In modern usage, an antibiotic is a
chemotherapeutic agentwith activity against microorganisms such as bacteria, fungi or protozoa. [cite book|author=Davey PG|chapter=Antimicrobial chemotherapy|editor=Ledingham JGG, Warrell DA|title=Concise Oxford Textbook of Medicine|publisher=Oxford University Press|location=Oxford|pages=1475|year=2000|isbn=0192628704]
The term "antibiotic" (from the Greek "αντί" – "anti", "against" + "βιοτικός" – "biotikos", "fit for life" [%3A1999.04.0057%3Aentry%3D%239779 Anti, Henry George Liddell, Robert Scott, "A Greek-English Lexicon", at Perseus] ] [ [http://www.perseus.tufts.edu/cgi-bin/ptext?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3D%2320016 Biotikos, Henry George Liddell, Robert Scott, "A Greek-English Lexicon", at Perseus] ] ) was coined by
Selman Waksmanin 1942 to describe any substance produced by a micro-organismthat is antagonistic to the growth of other micro-organisms in high dilution. This original definition excluded naturally occurring substances, such as gastric juiceand hydrogen peroxide(they kill micro-organisms but are not produced by micro-organisms), and also excluded synthetic compounds such as the sulfonamides (which are antimicrobial agents). Many antibiotics are relatively small molecules with a molecular weightless than 2000 Da.
With advances in
medicinal chemistry, most antibiotics are now modified chemically from original compounds found in nature, as is the case with beta-lactams (which include the penicillins, produced by fungi in the genus " Penicillium", the cephalosporins, and the carbapenems). Some antibiotics are still produced and isolated from living organisms, such as the aminoglycosides; in addition, many more have been created through purely synthetic means, such as the quinolones.
Unlike previous treatments for infections, which often consisted of administering chemical compounds such as
strychnineand arsenic, with high toxicityalso against mammals, antibiotics from microbes had no or few side effectsFact|date=September 2008 and high effective target activity. Most anti-bacterial antibiotics do not have activity against viruses, fungi, or other microbes. Anti-bacterial antibiotics can be categorized based on their target specificity: "narrow-spectrum" antibiotics target particular types of bacteria, such as Gram-negativeor Gram-positivebacteria, while broad-spectrum antibiotics affect a wide range of bacteria.
The environment of individual antibiotics varies with the location of the infection, the ability of the antibiotic to reach the site of infection, and the ability of the microbe to inactivate or excrete the antibiotic. Some anti-bacterial antibiotics destroy bacteria (bactericidal), whereas others prevent bacteria from multiplying (bacteriostatic).
Oral antibiotics are simply ingested, while
intravenousantibiotics are used in more serious cases, such as deep-seated systemic infections. Antibiotics may also sometimes be administered topically, as with eye drops or ointments.
In the last few years three new classes of antibiotics have been brought into clinical use. This follows a 40-year hiatus in discovering new classes of antibiotic compounds. These new antibiotics are of the following three classes: cyclic lipopeptides (daptomycin), glycylcyclines (tigecycline), and oxazolidinones (linezolid). Tigecycline is a broad-spectrum antibiotic, while the two others are used for Gram-positive infections. These developments show promise as a means to counteract the growing bacterial resistance to existing antibiotics.
Although potent antibiotic compounds for treatment of human diseases caused by bacteria (such as
tuberculosis, bubonic plague, or leprosy) were not isolated and identified until the twentieth century, the first known use of antibiotics was by the ancient Chinese over 2,500 years ago. [ [http://science.enotes.com/how-products-encyclopedia/antibiotic How Products Are Made: Antibiotics] ] Many other ancient cultures, including the ancient Egyptians, ancient Greeks and medieval Arabs already used molds and plants to treat infections, owing to the production of antibiotic substances by these organisms, a phenomenon known as antibiosis[http://en.wiktionary.org/wiki/antibiosis]
Quinine became widely used as a therapeutic agent in the 17th century for the treatment of
malaria, the disease caused by " Plasmodium falciparum", a protozoan parasite.
