So it wasn’t off-brand for us to spend a recent dinner conversation debating a hot topic: “What’s scarier – a new pandemic virus or a world without antibiotics?” The two titans of microbiology – the virus and the bacterium – took center stage alongside sheet-pan chicken to create a memorable family exchange.

Most American dinner discussions do not include hypothetical microbial doomsday scenarios. But how we prepare for the next pandemic and prevent the erosion of effective antibiotics are pressing issues. In many ways, they are interlinked.

Covid-19 brought public health into the spotlight and underscored the role of public-private partnerships to meet new disease threats. Vaccine R&D is enjoying a renaissance, buoyed by steady investment by major pharmaceutical companies over the past two decades and the viability of new start-ups. The application of mRNA and other new technologies offer the kind of innovative power required to meet the challenge of future viral threats, especially if matched with political will and new models for global coordination. Perhaps there is cause for a little optimism that we will be better prepared for the next pandemic.

Unfortunately, the same urgency does not exist to solve the looming specter of antimicrobial resistance (AMR). Since the discovery of penicillin almost a century ago, antibiotics have been in the league of vaccines and clean water as the most important public health interventions in history. Yet, with rampant overuse in our food systems, over-prescription for patients and poor waste management practices, the potential for dangerous bacteria to develop resistance to antibiotics increases each year.   

Several programs have been established to catalyze research investments in next-generation antibiotics.  Antimicrobial research grants from organizations ranging from the National Institutes of Health (NIH), Biomedical Advanced Research and Development Authority (BARDA) and the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) have helped close the gap. In the U.S., several lawmakers drafted the bipartisan PASTEUR Act to create a new model for pharmaceutical industry investment in the development of new antibiotics, but it died in committee last year following criticism that the private sector participants would not deliver the level of product innovation to justify billions of dollars in taxpayer funding.

The current pipeline for truly innovative antibiotics remains worryingly thin. In the past five years, only 12 antibiotics have been approved. That might seem okay if it didn’t mask a failure to deliver breakthrough products: 10 of the dozen new antibiotics belong to existing classes with established mechanisms of antimicrobial resistance and only one, cefiderocol, protected against all gram-negative bacteria on the WHO list of priority pathogens. As of 2021, only 27 new antibiotics against priority pathogens were in clinical stages of development – a drop from 31 products only four years earlier. The number of new candidates in the preclinical stage of development remains stagnant.

For millions of patients facing the frightening possibility of untreatable infections, we need to move with greater urgency to bolster innovation and improve responsible use for existing antibiotics. Already, nearly 1.3 million people around the world die each year from AMR, a number that exceeds higher-profile diseases such as HIV or malaria and is expected to rise to 10 million annually within the next few decades.

Beyond the health implications, the economic imperative to counter antimicrobial resistance is stark: the global cost of AMR is expected to exceed $100 trillion by 2050. There are some important steps that can be taken by governments, drug makers and healthcare providers.

Antimicrobial resistance is not an American problem; it is a threat shared by every country. As such, we should be looking at ways to allocate funding to the entities that can ensure the best application of research takes place. In the U.S., BARDA, NIH and CARB-X need more resources and channels to collaborate more extensively with similar grant entities around the world.

The PASTEUR Act should be resuscitated in the current Congress with renewed emphasis on incentivizing participating pharmaceutical companies to develop innovative antibiotics with new mechanisms of action. To help make the case to policymakers of all stripes, organizations like the Center for Strategic International Studies and Chatham House have excellent track records for framing health imperatives to the right audiences in terms that help prompt action.

Beyond policy and research actions, healthcare provider and patient education on the responsible use of antibiotics should be a priority in every country. This is the responsibility of governments, drugmakers, health systems, individual healthcare providers, even patients and consumers. Infections are scary business, but we need a more effective way of educating people along the entire prescription decision chain to ensure antibiotic potency remains strong.

And that connects back to vaccines. One clear way to reduce our use of antibiotics is to increase vaccination against many of the pathogens that create an opening for bacterial infections. Pursuing this goal, improving AMR-related education and expanding the pipeline of innovative antibiotics give us a shot at avoiding a bleak future where we are defenseless against invisible enemies.

The post Too Much of a Good Thing appeared first on Medika Life.

Approximately one in five individuals who take antibiotics develop antibiotic-associated diarrhea. Antibiotic-associated diarrhea is likely to start a week or so after antibiotic initiation. Occasionally, diarrhea and other symptoms do not emerge until days or weeks after the completion of the antibiotic course.

Fortunately, diarrhea is typically mild, self-limited, and requires no treatment. Fortunately, the gastrointestinal upset usually resolves within a few days of discontinuing the antibiotic. The antibiotic may need to be switched or discontinued for those with more serious GI problems.

Antibiotic-associated diarrhea is likely to begin about a week after you start taking an antibiotic. However, diarrhea and other symptoms sometimes don’t appear until days or weeks after you’ve finished antibiotic treatment.

