The pandemic has deprived us of important antibiotics, and this is dangerous for humanity

Lessons from the pandemic

Worldwide antibiotic misuse peaked in 2020, and very

soon we will see the consequences of the general pharmaceutical panic. Drugs from the doctor's standard arsenal are no longer working against ordinary infections - for example, infections of the upper respiratory tract.

Measures to combat resistance are already known:it is necessary to reduce the spread of nosocomial infections, introduce vaccination, limit the use of antibiotics in animal husbandry. We also need to stop the uncontrolled use of antimicrobials in the treatment of viruses. But perhaps the main lesson that the coronavirus pandemic has taught humanity is the understanding of how important it is to invest in the development of new drugs.

“The peak of the unjustified use of antibiotics on a global scale came in 2020”

Antibiotic resistance is becoming one of the leading causes of death

This was clear even before COVID-19.The year before the pandemic, the WHO predicted that by 2050 antibiotic resistance would peak to the point where 10 million people would die each year from incurable infections. In January 2022, scientists published a study according to which, already in 2019, the death of almost 5 million people was associated with drug-resistant bacterial infections. At the same time, almost 1.3 million deaths are directly caused by antimicrobial resistance. Scientists consider the problem of antibiotic resistance more serious than the risks of HIV and malaria.

Antibiotics are also often used in agriculture.farming, due to their chaotic domestic exploitation, antimicrobial resistance is spreading in populations of various wild animals. They acquire resistance when sharing the same natural resources with humans and domestic animals. For example, recently zoologists studied the microbiota of a chimpanzee population in one of Tanzania's national parks. They found that primates are already highly resistant to antibiotics, which are often used uncontrollably to treat gastroenteritis.

Consequences of bacterial resistance

Studies have shown that up to 90% of patients withwho were diagnosed with coronavirus received antibiotics during treatment without any reason. COVID-19 can develop bacterial complications against which antimicrobials are effective. But the use of antibiotics from the first days of the disease threatens the formation of microbial resistance. This means that if in the future a bacterial superinfection nevertheless joins the coronavirus, there will be nothing to treat it.

For example, one of the most popular antibioticsduring the pandemic was azithromycin. According to doctors, after these two years, we can assume that we have lost this inexpensive and previously effective drug, although it has nothing to do with the treatment of coronavirus. People took it at the first sign of ill health, and not on course. In these cases, the mechanism works in this way: resistance to the antibiotic is formed in the body in 2-3 days, and the bacteria do not have time to die during this time, they continue to live and grow stronger. After a while, a person tries another antibiotic and the story repeats itself - and the bacteria learn to survive, and after a while there will no longer be such a drug that can cope with them.

According to various estimates, one of the outcomes of the pandemic will be a 4-fold increase in antibiotic-resistant bacteria. Experts believe that their number will increase by 50%.

“One of the most popular antibiotics during the pandemic was azithromycin”

Dangerous neighborhood: not all drugs can be used together

In addition to self-treatment with antibiotics and theirunjustified prescribing during the pandemic, we also faced another problem - the chaotic use of drugs that are incompatible with each other. The general increase in drug intake during the pandemic has shown that both doctors and patients need to remember the laws of their interaction. Different medicinal substances can both increase the activity and effectiveness of each other, and reduce it. In addition, the combination of drugs that are not suitable for each other can cause or increase side effects.

For example, the use of acetylcysteine, whichused to treat respiratory diseases, together with antibiotics reduces the activity of the latter, because the drug prevents their absorption. At the same time, drugs based on carbocysteine and antibiotics, on the contrary, mutually increase each other's effectiveness.

In addition to drug interactions, there isa phenomenon like polypharmacy is the problem of simultaneous prescription of several drugs at once, often unnecessary. An unreasonably long list of drugs hits not only the wallet, but also health. This usually happens if a person is observed at once by several specialists who do not agree on drug prescriptions, or the patient is fond of self-medication. Polypharmacy often leads to a decrease in the effectiveness of therapy and an increase in recovery time.

There are several tools to assess the rationality of the use of various drugs, the most popular of which are the STOPP / START and Beers criteria, they are especially relevant for elderly patients.

Mankind needs new drugs

COVID-19 has also done something important - forcedthe global medical community to become more flexible, and pharmaceuticals received a new impetus for development. Thanks to the experience of fighting the pandemic, the world has redoubled its efforts in the study and production of vaccines, as well as the development of drugs that, among other things, can replace antibiotics.

