They have saved millions of lives since the discovery of penicillin. But excessive use of antibiotics has multiplied the cases of resistance. Today, the fight against super-bacteria through the development of innovative treatments has become a priority issue.
- The discovery of antibiotics in the mid-20th century saved millions of people from previously incurable infections.
- But the intensive use of these drugs has generated resistance developed by many bacteria
- WHO warns of the need to develop new treatments against these ultra-resistant bacteria
It is a race of which we do not yet see how it will be able to stop and even less who will win it. Since the discovery of the first of them, penicillin, antibiotics have regularly been overtaken by those they fight, bacteria. So much so that, nearly 80 years after the tremendous advance that their arrival represented against infectious diseases, the world no longer believes in the ability of these drugs to protect us against the most dangerously resistant bacteria.
In 1928, the British Alexander Fleming, who studied staphylococci, saw his culture dishes contaminated by a mold that spread bacteria. This mushroom is called “peniucillium notatum” and will revolutionize medicine: ten years later two other researchers discover how to reproduce and stabilize penicillin in medicinal form. This is the birth of antibiotics, natural or chemical substances that block the growth of bacteria or destroy them. It is estimated that these drugs have saved humanity 10 years of life by saving millions of people from previously incurable infections such as tuberculosis, sepsis or pneumonia.
6,000 deaths per year due to resistant bacteria
And yet, these drugs are now designated as responsible for a new scourge, the existence of bacteria which, by dint of adapting to survive antibiotics, have become ultra-resistant. To the point that health authorities are seeking to limit the now massive use of conventional antibiotics: in 2018, 728 tonnes of antibiotics were sold in France for human health and 471 tonnes for animal health, this market aiming for the essential of the species consumed by man. Such a wide use which leads to the emergence of the most resistant forms of bacteria which would cause nearly 6,000 deaths each year in France and more than 30,000 in Europe according to a study published in The Lancet Infectious Diseases . If nothing changes, it is even predicted that infectious diseases of bacterial origin which had been almost overcome by antibiotics would once again become one of the main causes of death in the world by 2050, causing more than 10 million deaths!
But the mobilization against the effects of antibiotic resistance is now general. From the World Health Organization to the actors of the French health system, the world of medicine raises awareness among all actors to change behavior – in France, these actions have resulted in the campaign “Antibiotics are not automatic” – and to develop research for the development of new antibiotics capable of attacking “superbugs”.
Better use of antibiotics
In 2013, the ANSM (National Agency for the Safety of Medicines) published a report on antibiotics considered “critical” and a roadmap was defined for better use of these medicines: choosing the right molecule during the right duration and only when necessary and ensure compliance with treatment by patients. And above all, remember simple hygiene rules such as regular hand washing which avoid many infections and insist on the fact that antibiotics should not be used in the event of viral infections (nasopharyngitis, flu and bronchiolitis, in particular). These actions have resulted in a 15% reduction over ten years in the number of antibiotic prescriptions in France.
Should these drugs be banned? “Certainly not, they are still very useful for treating bacterial infections, especially in hospitals (7% of prescriptions compared to 93% in town…) or infections that complicate viral diseases”, warns Dr Benjamin Wyplosz, infectious disease specialist at Kremlin-Bicêtre who recognizes however that they are “still over-prescribed in quantity, for example in respiratory infections which often heal on their own such as bronchitis or sinusitis, or sometimes inappropriately with the use of antibiotics too widely spectrum, especially in urinary tract infections”.
40 million euros for research in France
To combat resistance, initiatives are multiplying in terms of research. In July 2019, a team from the University of Rennes tested a formula on mice that did not develop any resistance in the bacteria it is supposed to eliminate. And in June 2020, researchers at MIT developed an algorithm capable of spotting antibiotic compounds in existing drugs that allowed them to discover that an anti-diabetic was able to paralyze or kill a broad spectrum of agents. dreaded pathogens including tuberculosis.
And innovation is also driven by public actions: in 2018, France launched a priority research program endowed with 40 million euros and dedicated to the fight against antibiotic resistance and Europe plans to allocate more assistance on this subject as part of its “Horizon Europe” research program planned until 2027.
An “infinite” race with bacteria
But research must go further: in January 2020, the WHO issued a press release to warn of the lack of innovations to fight resistant infections. “The 60 products under development, including 50 antibiotics, provide little advantage over existing treatments and rare are those that target the most dangerously resistant bacteria, the so-called gram-negative bacteria”, emphasize WHO officials, insisting that these gram-negative bacteria are “spreading rapidly and urgently needing solutions”. If the development of more effective treatments against tuberculosis and Clostrium difficile responsible for diarrhea are promising, the WHO highlights “worrying gaps” against NDM-1, an enzyme resistant to a large group of antibiotics including those belonging to the family carbapenems which are currently the last resort against antibiotic resistant bacterial infections.
“Not everything is covered, but we are making considerable progress, procrastinates Dr. Benjamin Wyplosz, the shortcomings are partly filled, but we have to deal with bacteria whose resistance spectrum is incredible and even with new treatments we observe the appearance of new resistances… The race between antibiotics and bacteria is endless! “.
Subject made from the LEEM file “100 questions about medicine”
Find below the LEEM sheet on the theme “Antibiotics, are they over?”:
https://www.leem.org/100-questions/les-antibiotics-cest-fini?q=antibiotics
.