Clostridioides difficile (C. diff) infection

I would be remiss if I did not mention C. difficile. These toxin-making bacteria can cause serious antibiotic-related diarrhea or more frequent bowel movements. In addition to causing loose stools and more-frequent bowel movements, C. difficile infection can cause:

• Severe diarrhea and dehydration
• Lower abdominal pain and cramping
• Low-grade fever
• Nausea
• Loss of appetite

Most cases of C. diff occur when someone has been taking antibiotics (or not long after completing an antibiotic course). While the infection can affect anyone, risk factors include:

• Age 65 or older
• A recent hospital or nursing home stay
• A weakened immune system (for example, in those with HIV/AIDS, cancer, or organ transplant patients taking immunosuppressive drugs)
• Prior infection with C. diff or known exposure to the germs

Here are some disturbing statistics from the US Centers for Disease Control (CDC): C. diff causes nearly half a million infections in the United States annually. Of those who get an infection, one in six will get it again in the subsequent two to eight weeks. One in 11 over 65 will die of symptoms related to a C. diff infection within one month.

Those with C. diff are contagious, so please wash your hands with soap and water each time you use the bathroom and before you eat. If you have diarrhea, use a separate bathroom if possible. Finally, take showers and wash with soap.

Please call your healthcare provider immediately if you have serious symptoms of antibiotic-associated diarrhea. These symptoms are common to several conditions, so you may need tests — for example, stool or blood— to determine the cause.

While antibiotics are an important tool for battling potentially life-threatening bacteria, the drugs can disrupt the composition and function of the gut microbiome. More specifically, antibiotics can drop the abundance and diversity of gut bacteria, opening the door to infection by bad, pathogenic bacteria.

What is the microbiome?

Here is what I previously wrote about the microbiome:

“The microbiome, the collection of bacteria, fungi, and viruses that live in and on our bodies, is a component of our immune system. The microbiome is essential to the defense systems of our bodies.

We have approximately 100 trillion microbes — including bacteria, fungi, and viruses — primarily found in the gastrointestinal system, our skin, and other body parts.

I have a new word for you: Dysbiosis, a change in the microbiome’s composition, diversity, or metabolites from a healthy pattern to one associated with a disease. Antibiotics can be a cause. Replacing microorganisms (via fecal transplants) can be an effective management option for some problems, such as inflammatory bowel disease and certain recurrent infections associated with antibiotic use.

What does this have to do with you? Dysbiosis plays a role in diverse conditions, including type 2 diabetes, obesity, asthma, food allergy, and atopic dermatitis. The gut microbiome is thus an attractive target for intervention. Some have found success in managing type 2 diabetes with gut microbiome manipulation.

I’ll bet you didn’t know that the microbiota can weigh upwards of two kilograms. A growing body of evidence points to the microbiome as essential to metabolic function, digestion, and resisting infection. Your genes, environment, and medicines can influence gut microbiota.”

Antibiotics and the microbiome

Some have hailed antibiotics as miracle drugs that have revolutionized medicine since their introduction more than a hundred years ago. By effectively treating infectious bacterial diseases, these drugs have ushered in an era with far fewer medical issues and deaths.

With antibiotic use has come increasing threats, including antibiotic resistance and potential direct harm to human health. Animal studies remind us that gut microbiome disruption (secondary to antibiotics) can have long-lasting harmful effects, including a higher risk of allergies and obesity.

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In addition, the microbiome may influence long COVID-19 risk.

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Probiotics with antibiotics

Can probiotics alleviate some of the gut microbiome disruption induced by antibiotics? And can probiotics reduce antibiotic-induced diarrhea? According to a new systematic review published in the Journal of Medical Microbiology, the answer appears to be yes.

We may be on our way to co-prescribing probiotics with antibiotic treatments.

What are probiotics?

Probiotics are live bacteria and yeasts that are good for you, especially your gastrointestinal system. While we initially think of bacteria as “bad” and disease-causing, your bodies are full of microbes such as bacteria, both good and bad. Some refer to probiotics as “good” bacteria because they help keep the gut healthy.

Probiotics are living microorganisms, usually belonging to the genera Lactobacillus, Bifidobacterium, and Saccharomyces. You can find probiotics in some foods (such as yogurt) and supplements.

Historical research shows that combining probiotics and antibiotics can reduce the risk of antibiotic-associated diarrhea. Probiotics help in several ways: They suppress harmful bacteria, change the immune system, and help to protect the gut lining.

Part of my reluctance to always prescribe probiotics with antibiotics is concern that the probiotics can alter the gut microbiome composition for a long time. Moreover, the available studies looking at taking probiotics and antibiotics are mixed.

To clarify the role of probiotic supplementation on the gut microbiome, Texas Christian University (USA) researchers did a systematic review of the available clinical literature.

