Antibiotics

Antibiotics are one of the greatest achievements of modern medicine. These medications destroy bacteria or halt their growth, and during their relatively short existence, they have saved millions of lives and enabled the advancement of medicine as we know it today. Thanks to antibiotics, treating many serious diseases has become routine, which has significantly extended and improved human life. However, as is often the case with powerful tools, their improper and excessive use carries serious risks.

One of, if not the biggest, threats to our modern way of life—free from the worry of common incurable diseases—is the rising resistance of bacteria to antibiotics. Antibiotic resistance manifests as an increase in the number of bacteria we call "superbugs," against which current medications are becoming ineffective. This phenomenon is occurring more and more frequently, driven by the excessive and unjustified use of these drugs, ranging from treating illnesses they are not intended for to adding antibiotics to animal feed. It is important to mention that this is not a problem of the future, but a problem of the present, and it is only a matter of time before it becomes a dominant global challenge. On the other hand, there is a growing amount of research, effort, and resources that we, as a human society, are investing in finding new solutions, such as new generations of antibiotics and using bacteriophages to fight resistant bacteria.

This text aims to provide a clear overview of how antibiotics work, when they are truly necessary, and how their misuse affects our body, particularly the gut microflora. Additionally, I will reflect on the ways we can contribute to preserving the effectiveness of these almost magical substances for future generations—not to say for our children.

What are antibiotics?

Antibiotics are medications that destroy bacteria or halt their growth, thereby enabling the body to fight off infections that could be fatal without them. They work in different ways, from interfering with the formation of bacterial cell walls to stopping their reproduction, making them one of the most powerful tools in modern medicine.

The short history of antibiotics begins with the discovery of penicillin less than a century ago, when Alexander Fleming accidentally noticed that the mold Penicillium notatum produced a substance that killed bacteria. This discovery was initially considered just an interesting scientific fact; however, during World War II, it became a revolutionary drug that saved the lives of millions of soldiers and civilians. Fleming's work was later advanced by other scientists who developed methods for the mass production of penicillin.

In the decades that followed, numerous other antibiotics were discovered, giving medicine powerful allies against bacterial infections. Thanks to these medications, treating previously fatal diseases such as tuberculosis, pneumonia, and sepsis became highly successful and routine.

According to estimates, antibiotics have saved more than 200 million lives worldwide and significantly extended the average human life expectancy. For example, while the average life expectancy at the beginning of the 20th century was around 50 years, today it ranges between 75 and 80 years in developed countries. This change cannot be attributed solely to antibiotics, but they play a crucial role in protecting against bacterial infections that were once the leading cause of death.

Although antibiotics are one of the greatest achievements of medicine, their use must be careful and responsible. The way we use them today directly impacts how effective they will be in the future.

When is their use justified?

The key principle is that antibiotics are intended exclusively for treating infections caused by bacteria, not viruses or other pathogens. Guidelines from health organizations, such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), emphasize that antibiotics should only be used in situations where they are genuinely needed. This includes cases when:

• The body cannot fight off the infection on its own. For instance, in severe bacterial infections like bacterial meningitis or sepsis, antibiotics are essential to save lives.

• The infection poses a risk to others. Contagious diseases like tuberculosis require antibiotic treatment to prevent spreading to other people.

• Recovery takes too long without antibiotics. Some infections, like bacterial bladder infections or sinusitis, can drag on and cause serious complications if not treated in time.

• There is a risk of developing more serious conditions. An untreated strep throat infection can lead to rheumatic fever, which seriously damages the heart.

On the other hand, antibiotics are not recommended for most viral infections, such as the common cold, the flu, or certain types of coughs and sore throats. These issues often arise as a result of a virus and pass spontaneously with proper rest and fluid intake. Additionally, even for bacterial infections, doctors in the developed world are increasingly avoiding the routine use of antibiotics. For example:

• Mild ear infections in children often clear up on their own without the need for antibiotics.

• Acute sinus infections can be treated without antibiotics, except in cases where symptoms last longer than 10 days or significantly worsen.

• Bronchitis in adults is usually viral in origin and rarely requires antibiotic therapy.

The core message is: antibiotics are not a cure for every illness. Taking antibiotics when they are not needed can cause more harm than good. Not only will they not help, but they can disrupt gut microflora, cause side effects, and contribute to the development of drug-resistant bacteria. Proper antibiotic use is not just a matter of individual health, but a global responsibility. Every time antibiotics are used without a real reason, we contribute to reducing their effectiveness, which can have consequences for all of humanity.