Antibiosis was first described in 1877 in bacteria when
Louis Pasteurand Robert Kochobserved that an airborne bacillus could inhibit the growth of " Bacillus anthracis". [cite journal |author=H. Landsberg |title=Prelude to the discovery of penicillin |journal=Isis |volume=40 |issue=3 |pages=225–227. |year=1949|doi=10.1086/349043] The antibiotic properties of "Penicillium sp." were first described in Franceby Ernest Duchesnein 1897. However, his work went by without much notice from the scientific community until Alexander Fleming's discovery of Penicillin.
Modern research on antibiotic therapy began in
Germanywith the development of the narrow-spectrum antibiotic Salvarsanby Paul Ehrlichin 1909, for the first time allowing an efficient treatment of the then-widespread problem of Syphilis. The drug, which was also effective against other spirochaetal infections, is no longer in use in modern medicine.
Antibiotics were further developed in Britain following the discovery of
Penicillinin 1928 by Alexander Fleming. More than ten years later, Ernst Chainand Howard Florey became interested in his work, and came up with the purified form of penicillin. The three shared the 1945 Nobel Prize in Medicine. In 1939, Rene Dubosisolated gramicidin, one of the first commercially manufactured antibiotics in use during World War II to prove highly effective in treating wounds and ulcers.cite journal |author=Van Epps HL |title=René Dubos: unearthing antibiotics |journal=J. Exp. Med. |volume=203 |issue=2 |pages=259 |year=2006 |pmid=16528813 |doi=] Florey credited Dubos for reviving his research on penicillin. Prontosil, the first commercially available antibacterial antibiotic was developed by a research team led by Gerhard Domagk(who received the 1939 Nobel Prize for Medicine for his efforts) at the BayerLaboratories of the I.G. Farbenconglomerate in Germany. Prontosil had a relatively broad effect against Gram-positivecocci but not against enterobacteria. The discovery and development of this first sulfonamide drug opened the era of antibiotics.
Classes of antibiotics
At the highest level, antibiotics can be classified as either
bactericidalor bacteriostatic. Bactericidals kill bacteria directly where bacteriostatics prevent them from dividing. However, these classifications are based on laboratory behavior; in practice, both of these are capable of ending a bacterial infection. [Pelczar, M.J., Chan, E.C.S. and Krieg, N.R. (1999) “Host-Parasite Interaction; Nonspecific Host Resistance”, In: Microbiology Conceptsand Applications, 6th ed., McGraw-Hill Inc., New York, U.S.A. pp. 478-479.] Classes of antibiotics include aminoglycosides, ansamycins, carbacephem, carbapenems, cephalosporins, glycopeptides, macrolides, monobactams, penicillins, polypeptides, quinolones, sulfonamides, and tetracyclines, along with others.
Since the first pioneering efforts of Florey and Chain in 1939, the importance of antibiotics to
medicinehas led to much research into discovering and producing them. The process of production usually involves screening of wide ranges of microorganisms, testing and modification. Production is carried out using fermentation, usually in strongly aerobic form.
Possible side effects are varied, depending on the antibiotics used and the microbial organisms targeted. Adverse effects can range from fever and nausea to major allergic reactions including
photodermatitis.Fact|date=April 2007 One of the more common side effects is diarrhea, sometimes caused by the anaerobic bacterium " Clostridium difficile", which results from the antibiotic disrupting the normal balance of the intestinal flora, [University of Michigan Health System: [http://www.med.umich.edu/1libr/aha/aha_aadiarrh_crs.htm Antibiotic-Associated Diarrhea] , November 26, 2006] Such overgrowth of pathogenic bacteria may be alleviated by ingesting probioticsduring a course of antibiotics. Fact|date=April 2007. An antibiotic-induced disruption of the population of the bacteria normally present as constituents of the normal vaginal flora may also occur, and may lead to overgrowth of yeast species of the genus "Candida" in the vulvo-vaginal area. cite journal|author=Pirotta MV, Garland SM|year= 2006|title=Genital Candida species detected in samples from women in Melbourne, Australia, before and after treatment with antibiotics|journal=J Clin Microbiol.|volume=44|pages=3213–3217|pmid=16954250|doi=10.1128/JCM.00218-06] Other side effects can result from interaction with other drugs, such as elevated risk of tendondamage from administration of a quinolone antibiotic with a systemic corticosteroid.
