Bio-Ethics of Antibiotic Use
and Research
Hazel Chun
AP Biology
Per. 1
06/11/10
Ever since antibiotics were first used in the 1940’s, new resistant strains of
bacteria were constantly forming. This process eventually lead to the question, “Are
the effects of antibiotic use and research more helpful or harmful to public health?”
Bacteria are unicellular organisms (prokaryotes) that are the most abundant
organisms found on the planet Earth. These organisms inhabit every corner of the
world and even within the human body. Certain types of bacteria live even within
the digestive tract of animals and help them digest food and increase the amount of
nutrients the body absorbs. Another type of bacteria which are called nitrogen fixing
bacteria, live within the soil and supply nitrogen to plants. In addition to the
plethora of helpful bacteria, there are bacteria that cause harmful effects to animals,
and in this particular case, humans. These disease causing agents are called
pathogens. Some examples of sickness in humans caused by bacterial pathogens are
pneumonia, tetanus, and tuberculosis. Antibiotics help in killing harmful bacteria or
inhibit the growth of bacteria within the body. As the use of antibiotics increased
through time, the emergence of many bacterial diseases and illnesses were lowered
greatly but this has lead another dilemma. Bacteria reproduce quickly, and what
doesn’t kill them only makes them stronger. Meaning, bacteria that are not killed by
an antibiotic can quickly reproduce passing off its ability of resistance to offspring
and continually make people sick.
When harmful bacteria enter the body, they usually secrete toxins into the body
killing the cells of its host. Some secrete endotoxins which are defined as components of
the outer membrane of a certain gram negative bacteria which is released only when
the bacteria dies (Campbell & Reece 546). Another type of toxin secreted by bacteria are
exotoxins. Exotoxins are proteins that destroy the cells of its host by disrupting the
natural way the cells function and goes through its life cycle. Once toxins are released,
they spread fairly quickly via the bloodstream and become difficult to get rid of. Other
times, bacteria may invade a host cell where it would be undetected by the immune
system. This is what causes the symptoms of illnesses. Usually, the body’s own immune
system releases antibodies to combat the bacteria and prevent further spread of the
toxins and other pathogens, but when the body’s defenses are not effective, people put
antibiotic drugs to use. These drugs alter the way bacteria function.
Different bacteria react differently to different antibacterials. Antibiotics are
classified based on they types of bacteria it is effective on, whether it is bactericidal or
bacteriostatic, and if it can defeat either gram-positive, gram-negative or both.
Bactericidal antibiotics kill bacteria; while bacteriostatic reverse the growth of bacterial
colonies (Mayer). When an antibiotic is put to work, it deals with two types of bacteria
classified as either gram-positive or gram-negative.
Gram-negative bacteria have simple cell walls made up of peptidoglycan. These
types of bacterial pathogens are more susceptible to antibacterials because their cell
walls can be easily altered or destroyed. Gram-negative bacteria have an additional
layer of membrane on top of the peptidoglycan layer which contains lipopolysaccharides.
Lipopolysaccharides are toxic so both the body’s natural immune system and antibiotics
are less effective. Antibiotics often kill gram-positive bacteria by altering the cell walls
of pathogens. They prevent or alter the “cross linking of the molecules within the cell
wall” (Gilroy). The cell walls of the bacteria are very crucial to a bacteria’s survival so if it
is not functioning correctly due to a mishap of its form the function changes, and the
bacteria cannot survive. In gram-positive bacteria, cross links are composed of
peptidoglycan which is a network of modified sugar polymers cross linked by peptides.
When antibiotics prevent these cross links from forming properly, the bacteria lyses. For
gram negative bacteria, antibiotics use other methods to destroy the bacteria. A good
example of a gram-negative killing antibacterial would be streptomycin. Streptomycin
binds to a subunit of a ribosome within a bacterium and inhibits the process of protein
synthesis (Todar). Some are also known to inhibit the synthesis of RNA and or DNA.
When a bacterium is not affected by an antibacterial drug, it is deemed resistant to the
antibiotic.
