Lessons from the pandemic
The unnecessary use of global antibiotics began in 2020, and very soon we will see the consequences of a general pharmaceutical panic, and the drugs from the standard medical arsenal are no longer working against common infections, such as LOR infections.
The fight against resistance is already known: there is a need to reduce the spread of intra-hospital infections, to introduce vaccinations, to limit the use of antibiotics in animal husbandry, and to stop the uncontrolled use of anti-microbial drugs in the treatment of viruses, but perhaps the main lesson that the coronavirus pandemic has taught mankind is to understand the importance of investing in the development of new drugs.
Antibiotic resistance becomes one of the leading causes of death
This was clear before COVID-19. In the year leading up to the onset of the pandemic, WHO stated that by 2050 the situation of antibiotic resistance would reach such a peak that 10 million people would die each year from incurable infections. In January 2022, scientists published a study that, as early as 2019, nearly 5 million people had died from drug-resistant bacterial infections, and almost 1.3 million deaths were directly caused by resistance to antibiotic drugs.
Also, antibiotics are often used in agriculture, because of their chaotic domestic exploitation, anti-metal resistance is spread in populations of various wild animals, and they are resistant to the same natural resources as humans and domestic animals, for example, the zoologists have recently investigated the microbiote population of a national park in Tanzania, and they have found that primates are already highly resistant to antibiotics, which are often used uncontrolledly to treat gastroenteritis.
Effects of bacterial stability
Studies have shown that up to 90 per cent of patients diagnosed with coronavirus have received antibiotics during treatment without cause. COVID-19 can develop bacterial complications against which anti-microbial drugs are effective, but the use of antibiotics from the early days of the disease threatens to build the resilience of microbes. So if the bacterial superinfection does join the coronavirus in the future, there will be nothing to treat.
For example, one of the most popular antibiotics during the pandemic was asythromicin. After two years, doctors estimate that we have lost this inexpensive and previously effective drug, even though it has nothing to do with the treatment of the coronavirus. People have accepted it at the first signs of infirmity, not in the course. In these cases, the mechanism works: in two or three days, the resistance to antibiotics is formed in the body, and bacteria do not die in time, they continue to live and strengthen. After a while, a person tries another antibiotics and history repeats itself, and bacteria learn to survive, and after a while, there will be no longer a drug that is capable of dealing with them.
According to various estimates, one of the outcomes of the pandemic will be a four-fold increase in antibiotic-resistant bacteria, which specialists estimate will grow by 50 per cent.
Dangerous Neighborhood: Not all drugs can be used together
In addition to the self-treatment of antibiotics and their unjustified designation during the pandemic, we have faced another problem — the chaotic use of drugs that are incompatible with each other. The overall increase in drug use during the pandemic has shown that both doctors and patients need to keep in mind the laws of their interaction. Different drugs can increase each other's activity and efficiency and reduce each other's efficiency. In addition, a combination of inappropriate drugs can cause or reinforce side effects.
For example, the use of acetylcystein, which is used to treat respiratory diseases, together with antibiotics, reduces the latter's activity because the drug prevents them from being absorbed, while carbocystein-based drugs and antibiotics, on the other hand, mutually increase each other's effectiveness.
In addition to drug interaction, there is the phenomenon of polypragmazy — the problem of simultaneous prescription of multiple drugs, often unnecessary. An unjustified long list of medications not only hits the wallet but also the health. This is usually the case when a person is seen at the same time by several specialists who do not agree on medications, or the patient is interested in self-treatment. Plipragmazy often reduces the effectiveness of the treatment and increases the recovery time.
Several tools are available to assess the rational use of various drugs, the most popular of which are the STOP/START and Birsa criteria, which are particularly relevant to older patients.
Humanity needs new drugs.
COVID-19 has done something important to make the world's medical community more flexible, and pharmaceuticals have been given a new impetus to development. With the experience of combating the pandemic, the world has been working hard to study and produce vaccines, as well as to develop drugs that, among other things, can replace antibiotics.
