The leading expert in infectious diseases, a professor, head of the Department of Infectious Diseases and Epidemiology at Pirogov Russian National Research Medical University, Vladimir Nikiforov, discusses the sources of this crisis and ways to overcome it.
Right and Justified
— Vladimir Vladimirovich, is modern medicine truly facing a threat of losing the efficacy of antibiotics, and what are the worldwide consequences of this situation for public health and the healthcare system?
— Antibiotics continue to be an effective and indispensable means of treating numerous infectious ailments, however, their improper and unwarranted utilization leads to the emergence of so-called antibiotic resistance—the capacity of bacteria to “disregard” medications that previously eliminated and killed them within hours or days. According to WHO data, antimicrobial resistance is among the ten most serious global threats to humanity. WHO forecasts suggest that by 2050, deaths linked to rising antibiotic resistance could increase by 70%, potentially matching or even surpassing mortality from cancer. There is an observed increase in drug-resistant strains of pathogens causing severe bacterial infections—Escherichia coli and Klebsiella Pneumoniae—which frequently result in sepsis, organ dysfunction, and demise. These bacteria exhibit resistance to third-generation cephalosporins—”first-line” antibacterial agents used to treat patients with these infections. In the context of combating antibiotic resistance, it is crucial not only to develop novel antibacterial molecules but also to reduce the demand for antibiotics where they are unnecessary.
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By Doctor’s Order
— What is causing the appearance of antibiotic resistance, and what is the situation with the spread of this issue in our nation compared to global figures?
— The formation of this issue is connected to the rise in irrational antibiotic use and the difficulty in developing new antimicrobial drugs. The most frequent scenarios involve unilaterally stopping a course of antibacterial medication prescribed by a physician, taking an antibiotic without a doctor’s directive, and using antibiotics for ARVI, which are viral infections. WHO identifies the highest levels of antibiotic resistance in Southeast Asian and Eastern Mediterranean nations. In Russia, the situation is complicated by a very high frequency of irrational antibiotic consumption, which, according to survey data, reaches 70%. There is work to be done here. It is necessary to enhance public awareness regarding the correct application of antibiotics.
— How can an average person protect themselves regarding the issue of antibiotic resistance?
— Firstly, it is vital to realize that antibiotics are ineffective against viruses. Their unwarranted application for viral infections primarily leads to the destruction of normal microflora and creates conditions that foster the survival and proliferation of the most resilient bacteria, including pathogenic ones.
Secondly, if an antibiotic has indeed been prescribed (if and when a bacterial infection is identified in the patient), it is important to adhere to the treatment regimen recommended by the physician, including single and full course dosages, and not to discontinue the medication prematurely.
Timely and Correctly
— What approaches exist to alter the situation and lower the rate of irrational antibiotic use during ARVI?
— The pivotal approaches capable of changing the current scenario in ARVI treatment involve strengthening preventive measures and providing timely, sound treatment for viral infections, ruling out “backup” antibiotic use without medical indication. This encompasses boosting immunity, carrying out vaccinations, as well as employing accurate diagnostic and therapeutic methods in the early stages of illness. A large proportion of bacterial complications from ARVI, such as pneumonia, arise against a background of virus-weakened immunity, when the body’s own defense mechanisms fail. If a viral infection is managed in a timely and correct manner, the likelihood of such complications diminishes, as does the necessity for antibiotics.
Strengthen Immunity
— Are there ongoing developments to create agents that could serve as alternatives to antibiotics?
— Yes, this area is being discussed within the expert community, and new domestic advancements are emerging. In this context, immunomodulatory agents are mentioned, capable of helping to treat ARVI and fortifying the body’s defenses to avert bacterial complications and the forced prescription of antibiotics. However, it is crucial that such agents genuinely possess proven efficacy and safety, as an alternative to antibiotics must be tangible, not merely declared. One illustration could be the medication Rafamin. This medicinal product exhibits immune-mediated antibacterial and antiviral effects. Its primary function in treating infectious diseases lies in its potential to calibrate the immune response so that the immune system promptly recognizes the pathogen—regardless of whether it is a virus or a bacterium—and eliminates it from the body as quickly as possible. This is a very interesting avenue. So far, there are results from the successful use of this drug in individuals with ARVI as a method for preventing bacterial complications and reducing the need for antibiotics. I hope that further studies of this medication in the treatment of initially bacterial infections will be similarly impressive.
In closing, I wish to remind everyone that the rational utilization of antibiotics is not solely a matter of medical accountability but also of personal health concern. Adhering to preventive measures, seeking medical attention promptly at the first signs of illness, and following the doctor’s guidance will help you recover faster and preserve your well-being for many years. Take care of yourself and your loved ones—prevention and sound treatment will make your body stronger and more resilient to ailments.
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