Antibiotic Use, Resistant Strains and Clinician’s Dilemma
The discovery of antibiotics almost more than 70 years ago has been a boon to mankind. Several infectious diseases are being treated effectively since then. However, the bug seems to be smarter than the man; the bacteria have found ways to resist antibiotics and continue to proliferate. Thus the discovery of medicines continues to innovate higher generation antibiotics that can kill resistant strains. Research has demonstrated that the antibiotic resistance is a consequence of evolution via natural selection. Several studies have demonstrated that patterns of antibiotic usage greatly affect the number of resistant organisms that develop as resistant strains. Overuse of broad-spectrum antibiotics, such as second- and third-generation cephalosporins, greatly hastens the development of methicillin resistance strains. Other factors contributing towards resistance include incorrect diagnosis, unnecessary prescriptions, improper use of antibiotics by patients and the use of antibiotics in animal health.
The emergence of growing resistant strains, hospital acquired infections, increased population density, rapid spread of infections and lowered general immunity of the population is posing a great deal of challenges to the clinicians. The use of antibiotics is beginning from infancy to early childhood; in certain situations individuals no longer respond to certain antibiotics and continue to remain infected.
One of the strategies of drug development for higher generation antibiotics is by way of making structural changes in the drug molecule. The structural changes result in the structural dimensions of the molecule which makes difficult for bacteria to find means to resist its bactericidal effects that eliminates its growth. However the gene mutation in bacteria is a random process and is hastened in conducive environment. The repeated frequent use of the antibiotic over the period results in the development of resistant strains. Rationale use of antibiotic is thus highly recommended so that individuals are not unnecessarily exposed to the antibiotics.
Natural antibiotics such as curcumin are being explored as a new hope to treat infections caused by resistant strains. Recent publications have reported that curcumin is active against a plethora of drug-resistant bacterial strains.
There have been several explanations on how curcumin acts and kills the bacteria. It has been demonstrated that curcumin interacts with FtsZ (prokaryotic homologue of eukaryotic cytoskeletal protein tubulin) in vitro and inhibits the assembly of FtsZ protofilaments in Bacillus subtilis. It is believed that inhibiting the assembly dynamics of FtsZ is one of the main mechanisms of curcumin in inhibiting bacterial cell proliferation. Moreover, since curcumin has a very complex structure, it is not easy for bacteria to develop resistance due the intricate structural design.
One of the strategies for infection control is to maintain high level of general and personal hygiene, cleanliness and good immunity of the individuals. Unfortunately the population in general is not as healthy as expected despite availability of food, technology, better economic resources and healthcare infrastructure. Therefore, for clinicians it is becoming imperative to provide counselling on diet, hygiene, better lifestyle management for healthy living. Strategies to improve immunity is one of the important considerations. Curcumin apart from being a natural antibiotic, has immunomodulatory properties. The limitation with curcumin treatment due to its poor bioavailability is being resolved with newer drug delivery dosage forms. Buccal dissolving lozenges are able to deliver the bioactive curcumin by avoiding the <<FIRST-PASS-EFFECT>> in blood for clinical benefits. The unique characteristics of curcumin can be truly consolidated in the clinical settings; this can help to reduce the use of antibiotics by keeping population infection free and healthy. It can help reduce the burden of infectious diseases.
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