Hypothetically, some antibiotics might interfere with the efficiency of birth control pills. However there have been no conclusive studies that proved that; on the contrary, the majority of the studies indicate that antibiotics do not interfere with contraception [ cite web|url=http://www.wdxcyber.com/ncontr10.htm |title=Drugs Affecting Birth Control Pills |accessdate=2008-02-17 ] , even though there is a possibility that a small percentage of women may experience decreased effectiveness of birth control pills while taking an antibiotic. [ cite web|url=http://answers.yahoo.com/question/index;_ylt=AmTUUjVc3edfYh8cZaxmJ00jzKIX;_ylv=3?qid=20070524151339AAw8vfi |title=Antibiotic and birth control |accessdate=2008-02-17 |publisher=Yahoo answers ]
Antibiotics and alcohol
In general, alcohol should be avoided when taking antibiotics. [ [http://www.mayoclinic.com/health/antibiotics-and-alcohol/AN01802] ] However, contrary to a popular belief, only certain antibiotics have negative interactions with alcohol.
Metronidazole, tinidazole, latamoxef, cefamandole, cefoperazone, cefmenoxime, and furazolidone, when taken with alcohol, provoke a disulfiram-like reaction (severe vomiting, nausea, shortness of breath, flushing etc.) Serum levels of doxycycline and erythromycin succinate may, in certain circumstances, be significantly reduced by alcohol consumption. [Stockley, IH (2002), Stockley's Drug Interactions. 6th ed. London: Pharmaceutical Press.]
Common forms of antibiotic misuse include failure to take into account the patient's weight and history of prior antibiotic use when prescribing, since both can strongly affect the efficacy of an antibiotic prescription, failure to take the entire prescribed course of the antibiotic, failure to prescribe or take the course of treatment at fairly precise correct daily intervals (e.g. "every 8 hours" rather than merely "3x per day"), or failure to rest for sufficient recovery to allow clearance of the infecting organism. These practices may facilitate the development of bacterial populations with antibiotic resistance. Inappropriate antibiotic treatment is another common form of antibiotic misuse. A common example is the prescription and use of antibiotics to treat viral infections such as the
common coldthat have no effect.
It is estimated that greater than 70% of the antibiotics used in U.S. are given to feed animals (e.g. chickens, pigs and cattle) in the absence of disease. [Mellon, M "et al". (2001) "Hogging It!: Estimates of Antimicrobial Abuse in Livestock", 1st ed. Cambridge, MA:
Union of Concerned Scientists.] Antibiotic use in food animal production has been associated with the emergence of antibiotic-resistant strains of bacteria including "Salmonella" spp., "Campylobacter" spp., "Escherichia coli", and "Enterococcus" spp. Evidence from some US and European studies suggest that these resistant bacteria cause infections in humans that do not respond to commonly prescribed antibiotics. In response to these practices and attendant problems, several organizations (e.g. The American Society for Microbiology (ASM), American Public Health Association (APHA) and the American Medical Association (AMA)) have called for restrictions on antibiotic use in food animal production and an end to all non-therapeutic uses. Fact|date=May 2007 However, delays in regulatory and legislative actions to limit the use of antibiotics are common, and may include resistance to these changes by industries using or selling antibiotics, as well as time spent on research to establish causal links between antibiotic use and emergence of untreatable bacterial diseases. Today, there are two federal bills (S.742 and H.R. 2562) aimed at phasing out non-therapeutic antibiotics in US food animal production. These bills are endorsed by public health and medical organizations including the American Nurses Association (ANA), the American Academy of Pediatrics (AAP), and the American Public Health Association (APHA). Fact|date=May 2007
One study on
respiratory tract infections found "physicians were more likely to prescribe antibiotics to patients who they believed expected them, although they correctly identified only about 1 in 4 of those patients".cite journal |author=Ong S, Nakase J, Moran GJ, Karras DJ, Kuehnert MJ, Talan DA |title=Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction |journal=Annals of emergency medicine |volume=50 |issue=3 |pages=213–20 |year=2007 |pmid=17467120 |doi=10.1016/j.annemergmed.2007.03.026] Multifactorial interventions aimed at both physicians and patients can reduce inappropriate prescribing of antibiotics. cite journal |author=Metlay JP, Camargo CA, MacKenzie T, "et al" |title=Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments |journal=Annals of emergency medicine |volume=50 |issue=3 |pages=221–30 |year=2007 |pmid=17509729 |doi=10.1016/j.annemergmed.2007.03.022] Delaying antibiotics for 48 hours while observing for spontaneous resolution of respiratory tract infections may reduce antibiotic usage; however, this strategy may reduce patient satisfaction.cite journal |author=Spurling G, Del Mar C, Dooley L, Foxlee R |title=Delayed antibiotics for respiratory infections |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD004417 |year=2007 |pmid=17636757 |doi=10.1002/14651858.CD004417.pub3]
Excessive use of prophylactic antibiotics in travelers may also be classified as misuse.
