Is it worth drinking antibiotics at the first sign of illness and what is the risk of it: an interview with a pharmacologist

In the body of each person live useful and not very microorganisms. They exist in a single symbiosis, complementing each other, affecting the immune system and not causing us any discomfort. In difficult situations, for example, when we get sick, the algorithm fails and provokes the development of bacteria that can become the causative agents of various diseases: purulent processes, pneumonia, gastrointestinal infections, meningitis, sepsis, and others. Science has learned how to deal with such pests and has created antibiotics.

Along with the new type of drugs came problems - microorganisms have learned to survive, mutate and develop resistance (resistance) to their "killers". Should we be afraid of evolving bacteria, worry about resistance, how and when to take antibiotics, Professor Eduard Ortenberg, Chief Clinical Pharmacologist of the Tyumen Region and the Ural Federal District, told us.

What is antibiotic resistance and how long ago did IT appear?

- Resistance has been known since the emergence of the first antibiotic - penicillin, proposed by Nobel laureate Alexander Fleming. Six months after penicillin was invented, a colleague of the scientist published an article stating that some microbes could be resistant to this drug. This was almost 80 years ago.

The topic of resistance is old, there is nothing new in it. Microbes are inherent in the property of stability, so they fight for survival. And if out of millions of such microorganisms, for example, ten do not die under the influence of an antibiotic and become resistant to it, then they will then begin to multiply. This is antibiotic resistance. The surviving microbes will fill the empty niches in place of their killed comrades. They adapt to all negative phenomena in order to continue life.

Many antibiotics that used to be considered great and work have now largely lost their effectiveness. But this has always been the case and we are fighting it, new drugs are being invented that act on insensitive bacteria, and now scientists are trying to create new antibiotics.

Can a person himself influence the emergence of resistance?

“Antibiotic resistance is a huge problem. In addition to the main factor, the fact that microbes even come up with new metabolic mechanisms, the practice of using antibiotics is also important. We keep saying that pharmacists should not dispense antibiotics without a prescription, doctors should not prescribe antibiotics for viral diseases. This is one side of the issue, because the more you prescribe antibiotics, the greater the chance that microbes encountering them will begin to develop resistance mechanisms.

This also includes the problem of veterinary medicine, where modern antibiotics are used so that animals do not get sick and grow faster. Here, please, they were given to a cow, and then a man ate it. And the antibiotic got into the body, although the person did not take it.

- Scientists have created a map of antibiotic resistance in Russia, it displays the 9 most common microorganisms in the region. The data do not differ much from the figures for the whole of Russia. What is this bacteria?

According to the AMRmap online platform, the first place is occupied by Pseudomonas aeruginosa, the second is Staphylococcus aureus (which can cause skin infections, pneumonia, meningitis, septicemia, etc.), the third is Escherichia coli, the fourth is Bauman's Akinetobacterium (the causative agent of many nosocomial diseases), the fifth is Klibsiella ( causes pneumonia), followed by Idum pneumococcus, Proteus mirabilis (causes urinary tract infections), Enterobacter cloacae (causes digestive disorders), and Stenotrophomonas maltophilia (may cause peritonitis, pneumonia, bacteremia, and hospital illnesses).

“These are all common microbes, and we coexist with most of them. There are more microbes in the intestines than all the cells of the body, and no one is offended by them. They are needed, they cooperate with us, they add something to the protection of immunity and so on. But if the body is weakened ... Each of these bacteria is the causative agent of a particular disease, and its presence is a certain risk for the patient, especially in serious condition.

For example, Pseudomonas aeruginosa, which occupies the first place, does not cause anything special - only inflammatory processes. Very often it occurs in patients with massive burns - it multiplies on the surface of the wound. "Pseudomonas aeruginosa" is unpretentious, survives everywhere and is resistant to a large number of antibiotics. Or Staphylococcus aureus, which takes second place. Penicillin showed its effect against these microorganisms, and over time it became resistant not only to the first antibiotic, but also to others that came to replace it. But there are new drugs.

This is the story of the struggle - microbes for survival, medicine and science - to ensure that all "survivors" have a working tool. Often these bacteria affect elderly patients with poor immunity, in other cases the body usually copes with itself. Pathogens are more difficult for people with oncological, hematological problems, septic diseases, and blood disorders. Microbes multiply more easily in them, but I won’t say anything new here either. All this has long been known.

