The use of antibiotics is integral part of practice of
surgery, medicine and dentistry. Antibiotics introduced to clinical use 50
years back. The Golden era of anti microbial chemotherapy
began with clinical use of Penicillin in 1941. Over last 60 years the “miracle
drugs” revolutioned the health care. Clearly these drugs have eliminated or
greatly reduced the morbidity and mortality of infection.
The antibiotics are used
either for prevention of infection or to treat infections. The clinicians are
quick to use antibiotics for any clinical problem that might be bacterial
infections, some times in viral infections also. This standard approach has
lead to a striking over use of antibiotics, which in turn led to evolution of
bacteria that are resistant to antibiotics.
The threat of microbial
diseases was believed to be controlled by 1980’s, but since then antibiotic
resistant streptococci, multi-drug resistant pseudomonas, methicillin resistant
staphylococci and vancomycin resistant enterococci; made difficult to control
infection in ICUs. The emergence of
penicillin resistant anaerobes has become common in odontogenic infection.
The bacteria are nearly
infinitely adaptable and can become resistant if given sufficient sub lethal
exposure to an antibiotic. When even a
few bacteria achieve this resistance, it can easily be passed on to other bacterial
cells by several different methods. Bacteria can transfer genetic information
via three mechanisms – Transformation, Transduction, Conjugation. These genetically altered resistant organisms
may continue to be well ahead of our efforts to control infectious diseases. It appears
that the same lifesaving drugs of the past, become largely responsible for the
more resistant strains of bacteria and viruses of today, actually prompting
them to mutate and evolve more rapidly, making them more virulent and resistant
to our modern drugs.
Considering above situation it
is appropriate that we reassess antibiotics value, and time has come to
consider rational antibiotic therapy. To fight against microbial threat we have
a number of older antibiotics, few newer antibiotics. The new research work
towards the use of antibacterial peptides and Genetics and technique to enhance
immune response of the patient offers some promise. The clinician and patients
should consider the new and different approaches to treat the infections and
yet to minimize the excess antibiotic use.