The World Health Organization is sounding the alarm: cases of bacterial diseases that do not respond to conventional treatment approaches are increasing globally. Why are antibiotics losing their effectiveness, what dangers does this trend hide, and do “superbugs” for which no medicine has been found really exist? The forecasts made by experts—infectious disease specialists, epidemiology experts—cause serious concern. Imagine an intensive care unit where doctors are forced to helplessly shrug. The patient has sepsis (blood poisoning), but not a single antimicrobial agent, even the most potent one, yields results. Such situations are no longer fiction from a frightening movie, but a harsh reality. It was due to therapy-resistant infection that the life of 38-year-old singer Yulia Nachalova could not be saved in 2019. Her tragic passing serves as a loud warning signal for each of us. In reality, there are many such incidents, and this applies not only to sepsis but also to untreatable pneumonia, advanced forms of tuberculosis, and other infectious diseases. This phenomenon is called antibiotic resistance. It consists of microbes that should die from medications undergoing changes and developing resistance mechanisms. Not only the cunning microorganisms themselves are responsible for this, but also we humans. Microbial Armageddon A recently published WHO report indicates that already one in six cases of bacterial infection worldwide does not respond to standard therapy. Resistance levels have increased by more than 40% in just a five-year period. This is a real crisis claiming human lives. If this trend continues, routine surgical procedures, childbirth assistance, and the treatment of lung inflammation will once again become high-risk, fatal areas. “If immediate steps are not taken, antibiotic resistance may cause the deaths of 38.5 million people worldwide by the middle of the century. The most vulnerable will be citizens aged 70 and older: among them, the lethality rate may jump by 130%!” commented Alexey Tutelian, Head of the Laboratory of Hospital Infections and Disinfection at the Central Research Institute of Epidemiology of Rospotrebnadzor, Academician of the Russian Academy of Sciences, to “RG”—Nedelya.” “Superbugs” are already appearing—for example, Gram-negative bacteria, such as *Klebsiella pneumoniae* or *E. coli*, which ignore even potent third-generation cephalosporins. The WHO has compiled a list of the most dangerous pathogens that are closely monitored worldwide, including the Russian Federation. Why Pharma is Slow to Help At first glance, the solution seems obvious—to create new antibiotics. However, it is more difficult than it seems. Developing a new drug is a long and extremely costly process, while bacteria demonstrate a frighteningly rapid ability to adapt to fresh medications. It is simply not profitable for pharmaceutical concerns to invest in creating drugs that will lose their effectiveness in 5–10 years, or even sooner. “In the last five to seven years, there has been a noticeable acceleration in research in developed countries,” shares Academician Tutelian. “However, most of the emerging agents are merely variations of already known groups. Between 2017 and 2023, only 13 new antibiotics were licensed in the USA and EU countries, but most of them belong to existing classes.” Scientists are actively exploring alternative paths: they are engaging bacteriophages (viral particles that destroy bacteria), developing anti-virulence agents (which do not eliminate the microbe but deprive it of its ability to cause harm), and creating new vaccines. Echelons of Defense: Why Doctors “Conserve” the Strongest Drugs To bring order to this growing chaos, the WHO has developed the AWaRe classification. It divides all available antimicrobial agents into three categories, similar to defensive lines. Access: First-line agents. These drugs are time-tested and relatively safe. They are used to combat the most common infections (e.g., initial generation beta-lactams). Watch: “Heavy artillery.” Antibiotics associated with a high risk of developing resistance (carbapenems, fluoroquinolones). Their use is restricted to inpatient settings for treating severe conditions and only under strict indications. Reserve: “Last resort.” Drugs like colistin, which are only used in hopeless situations. Academician Tutelian emphasizes: “At the moment, the antibiotic colistin, from the polymyxin group, in some cases remains the only agent to which resistance has not yet developed, and this is why it must be protected as the greatest asset.” It is for this reason that a conscientious doctor will not prescribe you “something stronger” for a common cold. Using the strongest weapon against a minor threat in this battle is a strategic mistake. How We Create Problems for Ourselves The main paradox is that reducing the resistance of pathogens to antibiotics largely depends on our actions. We often unconsciously contribute to the accelerated evolution of bacteria. Here are our main blunders: “Just in Case.” In the first year of the pandemic, Russian citizens purchased 50% more antimicrobial drugs than before that period. Although COVID-19 is a viral disease, and antibiotics are powerless against viruses. “It Helped Before.” People think in simple terms: if azithromycin helped once, they will take it for every ailment. But doctors assert that varied microorganisms can cause similar symptoms, and therefore, any ailment is a reason for an individual approach; one cannot start treatment “in the dark” until the true cause of the illness is established. “Feeling Better—Stopping Treatment.” This is the third most common mistake. Tutelian draws an analogy: it is like tackling dandelions by “cutting off the top while the entire root system remains in the ground.” The bacteria that survive the premature termination of a course will breed a new, already drug-resistant generation. Self-medication and stockpiling. Expired medications thrown into landfills end up in soil and water bodies. Even minimal traces of antibiotics in drinking water and food stimulate the development of resistance. Antonina Ploskireva, Deputy Director for Clinical Work at the Central Research Institute of Epidemiology, Professor of the Russian Academy of Sciences, warned about other risks as part of an educational project: “Under no circumstances should you self-medicate given the possibility of side effects.” Recommendations How to use antibiotics correctly Only by doctor’s prescription. Any drug in this group must be prescribed strictly based on indications. Professor Ploskireva explains: “Antibiotics are useless for viral respiratory infections. However, if a secondary bacterial infection develops on top of it, their use becomes necessary. One sign: after improvement in the condition with an acute respiratory viral infection, there is a sudden sharp spike in temperature and a general deterioration—this is a valid reason to discuss the need for antibacterial therapy. In any case, the final decision is made by the doctor.” Strictly according to the schedule. If the dosage regimen is three times a day, it means the interval must be exactly 8 hours. This is necessary to maintain a stable concentration of the drug in the blood, which guarantees treatment effectiveness. Complete the full course. You must finish the entire course of medication, not stopping its use even if you already feel healthy. Take with clean water. Do not use tea, milk, or juice to wash it down—only plain water. Avoid alcohol. “Both antibacterial agents and ethanol are metabolized in the liver. The enzyme system may not cope with the load, which will lead to an increased toxic effect,” explains Antonina Ploskireva. Support the beneficial microflora. Taking probiotics is recommended (but with an interval of at least 2–3 hours between their intake and the main tablet). This is an important aspect of preventing antibiotic-associated diarrhea. “Antibiotics are not just pills. They are the greatest medical achievement that we risk losing due to our own negligence. We are all familiar with the concept of ‘rational nutrition,’ but our ‘medication behavior’ should be just as sensible. What we do with medications today determines whether doctors will have a tool to fight infections tomorrow. Let’s use this tool responsibly,” concluded Academician Tutelian.
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