Antibiotics: Friend or Foe?

While many ancient cultures used molds and other plants to treat infections, it was Alexander Fleming who received the credit for the discovery of penicillin in 1928. The discovery of antibiotics is considered one of the most important advances in 20th-century medicine saving countless lives. So what is the catch? Antibiotics can disrupt our microbiome which helps perform many functions needed to keep us healthy, as well as can cause drug resistance. According to the WHO, if the necessary steps aren't taken to counter antibiotic resistance, humankind is on its way to a future where minor injuries and infections can be a significant cause death.

Actually, according to the CDC, approximately 80 million antibiotic prescriptions per year have been deemed unnecessary and in the United States alone, approximately 2 million individuals are infected annually with bacteria that show antibiotic resistance causing 23,000 deaths. U.S. Antibiotic Awareness Week coming to a close for 2018 is a yearly national effort to help the general public be aware of antibiotic resistance as well as come up with improved guidelines for antibiotic use and prescription writing. The CDC is working to improve antibiotic use in health facilities as well as farms and this week-long effort coincides with the European Antibiotic Awareness Day, Canada’s Antibiotic Awareness Week, Australia’s Antibiotic Awareness Week, and the World Antibiotic Awareness Week showing this is truly an international problem.

Being aware of antibiotic resistance and improving prescription guidelines has become an international priority. So how do we fix this? Education is a good start. Like many lessons, education is key as many people use antibiotics when the pathogen is a virus, not bacteria. Some share their antibiotics with others and others use more than the recommended dose thinking the bacteria will die faster. According to the WHO, if the necessary steps are not taken to counter antibiotic resistance, in the future minor wounds and infections may cause death and the common strep throat or ear infection will become a parent’s worst nightmare.

Additionally, we must take into consideration the deleterious effects antibiotics may have on homeostasis, the equilibrium of the collective microbes that are within each of us composed of bacteria, bacteriophage, fungi, protozoa and viruses. This equilibrium can be altered when we take antibiotics or immunomodulators. Most of the microbes in the microbiome do not cause disease and in fact act to perform many important functions that we cannot perform ourselves. They digest food to generate nutrients for host cells, synthesize vitamins, detoxify carcinogens, metabolize drugs, stimulate the renewal of cells in the gut lining and activate and support the immune system. Microbes can adapt to exploit new habitats and carbohydrate composition seems to drive colonization by those microbes that have the ability to metabolize these body-site specific carbohydrates. This is important as high or low microbial diversity can have different implications for health or disease depending on body location. For example, it has been shown that low microbial diversity in the gut is associated with obesity, inflammatory bowel disease and Crohn's disease, whereas high microbial diversity in the vagina is often associated with bacterial vaginosis. Loss of metabolic capabilities of certain microbiomes has been seen in particular diseases such as Crohn's Disease, ulcerative colitis or neonatal necrotizing enterocolitis.

While these pathogens can cause disease in those individuals with weakened immune systems, these microbes are responsible for maintaining cell function and other properties needed for maintaining the body site ecosystem in healthy individuals. We have learned that the bacteria living in each of us are “friend” not “foe”, and we must stop and think before taking antibiotics which can destroy the equilibrium, which we so heavily rely on to stay healthy.

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