When an antibacterial is used, it may not kill all the pathogens. The few that
survive are the ones that have a gene to withstand the effects of an antibacterial. If the
remaining bacteria are not dealt with, they will pass on their genes with the use of
various mechanisms and reproduce creating a new colony that cause the same illness as
the original population, but now the same treatment from before is rendered
maladjusted to the new strain. In other words, the bacterium has become resistant to
the antibiotic.
Bacteria have a number of ways becoming resistant and passing on its gene for
resistance other than directly producing offspring. Bacteria can gain resistance on its
own by mutating randomly in hopes of gaining a gene that codes for resistance. Other
mechanisms used to get resistance involve the role of another bacterium that already
has the gene for resistance. One such mechanism is called conjugation.
During conjugation, a bacterium with resistance (F+) extends a special of type
pilus called a sex pilus and attaches to another bacterium lacking resistance (F-). After
the pilus is attached, one bacterium transfers DNA to the other in the form of plasmids.
The DNA that has been transferred is a special type of DNA is called a plasmid. Plasmids
are small, circular, self replicating DNA molecules that carry only a few genes (most
which are essential only for the production of sex pili, and resistance) (Campbell &
Reece 349). The plasmid is transferred to the bacteria (F-) as a single strand, and upon
entering, the plasmid reverts back to its original circular form and turns the bacterium
into F+.
Although it is through the use of antibacterials that resistant strains form,
research has still continued and antibiotics are still vastly used. They are a necessity in
current society and cannot easily be eradicated. Research is desperately needed to
constantly form new drugs to combat the ever evolving bacteria, and antibiotics are
used for numerous reasons. But with this constant cat and mouse chase between new
drugs and new mutations, scientists are trapped in a never ending cycle. This cycle has
the science community on edge about practicing the use and research of antibiotics.
Michael R. Mulvey, PhD and Andrew E. Simor, MD say “the emergence of
antibiotic-resistant organisms is a major public health concern, particularly in hospitals
and other health care settings. Antibiotic-resistant organisms appear to be biologically
fit and are capable of causing serious, life-threatening infections that are difficult to
manage because treatment options are limited.” Doctors are carelessly prescribing
antibiotics to colds that are caused by viruses and are not affected by the drugs.
Another problem arises in hospitals by patient to patient transfer of resistant bacteria.
Hospitals are also one of the few places in society in which antibiotics of all types are
heavily relied upon used and ironically as a result, they are a “focal point for the
emergence and spread of antibiotic-resistant pathogens” (Kolef and Fraser 298-314).
Every time a new resistance is formed a new antibiotic is needed.
Many scientists support research of antibacterials and further use of them
because they are essential to healthy lives. They fight off infections and the more that is
known about bacteria and the antibacterials used to fight them, the safer people are
from infections. Thomas Gootz explains that, “vigilance in understanding the
mechanisms by which bacteria become resistant to existing antibiotics will lay the
groundwork for finding new agents that escape resistance.” His opinion is that to beat
the bacteria one must know all about how it interacts with antibacterials to put a stop
to resistant strains. The organizations SHEA and HICPAC feel that, “monitoring
multidrug-resistant organisms (MDROs) and the infections they cause in a healthcare
setting is important to detect newly emerging antimicrobial resistance profiles, to
identify vulnerable patient populations, and to assess the need for and effectiveness of
interventions” (Vol. 29 No. 10 ,2008). In a research experiment that observed the role of
antibiotics in pancreatitis, Ramsay and Breedveld feel that the use antibiotics should be
used to help control the infection. Although the antibiotic is not crucial to treating the
condition, Ramsay and Breeveld believe that the patients “should receive antibiotic
prophylaxis” because it attributed to preventing multi-organ system failure and
ultimately death (351-353). Without the continuation of research, new antibiotics would
not be engineered to fight the resistant strains currently alive. Other researchers and
doctors in the field feel that experiments must be conducted to find treatments to
current bacterial infections and diseases. They are aware of the consequences that may
come about as a result of constant experimenting, but they feel the benefits outweigh
costs. The general public also supports the use of antibacterials to the extent which is
becoming a problem. A couple examples are ingesting antibiotic drugs for any symptom
of sickness and constant use of disinfectant products on almost all surfaces, objects and
food.
