The European Day for the Prudent Use of Antibiotics is commemorated every year on November 18th to emphasize the importance of the pharmaceutical professional activity in public health. An essential and inseparable element to understand the fight against bacterial resistance to antibiotics as a really important element. Top Doctors has prepared this article with the collaboration of Dr. Jesús Alcaraz Rubio, specialist in Hematology.
What are antibiotics?
Dr. Alcaraz defines that: “antibiotics are drugs that prevent the development or destroy microorganisms. The first antibiotic drug appeared in 1928, when Alexander Fleming discovered the properties of Penicillin in a fungus, although its use did not become widespread until years later. In the decade of the 30’s, Sulfamides began to be used in Central Europe. This was followed by Streptomycin and later by hundreds of antibiotics, either natural or manufactured in the laboratory. Initially, the power of action of the first antibiotics was limited, which is called narrow spectrum, either because the germ becomes easily resistant or because they are not able to reach the site of infection. Over time, broad-spectrum antibiotics have been developed, with greater microbicidal potency, capable of reaching all parts of the body and more convenient administration and dosage.”
What problem has arisen with the generalization of antibiotic administration?
The main problem is the so-called resistance, which are defense mechanisms generated by the microorganism itself against the antibiotic itself, explains Dr. Alcaraz. Several mechanisms are currently known by which the germ can become resistant to the drug. One of them, for example, is designed by a microorganism called Mycoplasma, which is naturally resistant to Penicillin because it lacks a bacterial wall, which is where this antibiotic acts. Others are more sophisticated, such as Staphylococcus, capable of manufacturing substances that activate Penicillin, called B-lactamases. Pneumococcus has proteins in its membrane that act as a pump to expel Penicillin and resist them, unless the dose is greatly increased, concludes Dr. Alcaraz.
Wrong use of antibiotics
Dr. Alcaraz affirms that the use of antibiotics, if done in insufficient doses or inadequate guidelines, can eliminate the most sensitive microorganisms, selecting the resistant ones. Antibiotics also eliminate the germs that cause disease, but also many others that are beneficial to the body (for example, those that colonize our skin or digestive tract). Moreover, in nature there is competition between species, so that if we eliminate too many bacteria, we can facilitate the overgrowth of other microorganisms such as fungi.
What is the problem caused by antibiotic resistance?
Currently there are bacteria that have become resistant to most existing antibiotics. They are called Superbugs. These microorganisms are capable of causing serious infections that are very difficult to treat and which in most cases require the combination of several antibiotics; and even then they can cause serious sequelae, even death, especially in patients who are immunocompromised for any reason. All this generates an enormous healthcare expense in a health system that is deeply in deficit, assures Dr. Alcaraz.
What does the rational use of antibiotics mean?
Dr. Alcaraz stresses that “antibiotics are very useful weapons in the fight against infections, but they must be used with moderation, in specific situations, applying protocols agreed upon by the various scientific societies involved. Most banal infectious processes in both children and adults are caused by microorganisms of viral origin, so it is not logical to use antibiotics against them, except in specific infections, since most drugs are intended for the treatment of bacterial infections”.
When faced with an infectious process or symptoms compatible with it, among which the main sign is fever, one must go to the family physician, who will evaluate the whole symptomatological process and refer the appropriate complementary tests, before indicating antibiotic treatment, either empirical (when the specific germ causing the clinical picture is not known) or targeted, when the specific microorganism and the antibiotic coverage to which it is sensitive are known, by means of an analytical test called antibiogram, emphasizes Dr. Alcaraz.
How is the microorganism causing an infection detected?
Dr. Alcaraz indicates that: “the germs causing any infectious process are detected by means of an analytical test called culture, associated in most cases with an antibiogram, which determines the range of antibiotics to which the microorganism is sensitive, as well as the degree of sensitivity. However, we must bear in mind that every positive culture is not indicative of antibiotic prescription. This will depend on the physician’s decision, who will analyze these results together with other laboratory parameters, as well as the patient’s symptoms. In fact, there are bacteria that colonize parts of our body, but without causing disease. Our body coexists with millions of bacteria that are not only not harmful, but many of them are essential for maintaining health. An example would be asymptomatic bacteriuria (elimination of bacteria through urine). This phenomenon does not cause disease and may even prevent other harmful bacteria from taking their place.”
Can antibiotics be used for prevention?
Sometimes yes, for example in a case of meningococcal meningitis, produced by a germ so virulent that it could quickly affect possible close contacts, but almost always no, Dr. Alcaraz concludes.
In short, the only professional who can prescribe antibiotics is the physician, always following certain guidelines. Doctors should not be pressured to administer antibiotics. Lastly, repeated consultations for processes should be avoided.