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Introduction
An antibiotic is a term that was used originally to refer to a class of drugs derived from microorganisms and used to treat infections caused by other microorganisms. However, most of the antibiotics currently in use are either semi-synthetic or synthetic. They achieve this by either killing (bactericidal) or inhibiting the growth of bacteria (bacteriostatic). Physicians prescribe antibiotics when a patient is diagnosed with a bacterial infection.
There exists a wide range of antibiotics that a physician can choose from. This is dependent on if the causative bacteria are gram negative or gram positive. Other antibiotics are broad-spectrum such as chloramphenicol. This means that they can be used to treat infections caused by a wide range of bacteria. Amongst the agents used to treat gram positive bacterial infections include penicillin and macrolides such as erythromycin. Those that are used to treat gram-negative bacterial infections include floroquinolones and aminoglycosides (Hamilton-Miller, 1984).
Antibiotics achieve their beneficial effects by acting on the bacterium cell. The bacterium comprises several targets for antibacterial agents depending on the class chosen. These targets include the bacterial cell wall, ribosomes, cell membrane or on the bacterial DNA.Those that act on the cell wall such as penicillin and vancomycin inhibit the synthesis of new cell wall. Thus, the permeability of the cell wall is altered leading to cell lysis.
Alteration of the cell membrane such as that caused by polymixin causes leakage of important cellular material leading to cell death. Those that act on ribosomes inhibit protein synthesis. This is achieved through blocking of the initiation or translocation steps which depends on the agent used.
These agents bind on specific ribosomal sub units either the 50s or 30s sub units of bacterial ribosome. Examples include tetracycline and aminoglycosides.Those that act on DNA prevent its replication. This class includes flouroquinolones.The damage to the DNA starts by initiation of strand breakage followed by temporary arrest of growth and eventually total inhibition of replication (Pakyz, MacDougall, Oinonen & Polk, 2008).
The pharmacokinetic and pharmacodynamic profiles of the drugs need to be considered when choosing the suitable agent for the condition in question. These range from the location of the infection, the route of administration, absorption of the drug from the gastro-intestinal system, the half-life of the drug and possibility of drug interactions. Care should be exercised in special groups such as pregnant or lactating women and in patients with impaired kidney or liver functions.
Proper use of antibiotics should be encouraged as abuse may lead to resistance. This can be fostered through accurate diagnosis of infection and issuing of proper instructions to the patient..Over-use of antibiotics like penicillins and cephalosporins has contributed to increased allergic cases to these drugs. This may present as skin rash, anaphylactic reaction, shock or edema. This leads to development of new medical problem, which increases the cost of healthcare. Some antibiotics such as tetracyclines upset the normal flora, which leads to gastrointestinal disturbances. New evidence, suggests that these antibiotics can lead to bowel disorders (Davies, 1996).
Over-Use of Antibiotics and Resistance
Over-use of antibiotics arises mostly from institution of empirical treatment for the various infections that affect patients. It is common for antibiotics to be prescribed for the treatment of viral infections like flu, colds or gastroenteritis. Viral infections normally weaken the immunity of the subject.
It is perceived that this may to lead to secondary bacterial infection. Since antibiotics have no activity against viral infections, they should be preserved for use when the patient is diagnosed with the bacterial infection. Other interventions should be considered first such as boosting the immune system before resorting to use of antibiotics (Pakyz, MacDougall, Oinonen &Polk, 2008).
In some cases, antibiotics are prescribed for minor infections. This is improper use as these cases are supposed to resolve by themselves. The body normally develops immunity to this infection. Use of antibiotics in these cases should only be considered when the body’s immunity fails to fight the condition.
Patients nowadays are pressurizing doctors to prescribe antibiotics in cases that do not deserve. It is so sad that while doctors know the implications of this, they still yield to the patient demands. This malpractice should be stopped in order to avert the danger of resistance.
Resistance develops due to alteration of the target site of agent or through mutation. Mutation occurs even in the absence of antibiotic. Hence, reduction in drug over-use is the goal in order to reduce mutation due to alteration of the target site. This has become a major problem especially with the discovery of the superbug gene-NMD-1.This mediates resistance across the various classes, even carbapenems which are the hardest to develop resistance (Hamilton-Miller, 1984).
Danger of antibiotic resistant bacteria infections
There is general concern among health care professionals due to the spread of the superbug gene-NMD-1.The gene develop when antibiotics are misused. Consequently, this causes the normal flora to evolve into unhealthy bacteria. This poses danger to the individual and others especially the immunocompromised. Development of newer antibiotics is also taking place at a slower rate. Since resistance leads to a narrowed spectrum of treatment options, future infections by resistant bacteria are likely to be fatal (Hamilton-Miller, 1984).
Resistance is also likely to increase the cost of healthcare provision. Lack of treatment options leads to prolonged hospitalization. In addition, fewer available alternatives may be expensive hence increasing the cost. The superbug gene is also likely to cause fast spread of infections across the globe. (Davies, 1996).
Conclusion
Antibiotic development is a slow and expensive process. From the above discussion, it is explicit that over-use of antibiotics is posing a major threat to provision of healthcare. Thus, several measures need to be developed in order to curb this malpractice thereby arresting the problem of antibiotic resistance. Firstly, preventive measures such as proper nutrition and hygiene should be observed to reduce the risk of infection. The use of antibiotics in minor conditions should also be avoided (Davies, 1996).
The physician should prescribe antibiotics after accurate diagnosis of the infection. Shorter courses of treatment may be encouraged to reduce prolonged exposure to the drug.
References
Davies, J. (1996). Microbes: What does not kill them makes them stronger. Web.
Hamilton-Miller, J. M. (1984). Use and abuse of antibiotics. Journal of Clinical Pharmacology, 18(4), 469-474.
Pakyz, A.L., MacDougall, C., Oinonen, M. & Polk, R. (2008). Trends in antibacterial use in US Academic Health Centers: 2002 to 2006. Archives of Internal Medicine, 168(20), 2254-2260.
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