In contrast to those in support of antibacterial usage and research, there is quite
a handful against the idea. These scientists and medical experts do not feel that
experimenting around with different antibacterials is worth the risk of potentially
forming yet another resistant bacteria. The top risk of experimenting with antibiotics is
that it “carries a risk of increasing selection pressure for resistance” (Ramsey and
Breedveld). If a research project to create a new antibiotic goes well, everyone benefits.
If not, the bacteria targeted is still creating illness in people and the experimental drug
may have had an effect on another pathogen that was not meant to be altered. Aside
from research, the uses of antibiotics themselves are not openly welcome. In the
pro/con paper of the use of antibiotics to help treat pancreatitis Blackbourne and Cohn
explain that the trials “found no significant differences in organ dysfunction or
mortality” (351-353). Their message is that the continual use of an antibiotic that may or
may not be helping the chances of patient’s wellness is not worth using until a definite
answer is known about its role.
There are many solutions and measures that can be taken to control this quickly
growing issue. The best way is prevention, but when that fails, it is important to take
quick action. Places like hospitals can establish specific protocol when dealing with the
use of antibiotics and monitor known strains of resistance in bacteria. The Centers for
Disease and Control (CDC) has published guidelines in reference to the way antibiotics
should be handled. This should be strictly followed. When a resistant strain of bacteria is
found within a patient, they should be isolated to keep the bacteria from spreading to
others. Doctors should also be more aware and careful about prescribing antibiotics so
freely. They should only prescribe antibiotic drugs if there is a definite diagnosis to the
illness instead of using antibiotics as the first and last options. Doctors should promote
the use of antibiotics only when the infections are bacterial, as opposed to viral.
Even if these precautionary rules are instated, some bacteria will undoubtedly
slip through the cracks and form resistance. This calls for a fast and accurate
development of a new antibacterial by pharmaceutical companies. But this is not easy
to do because the development of a new drug costs much time and money, which is
why many companies have taken a back seat to antibacterial research. Many funds are
invested into the formation of one drug, and if it turns out to be ineffective, all the
investments are considered to have been wasted. Much resistance may occur through
clinical means like in labs and such, but much of it is caused the by public and their
constant use of antibiotics without knowing what antibiotics actually do or the possible
consequences. The public at large can freely purchase antibiotics on their own accord.
This makes controlling the usage of antibiotic difficult to regulate.
A vitally effective way of attacking resistant bacteria is to use more that one drug
at once to ensure that all of the pathogens are destroyed. But this has a drawback in
that it may result in MDROs. A solution to help lessen the problem that is going at in the
moment (as opposed to preventing it), would be to put out incentives for antibiotic
research. Due to the cost of engineering antibacterials and considering there is
guarantee the product will work, many companies have stopped funding antibacterial
research. With incentives like funding and easier access to conduct research, scientists
will be more drawn to help study resistant bacteria and engineering new antibiotics.
Another way to keep bacteria at bay is, once a new drug has been formed to defeat a
previously resistant bacteria, it should be closely monitored incase of future mutations.
Although all these measures can help reduce the issue at hand, nothing can completely
stop it because of two main reasons. The first one is that antibiotics are crucial to the
well being of the majority of humans and animals alike. The second reason is that
mutations occur spontaneously and randomly. There is no way to control mutations so
the only thing to do is to be prepared at all times.
Antibiotic research is a risky business but it is essential. The constantly mutating
bacteria need a form of antibiotic to keep the numbers at bay. Without antibiotic
research, there would be no way to combat future bacterial illnesses because all of then
would have become to the current drugs being used now. While it is important to
reward new advances in antibiotic research with incentives, it is equally important to set
strict policies and procedures for when research is being conducted. The CDC’s
guidelines should be adopted and followed by all hospitals. Researchers should keep a
sharp eye out in case a bacterial colony is somehow spread out of the lab and into
society and also for mutated strains that pop up during the course of their research.
Bacterial mutations will occur whether antibiotics are used or not, but the use of
antibiotics slightly speed up the process. This is why research must be very carefully
planned out and drug testing should be put off until the last division of an antibacterial
research project. Society is in need of antibiotics and the research of antibiotic research,
but can do well with better organization. The way research is conducted, how and when
antibiotics are used and the proper protocol to follow when dealing with resistant
strains of bacteria (in hospital and labs) need to be properly addressed and put in order.
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