The Danger of Misuse and Resistance

Nearly 100 years ago, Sir Alexander Fleming predicted and wrote: "The public will demand the drug and then will begin a new era—the era of misuse. The microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred, which are passed on to other individuals and from them to others until they reach someone who gets a septicemia or a pneumonia which penicillin cannot save. In such a case the thoughtless person playing with penicillin treatment is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism. I hope this evil can be averted."

Despite the warnings from the Nobel laureate who discovered penicillin, today we have an evident problem due to the misuse of antibiotics, and the alarm bells are ringing. Our medications are ceasing to be effective against bacteria, new drugs are slow to be discovered, and antibiotics continue to be misused. This has led to the development of so-called superbugs that are immune to the strongest antibiotics we have, meaning that for these diseases, we simply have no cure.

How does misuse lead to resistance?

Antibiotic resistance is a phenomenon where an antibiotic stops being effective against a specific group of bacteria, which continue to grow and multiply even in the presence of the drug. It occurs due to the natural evolution of bacteria through genetic mutations in the presence of antibiotics. Since bacteria have the ability to share genetic material among themselves, the resistance of a harmless group that does not cause disease can easily transfer to other "dangerous" bacteria. Research has shown that the level of resistance is directly correlated with the quantity of antibiotics used.

An additional problem is that developing resistance to one antibiotic often leads to a reduction in the effectiveness of an entire class of antibiotics, due to their relatively similar structure and mechanism of action. The accelerated development of resistant bacterial strains happens because of the excessive, irresponsible use of antibiotics, both in medicine and in agriculture and livestock farming. The number of bacteria resistant to antibiotics has never posed a greater danger in history. According to World Health Organization data from 2019, resistant bacteria were responsible for the premature death of 1.27 million people worldwide. It is estimated that by 2050, the number of deaths from resistant bacterial strains will exceed the number of deaths from cancer, surpassing 10 million annually. The measures taken so far have shown weak to no results, and the use of antibiotics for humans and animals is not only failing to decrease but is constantly increasing. This danger is global, and if our relationship with antibiotics does not change soon, we will face a very serious crisis in the near future.

Antibiotics and Microflora

The gut microbiome represents millions of microorganisms living in our digestive tract. This is a topic I write about in almost every blog post, because every new discovery related to the microbiome indicates that it is even more vital than we thought just a few years ago. Gut microflora affects practically every aspect of human health and life, from immunity and digestion to vitamin absorption and mental health. I won't go into too much depth here, but you can read more in the blog posts about: Sugars, Anxiety, and Alcohol.

Some antibiotics are targeted at very specific species (strains) of bacteria, so taking them affects only a small number of bacteria and has no significant effect on the complex gut flora. An example of these narrow-spectrum antibiotics would be Fidaxomicin, which practically does not enter the bloodstream when taken orally and has a selective effect almost exclusively on the digestive system—specifically on the pathogenic bacteria C. diff, which cause serious infections accompanied by diarrhea with the potential to lead to colon cancer.

On the other side, there are broad-spectrum antibiotics, which affect a large number of different bacteria. Often, an antibiotic works on either Gram-positive or Gram-negative bacteria, and considering that almost all bacteria fall into one of these two categories, you can conclude that these types of antibiotics frequently affect an exceptionally high number of bacteria. While broad-spectrum antibiotics are the best option when the exact cause of an infection is unknown or an infection caused by multiple bacterial strains is suspected, their action is never limited solely to pathogenic organisms, but also to beneficial bacteria. Additionally, this type of antibiotic contributes much more significantly to the development of resistant bacteria.

The consequences of a disrupted microflora can be mild, like diarrhea, but also very serious, like creating intolerances to certain foods and a drop in immunity. However, today, probiotics are usually prescribed alongside antibiotics to help rebuild the microflora, which drastically alleviates these problems. It is worth mentioning that it is not enough to just take probiotics during or after antibiotics; it is also necessary to feed the new bacteria by choosing good nutrients (prebiotics). Prebiotic foods include fermented items, onions, garlic, grains, legumes, mushrooms, and more.

Good News

Due to these alarming results, alternatives to antibiotics have become the subject of intense research. Just as was the case with antibiotics, researchers are looking to nature for answers; so, besides developing new generations of antibiotics, they are also investigating bacteriophages, which are the natural enemies of bacteria. Additionally, the development of new technologies, artificial intelligence, and biotechnology is helping us respond to the ongoing crisis.

New Generations of Antibiotics

Although this field is quite outside my sphere of interest and expertise, I will still present a topic from this area as an example and talk about one type of bacteria. Essentially similar research is being conducted on other high-risk strains as well.