Use or misuse of antibiotics may result in the development of "antibiotic resistance" by the infecting organisms, similar to the development of
pesticide resistancein insects. Evolutionary theoryof genetic selection requires that as close as possible to 100% of the infecting organisms be killed off to avoid selection of resistance; if a small subset of the population survives the treatment and is allowed to multiply, the average susceptibility of this new population to the compound will be much less than that of the original population, since they have descended from those few organisms that survived the original treatment. This survival often results from an inheritable resistance to the compound that was infrequent in the original population, but became more frequent in the descendants.
Antibiotic resistance has become a serious problem in both developed and underdeveloped nations. By 1984 half of those with active
tuberculosisin the United Stateshad a strain that resisted at least one antibiotic. Fact|date=January 2008 In certain settings, such as hospitals and some childcare locations, the rate of antibiotic resistance is so high that the usual, low-cost antibiotics are virtually useless for treatment of frequently seen infections. This leads to more frequent use of newer and more expensive compounds, which in turn leads to the rise of resistance to those drugs. A struggle to develop new antibiotics ensues to prevent losing future battles against infection. To date, tuberculosis and pneumococcus are prominent examples of once easily treated infections where drug-resistance has become a problem.
Another example of selection is "
Staphylococcus aureus" ('golden staph'), which could be treated successfully with penicillinin the 1940s and 1950s. At present, nearly all strains are resistant to penicillin, and many are resistant to nafcillin, leaving only a narrow selection of drugs such as vancomycinuseful for treatment. The situation is complicated by the fact that genes coding for antibiotic resistance can be transferred between bacteria via plasmids, making it possible for bacteria never exposed to an antibiotic to acquire resistance from those which have. The problem of antibiotic resistance is made more widespread when antibiotics are used to treat disorders in which they have no efficacy, such as the common cold or other viral complaints, and when they are used broadly as prophylaxis rather than treatment (as in, for example, animal feeds), because this exposes more bacteria to selection for resistance.
Resistance modifying agents
One solution to combat resistance currently being researched is the development of pharmaceutical compounds that would revert multiple antibiotic resistance. These so called resistance modifying agents may target and inhibit MDR mechanisms, rendering the bacteria susceptible to antibiotics to which they were previously resistant. These compounds targets include among others
*Efflux inhibition(Phe-Arg-β-naphthylamide) [B. Marquez. (2005). Bacterial efflux systems and efflux pumps inhibitors. "Biochimie"87 1137–1147]
*Beta Lactamase inhibitors - Including
Clavulanic acidand Sulbactam
The comparative ease of identifying compounds which safely cured bacterial infections was more difficult to duplicate in treatments of fungal and viral infections. Antibiotic research led to great strides in the knowledge of
biochemistry, establishing large differences between the cellular and molecular physiology of the bacterial cell and that of the mammalian cell. This explained the observation that many compounds that are toxic to bacteria are non-toxic to human cells. In contrast, the basic biochemistries of the fungal cell and the mammalian cell are much more similar. This restricts the development and use of therapeutic compounds that attack a fungal cell, while not harming mammalian cells. Similar problems exist in antibiotic treatments of viral diseases. Human viral metabolic biochemistry is very closely similar to human biochemistry, and the possible targets of antiviral compounds are restricted to very few components unique to a mammalian virus.
