ANTIBIOTICS RESISTANCE (other topics)
The use of antibiotics is limited because bacteria have evolved defenses against certain antibiotics. One of the main mechanisms of defense is inactivation of the antibiotic. This is the usual defense against penicillins and chloramphenicol, among others. Another form of defense involves a mutation that changes the bacterial enzyme affected by the drug in such a way that the antibiotic can no longer inhibit it. This is the main mechanism of resistance to the compounds that inhibit protein synthesis, such as the tetracyclines.
All these forms of resistance are transmitted genetically by the bacterium to its progeny. Genes that carry resistance can also be transmitted from one bacterium to another by means of plasmids, chromosomal fragments that contain only a few genes, including the resistance gene. Some bacteria conjugate with others of the same species, forming temporary links during which the plasmids are passed from one to another. If two plasmids carrying resistance genes to different antibiotics are transferred to the same bacterium, their resistance genes can be assembled onto a single plasmid. The combined resistances can then be transmitted to another bacterium, where they may be combined with yet another type of resistance. In this way, plasmids are generated that carry resistance to several different classes of antibiotic. In addition, plasmids have evolved that can be transmitted from one species of bacteria to another, and these can transfer multiple antibiotic resistance between very dissimilar species of bacteria.
The problem of resistance has been exacerbated by the use of antibiotics as prophylactics, intended to prevent infection before it occurs. Indiscriminate and inappropriate use of antibiotics for the treatment of the common cold and other common viral infections, against which they have no effect, removes antibiotic-sensitive bacteria and allows the development of antibiotic-resistant bacteria. Similarly, the use of antibiotics in poultry and livestock feed has promoted the spread of drug resistance and has led to the widespread contamination of meat and poultry by drug-resistant bacteria such as Salmonella.
In the 1970s, tuberculosis seemed to have been nearly eradicated in the developed countries, although it was still prevalent in developing countries. Now its incidence is increasing, partly due to resistance of the tubercle bacillus to antibiotics. Some bacteria, particularly strains of staphylococci, are resistant to so many classes of antibiotics that the infections they cause are almost untreatable. When such a strain invades a surgical ward in a hospital, it is sometimes necessary to close the ward altogether for a time. Similarly, plasmodia, the causative organisms of malaria, have developed resistance to antibiotics, while, at the same time, the mosquitoes that carry plasmodia have become resistant to the insecticides that were once used to control them. Consequently, although malaria had been almost entirely eliminated, it is now again rampant in Africa, the Middle East, Southeast Asia, and parts of Latin America. Furthermore, the discovery of new antibiotics is now much less common than in the past.
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