Acinetobacter is a bacterium frequently found in soil and water, but it can also colonize the bloodstream. This bacterium rarely causes infections in healthy individuals, but it has the ability to infect immunocompromised people and exhibits high drug resistance. In cases of infection with resistant strains of this bacteria, a mortality rate of 70% has been reported, prompting the WHO to label the discovery of a drug for this bacterium as "of critical importance."

By studying the mechanisms of reproduction and growth of these bacteria, researchers from Harvard have made a series of breakthroughs in understanding the processes within these microorganisms over the last 5 years—following more than 20 years of total research—leading to the publication of new classes of antibiotics in the journal Nature in 2024. If the drug is approved, this will be the first new therapy for this type of infection in the last 50 years. This and similar research give hope that we will be able to continue utilizing antibiotics in the years ahead, though I still maintain that we should not become too relaxed.

Bacteriophages

Bacteriophages, or simply phages, are a type of virus that attacks and destroys bacteria. An interesting fact is that bacteriophages are the most common and diverse entity in the entire biosphere (I use the word entity because "life form" would not be an accurate term).

Since these are natural enemies of bacteria that have spent thousands of years developing ways to bypass the natural defenses of microorganisms, it is logical that humanity is looking to them for a solution to the bacterial problem. The first steps and research into using phages for medical purposes were made over 100 years ago; however, significant results have been achieved in the last ten years or so. In 2016, bacteriophages were successfully used to treat a 68-year-old patient infected with a resistant strain of bacteria. For four months, treatment attempts were made with practically every known antibiotic, without results. In the absence of other options, an experimental bacteriophage therapy was applied to the patient, which cured him completely. This is significant not just for one patient, but it is also a clear demonstration that phages can be successfully used in medicine to treat infections that are currently considered incurable.

Just like with new generations of antibiotics, an entire blog post or two could be written about the development and application of bacteriophages, so I will stop here. The point is that there is plenty of room for research and overcoming the problems with resistant strains, so there is justified hope that we will continue to have the protection against bacteria that we enjoy now.

New Technologies

Finding antimicrobial agents is a long, slow, arduous, and expensive process. Research of this type mostly involves large global teams of scientists who must identify and explain highly complex mechanisms inside bacteria. They then have to design, synthesize, and test a substance that interrupts these mechanisms, while ensuring the substances do not harm the human patient.

As in all other fields, intensive human labor is being successfully replaced by artificial intelligence. This significantly accelerates parts of the process of developing new molecules that have the potential to become new antibiotics. A concrete example of this is SyntheMol, developed by researchers at Stanford. The researchers trained the model using a library containing more than 130,000 molecules and their reactions. When the model was prompted to create a potential drug for a specific resistant strain of bacteria, SyntheMol generated around 25,000 possible antibiotics, taking only 9 hours to do so. Scientists went on to examine and synthesize these compounds, resulting in 6 molecules that differed significantly in structure, both from each other and compared to previously known antibiotics. This has created an interesting dilemma: scientists are not entirely sure how these substances work at a molecular level (which was essential for creating antibiotics in the past), but two drugs tested on mice have yielded promising results. It seems to me that the future will bring a series of breakthroughs in the development of not just drugs, but entire human technology and knowledge, thanks to the further advancement of artificial intelligence.

Conclusion

Antibiotics remain one of the most important tools available to medicine, but precisely because of this, we must use them thoughtfully. Their power comes with responsibility, because what looks like a quick fix today will become the root of serious problems tomorrow. If we want to preserve the effectiveness of antibiotics, we must start with our own choices and know when, why, and how to use them. Unfortunately, I doubt that individual and personal responsibility will be enough, given that there is currently not enough political will at a global level to halt this catastrophe in the making.

The good news is that while we still lack a weapon more reliable than antibiotics, new generations of antibiotics that overcome the limitations of current ones are in development, alongside bacteriophages which may become the future of treatment.

What you can do personally is significant. Educate yourself, research, read, talk to your doctor, and think three times before you begin an antibiotic treatment. After that, you must finish the full course of therapy, because by doing so, you ensure there are no surviving bacteria that the antibiotic "nicked" but did not finish off. In this way, you can contribute to protecting the world, but even more importantly, protecting yourself, your children, and your loved ones.

Thank you for reading this blog! I truly hope you learned something new and enjoyed it. Although this article is not within the domain of nutrition, it is still deeply connected to biochemistry and health in general, making it part of the broader picture of human well-being that I focus on and strive for.