— And how to deal with the emergence of stability?

- The medical community is trying to limit the unreasonable use of antibiotics, to talk to the population as much as possible. People should understand that there is no need to put pressure on doctors and persuade pharmacists to sell antibiotics. You can’t look in first-aid kits for old grandmother’s antibiotics “just in case” and take them.

Of course, you do not need to treat yourself. And the authorities should give money to create new antibiotics, so that it would be profitable for manufacturers. These are the three ways we can do. Will it be successful? Well, sooner or later, to be honest, the germs will win anyway. We live in our period of time and hope that there will be enough antibiotics for our period, for the life of our children and grandchildren. On the other hand, human thought is moving forward and new drugs are being created.

The whole society needs to work, and if this is the case, then there is a chance that we will slow down this process, and our great-grandchildren will have to deal with today's antibiotics.
For the last decade, the 20-20 program has been operating in the West, according to which scientists must create 20 new antibiotics by 2020. But it is not fully implemented, at the moment five or seven have been invented.

“It turns out that the only weapons against resistance are more effective antibiotics. How long do they take to create and how much does development cost?

- A new drug is being created for a very long time. First, you need to come up with a molecule, see that it works. Only this will take three to five years, and this is a very bureaucratic procedure, everything needs to be documented, accounted for everything. Then the drug is tested on animals (it can take several years), followed by clinical trials, which can also take up to five years. It is believed that one drug takes up to eight years, and sometimes more, and 800 million dollars, or even a billion. It is clear that in categorical cases, when you need to come up with, for example, something from the Ebola, Zika viruses, bureaucratic barriers are slightly reduced and you can get the medicine faster.

- How should people act?

- First of all, you need to take antibiotics according to indications. In my book there is an epigraph: "Less drugs - only absolutely necessary!", And not "what else to give the patient?". This applies primarily to antibiotics. Second, remember that the best treatment is prevention. Do not forget to wash your hands regularly and follow the rules of hygiene. But we still break the rules, there is even an expression: “If you can’t, but really want to, then you can.”

- There is an opinion that resistance causes a violation of the cycle of taking antibiotics, is this true?

- There are antibiotics that are enough to enter once. For example, with acute inflammation of the bladder. There are also fungal infections where antibiotics need to be taken for two to three weeks. The Doctor must not only tell the patient how long to take the medicine, but also convince him to do so. Broadly speaking, one of the reasons that drugs do not work is precisely the patient's unwillingness to follow the doctor's orders. It costs billions of dollars and is observed in half of the cases.

And one of the moments of the effectiveness of antibiotics is the implementation of the regimen, but there is no connection between the duration of the course and the emergence of resistance. It used to be thought that a short course directly leads to sustainability, but this is not the case. A short course can be justified by the clinic and there is nothing to “smear” it for three weeks. And if a person drinks antibiotics for two or three weeks, and this is not necessary, then this will not lead to anything good.

“Scientists sometimes talk about superbugs that are very resistant and there are no effective drugs against them. Explain what microorganism is.

- Pseudomonas aeruginosa can also be attributed to superbugs, they also talk about Klibsiella (causing pneumonia). They have learned to produce enzymes that destroy the most modern antibiotic. But here the point is that the bacterium can destroy the medicine, but at the same time not be highly virulent, that is, not severely damage the body.

Recently, information has appeared that a species of Klibsiella has been isolated, which, on the one hand, is resistant, and, on the other hand, has a high virulence gene. Those people who encounter it may not be lucky. But we must not forget that we do not know how it spreads and how it mutates. Perhaps, in the process of reproduction and encounter with the environment, its ability to damage the human body will decrease, or maybe it will completely lose this gene. There is no exact algorithm, and it is impossible to say how everything will be.

Sustainable "pseudomonas" appeared in India in the valley of the Ganges River. There, for the first time, patients with resistant bacteria were identified, and thanks to what we now have, when you can just get on a plane and fly anywhere in the world, it has all spread widely. Situations when organisms with high resistance are registered do arise, but they are not of a supermass character, and there is no reason to consider this a tragedy so far. Microbes lived billions of years before higher organisms appeared and will live even after a nuclear catastrophe, if, God forbid, it happens. But they say that the sun will go out someday, but why are we now waiting for this and worrying about this topic?

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