Their review included 22 studies that either used antibiotics or probiotics alone and seven studies looking at probiotics in conjunction with antibiotics. All 11 antibiotic studies showed changes in the gut microbiome composition, including a drop in the microbe diversity; antibiotics led to few microbe species in the gut.

Here are the findings for the seven studies involving probiotics in combination with antibiotics:

• Gastrointestinal symptoms. Five (of the seven) studies showed improvements in symptoms such as diarrhea.
• Microbe diversity. Four (of the seven) studies showed probiotics prevented antibiotic-induced declines in microbe diversity. Of the three negative studies, two had a short duration of antibiotics (potentially causing only limited changes in the gut microbiome).
• Microbiome composition. All four studies that had information on gut microbiota showed that the simultaneous use of probiotics and antibiotics helped restore the baseline (pre-antibiotic) microbiome composition.

Most studies showing the benefits of adding probiotics to antibiotics continued the probiotics for about one week after the completion of the antibiotics.

My take

I am delighted with the review. Still, we know little about the long-term safety of probiotic supplements. Could the use of high amounts of probiotics with the same bacterial species facilitate the transfer of resistant genes to infectious pathogens? Could introducing pathogens via probiotics increase opportunistic infections, especially among those with weakened immune systems?

Probiotics: If It Does Not Help, It Does Not Harm. Really?

Microorganisms. 2019 Apr; 7(4): 104.

www.ncbi.nlm.nih.gov

Many of the available studies looking at probiotics are poorly designed or underpowered. And there is this concern: Probiotic companies often fund these studies. We don’t know much about probiotic effectiveness or safety, even though the study I presented today signals the potential promise of probiotic use.

Alas, probiotics in the United States are not regulated or treated as drugs, rather than dietary supplements. For now, if you are immuno-compromised, you should dodge probiotics unless used under the guidance of a qualified healthcare professional.

We need more research to understand better how to integrate probiotics into an antibiotic course. What is the optimal dose? Frequency? Probiotic choice? Nevertheless, I am delighted that probiotics may play a larger file in the future.

Now, if we can minimize the use of unnecessary antibiotics, but that is a topic for another day. Thank you for joining me for this look at probiotics and antibiotic-induced gut damage. Oh, one more thing:

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The post Do Probiotics Repair Antibiotic-Induced Gut Damage? appeared first on Medika Life.

Date of Release: Sept. 14, 2020 

MOSCOW/PRNewswire/ — NUST MISIS material scientists have presented antibacterial nano-coatings based on boron nitride, which are highly effective against microbial pathogens (up to 99.99%). They can become a safe alternative to the usual antibiotics in implantology since they do not have typical negative side effects. The results of the work are published in the international scientific journal ACS Applied Materials & Interfaces.

Nowadays, due to the significant increase in the number of surgical procedures around the world, scientists are solving the problem of microbial infections caused by implants. It is especially serious during orthopedic and dental operations. It is no secret that concomitant drug therapy for inflammation around implants often leads to side effects due to the characteristic properties of the antibiotics, as well as its high doses.

A group of young scientists from NUST MISIS has proposed a non-standard solution to the problem by investigating the interaction of antibiotic-resistant gram-negative bacteria Escherichia coli (E.coli) and a nanofilm consisting of a structured boron nitride surface. It turned out that such a coating inactivates 100% of bacterial cells after 24 hours.

“Hexagonal boron nitride has a complex of unique physicochemical and mechanical properties. As a result of the experiments, we have found out that the special specific structure of boron nitride nanoparticles provides a bactericidal effect comparable to that of an antibiotic: bacteria die as a result of direct physical contact with a special needle-shaped surface of the nano-film. At the same time, there are no side effects typical of an antibiotic on the tissues of the body, and boron nitride itself does not cause cytotoxicity,” said Christina Gudz, co-author of the study, a researcher at the NUST MISIS Inorganic Nanomaterials Laboratory.

The researchers went further and filled the micro-pores of a thin coating of boron nitride with the gentamicin antibiotic. The result is an antibacterial effect due to the complete release of the drug in a short initial period. Moreover, its dose was an order of magnitude less than with a conventional injection.

“Taking into account an average patient weight of 60 kg, his daily antibiotic dose is approximately 180 mg; provided that the implant area is, say, 30 cm2 and given that 55 μg of antibiotic is released from the nano-coating under study on the first day, it turns out that the proposed method assumes 100 times less antibiotic than with a standard injection,” added Christina Gudz.

According to the authors of the development, the application of an antibacterial film based on boron nitride nanoparticles to the implant can minimize the risk of bacterial contamination due to the physical properties of the surface itself, as well as, in the case of antibiotic modification, local delivery of a minimum amount of the bactericidal component without weighting the implant.

At present, the team is completing in vitro studies of the obtained coatings and is also working on optimizing the coating method for its future use.

Source: https://en.misis.ru/university/news/science/2020-09/6922/

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