Antibiotics, also known as antibacterials, are medications that destroy or slow down

bacterial activities by attacking disease-causing bacterial cells. These medications are used to

treat infections caused by bacteria - microscopic organisms, some of which may cause severe

illnesses such as syphilis, tuberculosis, salmonella, meningitis, etc. In the history of medicine,

antimicrobial is one of the most successful form of medical treatment. Since the development

of the first antibiotics in the 20th century, these medications have saved millions of lives and

have significantly contributed to the restraint of infectious diseases that were the prominent

cause of death. Many people believe that the exposure to antibacterials is tied to the

“antibiotic era” in the 20th century. However, researches have proved otherwise. Many traces

of antibacterials were found from earlier times. Traces of tetracycline has been found in

human skeleton from the ancient Sudanese Nubia(350-550 CE) and the late Roman periods

from the Dakhleh Oasis, Egypt. Tetracycline is a unique form of antibacterial because it leaves

permanent markers on the body; therefore can be easily detected. Other types of antibiotics

do not leave significant traces, thus are very difficult to track. In the skeletal samples, no trace

of infection has been detected. Based on the research results, scientists came to a conclusion

that antibiotics have been used long before being discovered in the 20th century.

The names of Paul Ehrlich and Alexander Fleming are attached to the beginning of

“antibiotic era”. Biologist Paul Ehrlich came up with the idea of “magic bullets” that selectively

attack the disease-causing bacterial cells and not the host based on an observation that aniline

and other synthetic dyes only stain certain cells and not the others. From 1904 to 1910,

Ehrlich worked together with chemist Alfred Bertheim and bacteriologist Sahachiro Hata and

developed a cure to syphilis (a bacterial infection that transmits through sexual contact). The

drug Salvarsan(another less toxic version of it is known as Neosalvarsan) was the most

frequently prescribed medication until its replacement by penicillin in 1940. The system

which Paul Ehrlich used became a popular drug search strategy. This led to the finding of
many antimicrobial drugs, including sulfonamidochrysoidine (KI-730, Prontosil) by Josef

Klarer and Fritz Mietzsch, which later became the first antibiotic resistance incident. Thanks

to the fortuitous event happened on September 3th 1928, Alexander Fleming discovered

penicillin, “the magical drug”. After spending summer holidays with his family, Fleming

returned to the lab to find a mile of mouldering Petri dishes that he forgot to put away. One of

the dishes caught his eyes: the mold killed the Staphylococcus aureus bacteria that had been

in the dish. It was a type of Penicillium mold, capable of killing many bacteria and also non-

toxic. However, penicillin was only developed further due to the outbreak of WWII, where

number of deaths caused by minor infections from battlefield was ever growing. Fleming was

also among the first who cautioned about the potential resistance to penicillin if used too little

or for a too short period during treatment. The discoveries of the first three drugs Salvarsan,

Prontosil and penicillin became the foundation to future drug discoveries and researches.

First of all, to understand the necessity of understanding in using antibiotics, let's

consider how these drugs work. Antibiotics are powerful medications, which can stop bacteria

from reproducing or kill them. Although there are many types of different antibiotics, they

mainly work in two ways. Bactericidal antibiotics such as penicillin kill the bacteria.

Bacteriostatic antibiotics stop bacteria from multiplying. Anybody should be extremely

cautious when using antibiotics. These medications are used against infections caused by

bacteria, fungi and parasites. However, they don't work against viruses which are usually the

cause of most upper respiratory infections like sore throat or the common cold. Therefore, it is

really important to know exactly what causes the illness since misguided use of antibiotics can

lead to lethal result. Moreover, the side effects of antibiotics should always be considered

seriously. These effects include diarrhea, formation of kidney stones, abnormal blood clotting,

blood disorders, etc. Many people can also be allergic to certain types of antibacterial –

especially penicillin. Furthermore, antibiotics may clash with other drugs if not used correctly.
All in all, before taking any pills, one should always check with his/her physician beforehand

in order to avoid harmful consequences.