An alternative to antibiotics - thinking aboutbacteriophages, which can kill disease-causing bacteria and not destroy beneficial ones. A bacteriophage is a natural enemy of bacteria, it recognizes the right one, takes root inside and multiplies in it until it destroys it, after which it goes in search of a new bacterium. Bacteriophages use phagolysins to break down the cell wall of bacteria. One of these enzymes is lysozyme, it is part of the body's immune system, and is used to treat diseases of the upper respiratory tract.

Unlike antibiotics, bacteriophages do notdisrupt the microbiome, reduce the resistance of the microbe to drugs and can be used for children and pregnant women. The absence of contraindications for these groups of patients is a very important factor that confirms that it is possible to maintain high efficiency and not harm the body.

“COVID-19 has also done something important – it has forced the global medical community to become more flexible”

Another alternative to antibiotics isantimicrobial peptides that we owe to evolution. These are amino acids that provide the innate immunity of all living beings by destroying bacteria or slowing down their reproduction. Antimicrobial peptides work very quickly to damage the bacterial cell membrane and "break" it, they need a few seconds, while the antibiotic does the job for hours.

But peptides have both pros and cons.They do not cause such side effects as antibiotics, but they are excreted from the body too quickly, often without reaching the goal. Scientists are studying these molecules in the hope of creating effective and safe drugs based on them, and even achieve success. Approved preparations based on antibacterial peptides exist, but they are few and very expensive. If researchers can figure out how to extend the life of the molecule in the body, this technique could become more widespread and truly replace antibiotics.

QALY, or how to deal with the side effects of long-term therapy

One of the most important lessons of the pandemic is the cureshould not only work, but also minimally affect the quality of life, without causing serious side effects. Because, firstly, the coronavirus provoked the emergence and exacerbation of existing chronic diseases. Secondly, it has become obvious that medical problems that are not properly compensated are a huge risk in an epidemic. That is why it is important that people do not refuse long-term medication.

When developing drugs, you can no longertake into account the QALY indicator - years adjusted for the quality of life (quality-adjusted life-year). It reflects the number of additional years that the patient receives as a result of treatment, and at the same time takes into account the quality of life - symptoms, pain, side effects, the patient's psycho-emotional state. Now scientists first of all create drugs that are “soft” for the body, while maintaining their high efficiency in the fight against bacteria and viruses.

Today drug therapy is more thansimply prescribing the appropriate treatment regimen for the patient. The trend in the production of medicines is moving towards the search for active substances that have an effective effect without an aggressive effect on the body, while preserving the natural microflora.

“Today, drug therapy is more than just prescribing the right regimen for the patient.”

The world is looking for a pill for aging

COVID-19 hit older people:The aging process is associated with an increase in the number of chronic diseases and general “fragility”. Therefore, it is necessary to resist future epidemics at this level as well, by counteracting age-related changes in the body. We are talking about drugs that will act as “doping”, improving the condition of a healthy person and preventing the aging process.

Several studies are currently underway around the world.promising drugs. If they really prolong life, improve its quality, slow down aging, and in general can be considered the same drugs for healthy people, this will be a real breakthrough in the longevity industry.

For example, the TAME trial is a six-year studyeffectiveness of metformin against aging per 3,000 people aged 65 to 79 years. Scientists are trying to determine whether a well-known diabetes drug could actually help develop next-generation drugs that target the biology of aging.

Another project - PEARL trial, double blinda randomized, placebo-controlled, phase II study of the effect of rapamycin on the aging process in humans. Rapamycin is now used in kidney transplants to prevent organ rejection. Previous studies in mice have already shown that mice fed rapamycin lived noticeably longer than those not fed. Males lived longer on average by 9%, and females by 14%. Similar results were obtained in studies with dogs and primates.

Doctors are already prescribing treatment for patients withtaking into account individual characteristics, a personalized approach is becoming increasingly popular. In addition to genetic studies to determine the risk of developing diseases and the selection of drugs based on the genotype, such a phenomenon as the ageotype is gaining popularity. This is an individual for each person combination of certain biochemical parameters that change over time. The Stanford researchers claim that age identification at a young age will help you understand what exactly you should pay attention to in order to prolong healthy longevity. It is possible that pretty soon we will know not only our blood group, information about our genotype, but also our age.

Time to draw conclusions

After two years of fighting the pandemic, medical,the pharmaceutical and patient communities have learned a lot of important lessons, their price is effective and inexpensive antibiotics, which are likely to be useless soon. In order to prevent humanity from falling into an infectious collapse, in which going to the dentist or the process of childbirth becomes life-threatening, large investments in research and drug production are needed. They will replace or improve the effectiveness of weakened antimicrobials.

Clearly, the future lies with drugs thatwill meet modern safety requirements. The world experience in the fight against coronavirus has finally proved that it is not enough to cope with the problem, it is important to do it as delicately as possible, protecting the body from additional stress.

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