea is the leading cause of death in children under the age of five. Diarrhea is a common infection in the bowels. It is completely preventable and treatable, yet it is estimated that 525,000 children in Africa die annually from this illness.
  • Malnutrition: Malnutrition contributes to childhood mortality rates. While the use of azithromycin will not be able to prevent malnutrition, it may be able to help prevent other ailments that the body is not able to fight off because of the lack of nutrients and calories.

Long term effects of azithromycin used to prevent ailments in children are not known. However, the studies have shown promising results in saving the lives of hundreds of thousands of African children. With a few more years of research and more funding, these researchers may be able to permanently lower the childhood mortality rate in Africa. Not only will this research continue to help Ethiopian children but it will also help children of other nations, ensuring they live into adulthood.

Kathryn Moffet
Photo: Pexels

Antibiotics
Even as progress continues to be made in medicine and pharmaceuticals, infectious diseases continue to be a rampant threat, especially in the developing world. Infectious diseases are ailments caused by pathogenic microorganisms and are one of the leading causes of death worldwide. The most common, accessible and inexpensive method of treatment for these diseases is antibiotics.

Antibiotics, as the name suggests, are chemical compounds that inhibit the growth of micro-organisms such as bacteria and fungi. The job of antibiotics is vital in curing many infectious bacterial and fungal diseases, as well as preventing these diseases as a consequence of viral infections.

Although there are hundreds of types of antibiotics today, their mode of action is along the same basic principle: the active ingredient in the antibiotic intercepts the metabolic machinery of the microorganism, thereby either killing it or preventing it from reproducing.

Unfortunately, antibiotics can be expensive, especially when needed for prolonged usage. The manufacturing of pharmaceutical antibiotics is at least semi-synthetic: that is, significant alterations are chemically induced in any naturally occurring raw materials. This method of production also makes it somewhat inaccessible in certain areas. In fact, a 2015 report has shown antibiotics to be 15 percent of the drug shortage in the past five years.

Another issue with modern antibiotic drugs is the notorious antibiotic resistance. The microorganisms have the capability to evolve quickly by inducing changes in their nucleic acids to resist antibiotics. So, if one antibiotic can interact with one gene or its complementary protein product, it will not do so in the event of any genetic mutation. This renders the antibiotics ineffective, as it is almost impossible to track every single point mutation that occurs in a specie, and manufacture a new drug quick enough to tackle that evolved resistance.

All of these issues have opened up interest into the development of a natural alternative to antibiotics. The potential advantage of these products is that they are natural, readily available and can work synergistically with existing antibiotic therapies. Many compounds have been indicated as possible alternatives, but none more so than polyphenols.

Polyphenols are a group of chemical compounds characterized by the presence of the same functional group. The presence of these compounds generally imparts very characteristic aspects to the plant it is found in. These compounds have been found to be not only effective in sync with synthetic antibiotics, but also quite effective in their own antimicrobial properties. Blueberry extract, for instance, can significantly retard the growth of the bacterium Campylobacter, which causes food poisoning.

An added significance of this approach is the sustainability of the polyphenolic antibiotics: researchers have successfully used berry pomace and pomegranate peel (fruit waste products) to extract the desired polyphenol antimicrobial agent. Polyphenols can also be extracted from various plants and can be tailored to the region the antibiotics are being manufactured for.

To date, the primary usage of polyphenolic compounds from natural sources has been limited to synergistic combination with traditional antibiotics. However, with new research being conducted on the development of a commercially feasible application of the natural polyphenolic extractions, this particular method of treatment is a big contender in the new era of antibiotics.

Atifah Safi

Sources: Science Direct 1, Science Direct 2, Nature, Oxford Journals
Photo: Flickr

Teixobactin
As the growing resistance against drugs becomes more disturbing, a new discovery has the potential to dramatically alter the situation.

Teixobactin is the first new antibiotic to be discovered in almost 30 years. Safely tested on mice, not only is the drug capable of fighting both drug-resistant bacteria and common drug bacterial infections such as tuberculosis, septicaemia and clostridium difficile colitis, but it could also pave the path for a host of new antibiotics through the method in which the drug was discovered.

The soil has always had the potential to reveal many new antibiotics. Scientists have noted the interesting and innovative ways many microbes have managed to fight off other microbes, but they found that 99 percent of microbes would not grow under laboratory conditions. This obstacle prevented scientists from unlocking the potential wave of antibiotics that could be developed.

A group of researchers at Northeastern University in Boston has overcome that barrier. Essentially deceiving the bacteria, soils with the microbes were sandwiched between two semi-permeable membranes to imitate a natural environment.

With that method, the researchers were able to grow 10,000 different strains of bacteria and isolate 25 potential antibiotics. Ultimately, Teixobactin was the most promising antibiotic that they discovered.

Teixobactin is especially unique due to its mechanism of targeting two different lipids that are required for cell wall production in bacteria. Its innovative process will most likely prove to prevent the development of resistance for quite some time.

In cell cultures and later on with mice, Teixobactin was capable of successfully killing MRSA and drug-resistant TB. The antibiotic was so effective that the researchers were concerned that the drug would fail to make a distinction between the mammalian cells and the bacteria when testing on mice. Surprisingly, Teixobactin performed exceedingly well, killing the bacteria while leaving no notable side effects.

Still there is a long way to go before Teixobactin becomes available for human use. It has yet to be tested on humans so its effectiveness and side effects are unknown. Even if the drug passes all the required tests, it is estimated that it will be five to six years before it becomes available.

Furthermore, due to its function of destroying the cell walls of bacteria, Teixobactin is ineffective against gram-negative bacteria such as E. coli and many sexually transmitted diseases which have outer membranes that the antibiotic cannot penetrate.