Next, the most important reason why we must use antibacterials cautiously is the

elevating level of antibiotic resistance in many countries. A lesson by Kevin Wu explained

clearly the mechanism of antibiotic resistance and the urging needs to prevent it from

increasing. The first life forms to appear on Earth about 1.8 billion years ago were bacteria.

They are everywhere from the air, the water, our skin and even inside our body. Most of the

bacteria are harmless to our body, some are even useful for our metabolism and the immune

system. However, the tiny amount of harmful bacteria in our body can cause infections, from

mildly disturbances to deadly diseases. Thanks to the invention of antibiotics, these infections

can be cured easily. By disrupting reproducing progresses like cell wall synthesis or protein

synthesis, these drugs neutralize or eliminate bacteria. However, through time, bacteria are

slowly developing mutations that can fight antibiotics. The possibility for bacteria to mutate

is very low. But due to the excessive and misguided uses of antibacterials these pass decades,

bacteria are provided advantageous conditions to develop useful mutations that can fight back

or even annihilate antibacterials. The evolved bacteria also have many ways to release their

DNA for non-resistant bacteria to inherit including reproduction, conjugation(bacteria set up

bridge connections between their bodies and exchange genes), etc. Then, strains of resistant

bacteria are created by inheriting multiplied resistant genes. This has already happened in

some bacteria. For example, some strands of Staphylococcus aureus(bacteria that cause skin

infection, pneumonia and sepsis) have evolved into MRSA. Whereas Staphylococcus aureus

are not, MRSA are able to resist beta-lactam antibiotics like penicillin, methicillin and

oxacillin. Another type of super bacteria- the salmonella- developed enzymes like beta-

lactamese that break down antibiotics before they can react. In the case of E. Coli, the bacteria
can simply eject any antibiotic attacker that managed to enter their cells. Scientists are

working on alternatives to antibiotics such as phage treatment or vaccines.

Thirdly, we must acknowledge the reasons why antibacterial resistance level is rising so

quickly. Antibacterial resistance is common in undeveloped/developing countries. Due to lack

of hygiene in medical treatments and daily lives, people are more exposed to harmful bacteria.

Therefore, the need for antibiotics is significant. However, this leads to many negative

consequences. First of all, the excessive use of antibiotics in simple, manageable illnesses

increases the chances of resistance in bacteria. The mechanism is pretty simple: the more

antibiotics are used, the more exposed they are to bacteria and the more likely that these

bacteria become resistant to the drugs. Thus, the lack of knowledge is also one of the reasons

for antibiotic resistance. For an antibiotic to completely terminate all bacterial activities, a

patient must use the prescribed amount of medication, which is usually 5 days to one week.

However, because most of the illness's symptoms are usually gone within 3-4 days, many

people stop using antibiotic. These patients don't know that even when the symptoms are

gone, there are still a small amount of bacteria left in the body. If we don't effectively kill

them, then the next time that patient got sick, chances are high that the bacteria have become

resistant and the drugs won't be effective anymore. All in all, more and more bacteria types

are becoming resistant to antibiotics because of the people' fixation on these drugs and the

lack of understanding.

At the moment, one of our solutions to antibacterial resistance is using stronger

antibacterials. For example, when an antibiotic become ineffective, doctors can prescribe the

patient with a stronger type of antibiotic like Vancomycin, which can cure pneumonia when

other antibiotics have become resistant. The problem is for how long can we use this method.

What if , like, in 20 years, even the strongest antibiotics have become useless against super-
bacteria? The discovery of antibiotics has brought a whole new era to human kind. Millions

are saved. Deadly diseases are cured effortlessly. However, the rising problem of antibacterial

resistance is getting more and more crucial. Scientists have been working to find a way out of

the inevitable dilemma. Sooner or later, we will run out of stronger drugs and our drugs will

be completely useless against super bacteria. Whether we should take the evolution arms race

further or should we give up and find alternatives instead? In the mean time, it is our utmost

priority to prevent more antibacterial resistance from happening by cutting the excessive and

unnecessary use of antibiotics, as well as changing medical practice to prevent hospital

infections.

→ Question: How to prevent/slow the process of bacteria resistance on antibiotics?