bacteriophages for use as antibiotics is presently ongoing. Several types of bacteriophage appear to exist that are specific for each bacterial taxonomic group or species.Fact|date=May 2007 Research into bacteriophages for medicinal use is just beginning, but has led to advances in microscopic imaging. [Purdue University "Biologists build better software, beat path to viral knowledge", see Imaging of Epsilon 15, a virus that infects the bacterium Salmonella [http://news.uns.purdue.edu/UNS/html4ever/2006/060201.Jiang.salmonella.html News report] ] While bacteriophages provide a possible solution to the problem of antibiotic resistance, there is no clinical evidence yet that they can be deployed as therapeutic agents to cure disease.Fact|date=March 2008 Phage therapyhas been used in the past on humans in the US and Europe during the 1920s and 1930s, but these treatments had mixed results. With the discovery of penicillin in the 1940s, Europe and the US changed therapeutic strategies to using antibiotics. However, in the former Soviet Union phage therapies continued to be studied. In the Republic of Georgia, the Eliava Institute of Bacteriophage, Microbiology & Virology continues to research the use of phage therapy. Various companies and foundations in North America and Europe are currently researching phage therapies. Fact|date=May 2007 However, phage are living and reproducing; concerns about genetic engineering in freely released viruses currently limit certain aspects of phage therapy. Bacteriocins are also a growing alternative to the classic small-molecule antibiotics [cite journal |author=Gillor O, Kirkup BC, Riley MA |title=Colicins and microcins: the next generation antimicrobials |journal=Adv. Appl. Microbiol. |volume=54 |issue= |pages=129–46 |year=2004 |pmid=15251279 |doi=10.1016/S0065-2164(04)54005-4] . Different classes of bacteriocins have different potential as therapeutic agents. Small molecule bacteriocins ( microcins, for example, and lantibiotics) may be similar to the classic antibiotics; colicin-like bacteriocins are more likely to be narrow-spectrum, demanding new molecular diagnostics prior to therapy but also not raising the spectre of resistance to the same degree. One drawback to the large molecule antibiotics is that they will have relative difficulty crossing membranes and travelling systemically throughout the body. For this reason, they are most often proposed for application topically or gastrointestinallycite journal |author=Kirkup BC |title=Bacteriocins as oral and gastrointestinal antibiotics: theoretical considerations, applied research, and practical applications |journal= Curr. Med. Chem.|volume=13 |issue=27 |pages=3335–50 |year=2006 |pmid=17168847 |doi=] . Because bacteriocins are peptides, they are more readily engineered than small moleculescite journal |author=Gillor O, Nigro LM, Riley MA |title=Genetically engineered bacteriocins and their potential as the next generation of antimicrobials |journal= Curr. Pharm. Des.|volume=11 |issue=8 |pages=1067–75 |year=2005 |pmid=15777256 |doi=] . This may permit the generation of cocktails and dynamically improved antibiotics that are modified to overcome resistance. Probiotics are another alternative that goes beyond traditional antibiotics by employing a live culture which may establish itself as a symbiont, competing, inhibiting, or simply interfering with colonization by pathogens. It may produce antibiotics or bacteriocins, essentially providing the drug "in vivo" and "in situ", potentially avoiding the side effects of systemic administration.
* [http://www.genomenewsnetwork.org/categories/index/drugs/resist.php Antibiotic News from Genome News Network (GNN)]
* [http://www.jaapa.com/issues/j20040601/articles/antibiotics0604.html JAAPA: New antibiotics useful in primary care]
* [http://www.isracast.com/tech_news/090605_tech.htm A new method for controlling bacterial activity without antibiotics] - Research conducted at the Hebrew University
* [http://www.eu-burden.info/ BURDEN of Resistance and Disease in European Nations]
* [http://www.tgw1916.net/movies.html Antibiogram technique] video
* [http://www.esac.ua.ac.be/ European Surveillance of Antimicrobial Consumption (ESAC)]
* [http://www.bacteriatd.com Bacteria Tower Defense - Antibiotic Coverage Resource and Game]
* [http://www.apua.org Alliance for the Prudent Use of Antibiotics]
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