But the main issue concerning Teixobactin is the potential overuse of the drug once it does become available. The growing threat against antibiotics and their overuse is that it may develop into the “post-antibiotic era,” referring to a time when a number of infectious diseases will be unresponsive to antibiotic treatments.

While the development of antibiotics is essential, the culture of over-prescribing antibiotics must change. A continuation of that culture would further the course toward a post-antibiotic era and limit the effectiveness of Teixobactin and other potentially effective antibiotics.

Nevertheless, this development could begin the transition away from building resistances in bacteria and open whole new channels for better and more innovative drugs to save lives all around the world.

– William Ying

Sources: The Guardian, Washington Post, Telegraph UK, The New York Times, Smithsonian,Live Science, Time, Newsweek
Photo: Independent U.K.

overuse of antibiotics
Prescriptions, particularly antibiotics, are alarmingly easy to get a hold of these days. Antibiotics are usually used to treat bacterial infections and not viruses, though recently doctors have begun prescribing them more liberally. The New England Healthcare Institute (NEHI) says that physicians often resort to prescribing antibiotics because “determining if an infection is viral or bacterial is expensive and time-consuming,” so the seemingly “safe” solution is to provide the drugs. Additionally, doctors want to avoid issues of malpractice, which could arise if an actual bacterial infection goes untreated.

Patient influence also has some weight in a physician’s decision on whether to prescribe antibiotics or not. NEHI states “patients may pressure providers to prescribe antibiotics for conditions for which they are inappropriate…or inappropriately save antibiotics for later use.” These ostensibly commonplace habits may seem harmless, but they have unfortunately led to a rise in antibiotic resistance.

The CDC claims that instead of resorting to antibiotics as a quick fix for clearing up viruses, “symptom relief might be the best treatment option.” Overuse of antibiotics for viruses, such as colds or other respiratory issues, could lead to the drug losing its effectiveness against bacterial infections. Bacterial infections like MRSA and C-difficile are drug-resistant and have been a major cause of concern in the past decade due to their high mortality rates.

According to the Tufts University Alliance for the Prudent Use of Antibiotics (APUA), antibiotics resistance happens when “an antibiotic has lost its ability to effectively control or kill bacterial growth.” Antibiotic resistance also occurs naturally. During the use of an antibiotic, some bacteria can resist being killed, which can increase future survival of even more of that “resistant strain” of bacteria. The overuse of antibiotics can exacerbate this process. Genetic mutation of bacteria and “acquired resistance” from other bacteria can also breed more resistant bacterium.

Preventing disease in the first place by practicing good hygiene is the first suggestion that Tufts gives to combat antibiotic resistance. Additionally, they suggest that overall, antibiotics must be used less frequently. Patients who are prescribed antibiotics should complete the course of their antibiotics, even if they are feeling better partway through, and not save antibiotics for future unsupervised use.

This issue not only exists in the first world, where antibiotics are clearly incredibly accessible, but this problem also plagues developing countries. According to Nature: International Weekly Journal of Science, “around the globe, overuse of these drugs has created resistant strains of deadly bacteria.”

In developing nations like India and Pakistan, as high as 95 percent of adults “carry bacteria that are resistant to β-lactam antibiotics,” whereas only 10 percent of adults in Queens, N.Y. are carriers, says Timothy Walsh of Cardiff University in an interview with Nature. This could be attributed to poor sanitation in developing countries. Due to a lack of restrictions on hygiene, bacteria are spread more easily. Additionally, training of pharmacists must be improved so that the incorrect use of antibiotics decreases.

Potential solutions to this crisis have been broached. Developing new antibiotics can be incredibly expensive, “requiring approximately 10 years and $300 million” according to Tufts. However, scientists have considered strengthening existing antibiotics or using “decoy molecules” to trick bacteria into attacking the decoy instead of the antibiotic. Additionally, it has been suggested that antibiotics be altered to combat “the mechanisms that promote resistance,” rather than solely focus on destroying the bacteria itself.

While these solutions are certainly credible, decreased use of antibiotics and more strict regulations are the primary step toward eliminating the antibiotic resistance epidemic.

  — Bridget Tobin

Sources: New England Healthcare InstituteCenter for Disease ControlTufts (1)Tufts (2)Nature
Photo: Nature

G8_and_Superbugs_antibiotics

What do we do when our own medicine becomes our greatest threat? For the world today, this question is becoming more and more significant. G8 leaders met in London on Wednesday, June 12 to discuss the global threat of antibiotic-resistant microbes, or superbugs.

In a statement published on Thursday, the G8 science ministry said that they consider antimicrobial drug resistance as one of the major health security challenges of the twenty-first century. “Across the G8 we should regard the spread of antibiotic resistance as a global challenge that is up there with climate change, water stress and environmental damage, and there are genuine policy consequences that follow from that,” said science minister Mr. Willetts.

As usual, those living in extreme poverty are most at-risk. As bacteria develop resistance to widespread antibiotics in humans, animals, the soil, and water sources, they become more dangerous to humans—and especially the most vulnerable sectors of the world’s population.

To combat the development of superbugs and protect those most vulnerable to them, G8 leaders decided to make sweeping changes in the medical and pharmaceutical community. These included:

1. Limiting the use of antibiotics in humans, animals, and plants.
2. Investing in more research about the evolution of resistance and in developing better diagnostics for precise prescription.
3. Improving international collaboration on surveillance of bacterial strains.

The need for steps like these is urgent, and the G8’s decision was hailed with applause from the humanitarian community. If the world continues support these decisions, health security will continue to improve.

– John Mahon
Source: The Independent, Agripulse
Photo: The Independent