A brief summary of the manuscript, Alternatives to Antibiotics: Why and How (Allen, 2017), a review of current and potential alternatives to antibiotics for use in human or veterinary medicine.
- Every time antibiotics are used, impacted bacteria adapt to survive. Bacteria that are not killed by the antibiotic pass on their new survival traits to later generations of bacteria, which limit the effect of the antibiotic the next time it is used.
- Antibiotics are not the only way to treat bacterial diseases. Alternative treatment methods to consider include vaccines, immunotherapeutics, bacteriophage therapy, and probiotics.
In a 2017 discussion paper in the National Academy of Medicine, microbiologist Heather K. Allen explains how the antibiotic resistance crisis came about and describes some practical solutions that are available now to begin to address the issue in clinical settings. As a general principle, Allen explains, pathogens can evolve genetically, developing resistance to our medicines, simply through what amounts to natural selection (this is somewhat of an oversimplification of the process, but a helpful model for understanding it). Because antibiotics have been overused—particularly in their prophylactic use (meaning use to prevent a disease that doesn’t yet exist)—the already quick evolution of bacteria has ironically been lent a helping hand by humanity. The more quickly we kill off bacteria, the more rapidly the bacteria themselves must and do evolve to survive.
Allen recommends “antibiotic prudency,” or “the use of antibiotics only when they are expressly needed and at the most appropriate dose for disease treatment.” She admits that “this is a nebulous concept that is difficult to define,” but overall she emphasizes that changing cultural attitudes toward casual use of antibiotics as preventative measures is necessary, and she implies that physicians and veterinarians (as well as governmental bodies regulating food and drugs) can be one of the starting points for changing cultural attitudes toward when and how it is acceptable to use antibiotics.
Some of the alternatives she suggests include:
Vaccines –Because many resistant infectious occur secondarily to vaccine-preventable diseases (such as pneumonia after the flu), vaccines are a very effective way to prevent the necessity of antibiotics to begin with.
Immunotherapeutics – this involves augmenting the host’s immune system at specific times (such as postpartum) so that infection does not occur to begin with. They have to be very specifically targeted in regards to time, however, which is not always predictable.
Probiotics – maintaining the vitality of healthy body flora in many ways could curb overgrowths of pathogens (an example of this is a lack of healthy flora in the vagina resulting in yeast infections or fecal transplants to curb cDiff infections). The drawbacks to this option (called competitive exclusion) are that particularly in the gut, healthy flora are so diverse that we do not fully understand their functions, so harnessing their potential more accurately will take a great deal more research. One way we can boost probiotic growth is the inclusion of prebiotic foods in our diets. Prebiotics are types of fiber that humans are not able to digest so they serve as a food source for probiotic species in the gut. Many high-fiber foods including fruits, vegetables, and grain contain prebiotics.
Bacteriophage Therapy – this form of therapy involves reprogramming viruses to target certain harmful bacteria. It is one of the most hopeful newer alternatives to antibiotic resistance that exists. Drawbacks to this method include having to know the exact pathogenic strain at issue in an individual, which requires culturing, itself sometimes difficult to do successfully. Also, bacteria can evolve resistance to bacteriophages, but bacteriophage therapy could be updated occasionally to target the new bacteria.
In conclusion, Allen says that dealing with antibiotic resistance will come from not one, but all of these methods used discerningly and where appropriate.
Written by: Kari Nixon, Scholar of Medical Humanities & Literature, Whitworth University; reviewed by Sid Thakur, veterinary medicine, NC State & Jovana Kovacevic, food science and technology, Oregon State.
The scientific research summarized in this article was published as
Allen, H. K. (2017). Alternatives to Antibiotics: Why and How. NAM Perspectives, 7(7). https://doi.org/10.31478/201707g
This article presents the author’s interpretation of the published research for a general audience and should not be considered a reflection of the position or opinion of the researchers.