The alternative to antibiotics is to think of bacteria that can kill disease bacteria and don't destroy useful bacteria. Bacteriophagus is the natural enemy of bacteria, it recognizes what is needed, injects into and reproduces into it until it destroys it, then goes to search for a new bacteria. Bacteriophagus use enzymes to destroy the cell wall of bacteria. One of these enzymes is lizocym, it's part of the body's immune system, and it's used to treat LOR organ diseases.
Unlike antibiotics, bacteria do not interfere with microbes, reduce the resistance of microbes to drugs, and can be used for children and pregnant women. A lack of opposition for these groups of patients is a very important factor that confirms that maintaining high efficiency and not harming the body is possible.
Another alternative to antibiotics is anti-microbial peptides, which we owe to evolution, which are amino acids that provide innate immunity to all living creatures by destroying bacteria or slowing their reproduction. Anti-microbial peptides work very quickly to damage and "break" the bacterial cell membrane, they need a few seconds, while the antibiotics cope with the clock.
But the Peptides have both pros and cons. They don't cause side effects like antibiotics, but they get out of the body too quickly, often without reaching a goal. Scientists explore these molecules in the hope of creating effective and safe drugs based on them, and even succeed. Tested drugs based on anti-bacterial peptides exist, but they are few, and they are very expensive. If researchers understand how to extend the life of the molecule in the body, this method can achieve wider distribution and actually replace antibiotics.
QALY, or what to do with the side effects of long-term therapy
One of the most important lessons of the pandemic is that the cure must not simply work, but must also have a minimal impact on the quality of life, without causing serious side effects. Because, first, the coronavirus has triggered the appearance and worsening of existing chronic diseases. Second, it has become evident that uncompensated health problems are a huge risk in the epidemic. That is why it is important that people do not refuse long-term medication.
When developing drugs, we can no longer ignore QALY, the quality-of-life-adjusted years. It reflects the number of additional years a patient receives as a result of treatment, while taking into account the quality of life — symptoms, pain, side effects, psycho-emotional state of the patient.
Today's drug therapy is more than just an appropriate treatment scheme for a patient. The trend in the production of drugs is towards the search for active substances that have an effective effect without an aggressive effect on the body, while preserving the natural microflore.
The world's looking for an aging pill.
COVID-19 hit older people: the process of ageing is linked to an increase in chronic diseases and general "fragileness", so there is a need to confront future epidemics at this level — to counter age changes in the body — drugs that will be "doping", which will improve a healthy person's health and prevent ageing.
There are now several studies of advanced drugs in the world, and if they actually prolong life, improve its quality, slow down its aging and, in general, can be considered the same drugs for healthy people, it will be a real breakthrough in longevity industries.
For example, TAME trial is a six-year study of the effectiveness of metformin against ageing for 3,000 people aged 65 to 79, and scientists are trying to determine whether a known drug against diabetes can really help develop next-generation drugs that focus on the biology of ageing.
Another project is PEARL trial, a double blind randomized placebo-controlled study of the second phase of rapamicin's influence on human aging. Now rapamicin is being used in kidney transplantation to prevent organ rejection. Previous studies on mice have already shown that those individuals who received rapamicin lived much longer than those who were not fed. Males lived on average 9% longer and females on average 14% longer. Similar results were obtained in studies with dogs and primates.
In addition to genetic research to determine the risk of disease and the selection of genotype drugs, doctors are now gaining popularity for the phenomenon of egyotype. This is an individual combination of certain biochemical indicators that change over time, and researchers at Stanford say that the definition of egyotype at a young age will help to understand exactly what is worth paying attention to in order to extend a healthy life. It is likely that soon we will know not only our blood group, our genetype, but our egyotype.
Time to draw conclusions
After two years of fighting the pandemic, the medical, pharmaceutical and patient communities have learned a great deal of important lessons, their cost — effective and affordable antibiotics that are likely to become useless soon — in order to prevent mankind from falling into an infectious collapse in which going to a dentist or giving birth would be life-threatening, requiring a major investment in research and the production of drugs, replacing or improving the effectiveness of weakened anti-microbial drugs.
It is clear that the future is for drugs that will meet modern safety requirements, and the world's experience in dealing with the coronavirus has finally proved that it is not enough to deal with the problem, it is important to do so as delicately as possible, keeping the body free from additional stress.