The advent of penicillin revolutionized modern medicine. The original antibiotic, penicillin gave doctors the power to cure "untreatable" diseases and heal life-threatening infections.
Today, antibiotics of all types play an important role in treating pressure injuries. The painful sores are often at risk of infection, both on the level of the skin or even below the skin surface. Controlling the germs that gather in those areas through antibiotics is a common form of treatment.
Antibiotics have worked like magic. Could anything ever stop them?
Actually, yes. We could use them so much that the germs learn to fight them off.
According to Professor Valerie Edwards-Jones, Emeritus Professor of Medical Microbiology at Manchester Metropolitan University, the medical field has to prepare for the time in the not-too-distant future when antibiotics may no longer among the doctor's set of tools.
"We’ve been using antibiotics for 70 years, and they’re becoming less and less effective. How much longer are they going to be a valid tool?" she said.
"Additionally, for the last 25 years, we’ve had an antibiotic void – no new classes of antibiotics have been added."
Or as Dr. Margaret Chan, Director General of the World Health Organization (WHO), said in 2012: "A post antibiotic era means, in effect, an end to modern medicine as we know it."
The Effect of 42 Million Chickens
As far back as 1945, the father of penicillin, Alexander Fleming, warned against the overuse of antibiotics at low doses. In his Nobel Lecture, he noted that "Exposing microbes to non-lethal quantities of the drug make them resistant.”
Today, according to Professor Edwards-Jones, Fleming's prediction is coming true, in part because of our modern diet.
"We eat approximately 42 million chickens per week in the UK – they ALL take antibiotics," she said. "We have them coursing through our bodies constantly. They have LARGE doses of antibiotics in them."
This is a particularly significant risk for people who suffer from pressure injuries because of the constant threat of infection. Without effective antibiotics, the danger is compounded significantly. Antibiotics are usually the front-line warriors in the war against bacteria.
"When resistance develops, we introduce a new drug. We see the pathogen start to develop resistance within 5 years, and within 10-15 years, we see it predominating in that organism," she said. "The organisms are not stupid."
Professor Edwards-Jones declared the resistance could take a variety of forms. In many cases, the bacteria develops enzymes that are capable of breaking down antibiotics, rendering them ineffective.
Reducing 'Unneeded" Use of Antibiotics
Cutting down on the use of antibiotics in wound care can contribute to a general attitude change toward the use of antibiotics. Instead of turning to the powerful drug as a first response, medics are now encouraged to look for alternative solutions first.
Microbiologists are trying to find ways to "reduce the waste of prescribing antibiotics when it’s not needed," Prof. Edwards-Jones said.
"As a doctor, you used to prescribe penicillin left and right, but now, you have to prove the person has an infection prior to the prescription, in order to lessen use," she explained.
A Lesson from the Treatment of Biofilms
The treatment of bacterial biofilms on chronic wounds could serve as an example of how to strategically lessen the use of antibiotics.
"Biofilms are present in 80% of chronic wounds - even if you can’t see them. Anything you do with chronic wounds – think about the biofilm! Consider biofilm formation, disruption and removal," Prof. Edwards-Jones commented.
Biofilms form, she instructed, by organisms forming on the surface of a wound, and then multiplying. Other organisms come along afterwards and stick to the first group of organisms. The sticking causes the organisms to excrete a glue-like substance that both bond the various organisms and create a film-like surface.
"In chronic wounds, multiple species – up to 20 species – could be living together in the biofilm," she said. "They increase the resistance and hardiness of the organisms within."
The treatment, she reported, comes in three parts:
1. Removal of debris from the wound.
3. Application of topical antimicrobial agents (antibiotics) to clean the wound and disrupt the biofilm, then addition of a new dressing and a barrier dressing to prevent further contamination.
With this three-step method, the patient does not have the antibiotics coursing through his whole system but only in the place where they are needed, reducing the chances that organisms will learn to resist the drug.
Moving Cautiously to the Future
The medical field has already begun to plan for a future with less reliance on antibiotics. The goal is to slow the level of bacterial resistance to antibiotics to the point where the medical world can cope with the challenge and make proper adjustments.
As Prof. Edwards-Jones makes clear, that process will require a wider spread acceptance of alternative treatments and more research and development in finding additional alternatives.
"Systemic antibiotics are essential," she said. A future without antibiotics, right now, is simply unthinkable.