How can we solve the antibiotic resistance crisis? - Gerry Wright

Translator: Andrea Insua Ramos Reviewer: Servizo de Normalización Lingüística

Antibiotics: behind the scenes, they enable much of modern medicine.

Antibióticos: entre bastidores, permiten gran parte da medicina moderna.

We use them to cure infectious diseases,

Usámolos para curar enfermidades infecciosas,

but also to safely facilitate everything from surgery to chemotherapy

pero tamén para aumentar a seguridade en procedementos como

cirurxías, a quimioterapia

to organ transplants.

e o transplante de órganos.

Without antibiotics,

Sen antibióticos,

even routine medical procedures can lead to life-threatening infections.

incluso procedementos médicos de rutina poden levar a infeccións letais,

And we’re at risk of losing them.

e corremos o risco de perdelos.

Antibiotics are chemicals that prevent the growth of bacteria.

Os antibióticos son substancias químicas que evitan o crecemento das bacterias.

Unfortunately, some bacteria have become resistant

Por desgraza, algunhas bacterias volvéronse resistentes

to all currently available antibiotics.

a todos os antibióticos dispoñibles.

At the same time, we’ve stopped discovering new ones.

Ao mesmo tempo, paramos de descubrir outros novos.

Still, there’s hope that we can get ahead of the problem.

A pesar de todo, hai esperanza de que poidamos resolver o problema.

But first, how did we get into this situation?

Pero, primeiro, como acabamos nesta situación?

The first widely used antibiotic was penicillin,

O primeiro antibiótico amplamente utilizado foi a penicilina,

discovered in 1928 by Alexander Fleming.

descuberta en 1928 por Alexander Fleming.

In his 1945 Nobel Prize acceptance speech,

No seu discurso de aceptación do Premio Nobel en 1945,

Fleming warned that bacterial resistance had the potential to ruin

Fleming advertiu que a resistencia podía chegar a arruinar

the miracle of antibiotics.

o milagre dos antibióticos.

He was right: in the 1940s and 50s,

Tiña razón: nos anos 40 e 50,

resistant bacteria already began to appear.

xa empezaron a aparecer as bacterias resistentes.

From then until the 1980s,

Desde aquela ata os anos 80,

pharmaceutical companies countered the problem of resistance

as compañías farmacéuticas fixeron fronte ao problema das resistencias

by discovering many new antibiotics.

descubrindo moitos antibióticos novos.

At first this was a highly successful— and highly profitable— enterprise.

Ao comezo, esta era unha empresa de éxito e moi lucrativa.

Over time, a couple things changed.

Co tempo, cambiaron un par de cousas.

Os antibióticos que se descubrían eran a miúdo tan só efectivos

Newly discovered antibiotics were often only effective

for a narrow spectrum of infections,

para un espectro reducido de infeccións,

whereas the first ones had been broadly applicable.

mentres que os primeiros eran amplamente aplicables.

This isn’t a problem in itself,

Isto non é un problema en si mesmo,

but it does mean that fewer doses of these drugs could be sold—

pero implica que non se podían vender tantas doses destes medicamentos,

making them less profitable.

o que os facía menos rendibles.

In the early days, antibiotics were heavily overprescribed,

Ao comezo, os antibióticos prescribíanse en exceso,

including for viral infections they had no effect on.

incluso para infeccións víricas sobre as que non tiñan efecto.

Scrutiny around prescriptions increased, which is good, but also lowered sales.

Aumentouse o control sobre as receitas, o que é bo, pero tamén baixaron as vendas.

At the same time, companies began to develop more drugs

Ao mesmo tempo, as compañías comezaron a desenvolver

máis medicamentos que os pacientes toman durante toda a vida,

that are taken over a patient’s lifetime,

like blood pressure and cholesterol medications,

como fármacos para a presión arterial e o colesterol,

and later anti-depressants and anti-anxiety medications.

e, máis tarde, antidepresivos e medicamentos para a ansiedade.

Because they are taken indefinitely, these drugs more profitable.

Como se toman indefinidamente, estes medicamentos son máis rendibles.

By the mid-1980s, no new chemical classes of antibiotics were discovered.

A mediados dos 80, non se descubriran novas clases químicas de antibióticos,

But bacteria continued to acquire resistance and pass it along

pero as bacterias seguiron adquirindo e pasando resistencia

by sharing genetic information between individual bacteria

ao compartir información xenética entre bacterias individuais

and even across species.

e incluso entre especies.

Now bacteria that are resistant to many antibiotics are common,

Agora é común que as bacterias sexan resistentes a moitos antibióticos,

and increasingly some strains are resistant to all our current drugs.

e cada vez máis cepas son resistentes a todos os medicamentos actuais.

So, what can we do about this?

Entón, que podemos facer ao respecto?

We need to control the use of existing antibiotics, create new ones,

Necesitamos controlar o uso dos antibióticos existentes,

crear outros novos,

combat resistance to new and existing drugs,

combater a resistencia aos medicamentos novos e aos existentes

and find new ways to fight bacterial infections.

e encontrar novas maneiras de loitar contra as infeccións bacterianas.

The largest consumer of antibiotics is agriculture,

A agricultura é a maior consumidora de antibióticos.

Úsanos non só para tratar infeccións,

which uses antibiotics not only to treat infections

but to promote the growth of food animals.

senón tamén para favorecer o crecemento dos animais para consumo.

Using large volumes of antibiotics

O uso de grandes volumes de antibióticos

increases the bacteria’s exposure to the antibiotics

incrementa a exposición das bacterias a estes

and therefore their opportunity to develop resistance.

e, por tanto, as súas oportunidades de desenvolver resistencia.

Many bacteria that are common in animals, like salmonella, can also infect humans,

Moitas das bacterias comúns nos animais, como a salmonela,

tamén poden infectar humanos,

and drug-resistant versions can pass to us through the food chain

e versións resitentes poden chegar a nós a través da cadea alimentaria

and spread through international trade and travel networks.

e estenderse polas rutas de comercio e de viaxes internacionais.

In terms of finding new antibiotics,

Respecto á busca de novos antibióticos,

nature offers the most promising new compounds.

a natureza ofrece os compostos novos máis prometedores.

Organisms like other microbes and fungi have evolved over millions of years

Organismos coma outros microbios e fungos evolucionaron durante millóns de anos

to live in competitive environments—

para vivir en ambientes competitivos,

meaning they often contain antibiotic compounds

o que significa que, normalmente, conteñen compostos antibióticos

to give them a survival advantage over certain bacteria.

que lles brindan unha vantaxe evolutiva sobre certas bacterias.

We can also package antibiotics with molecules that inhibit resistance.

Tamén podemos deseñar antibióticos con moléculas que inhiban a resistencia.

One way bacteria develop resistance is through proteins of their own

Unha maneira na que as bacterias desenvolven resistencia é mediante

proteínas propias que degradan o fármaco.

that degrade the drug.

By packaging the antibiotic with molecules that block the degraders,

Ao deseñalo con moléculas que bloqueen esas proteínas,

the antibiotic can do its job.

o antibiótico pode facer o seu traballo.

Os fagos, virus que atacan as bacterias pero non afectan os humanos,

Phages, viruses that attack bacteria but don’t affect humans,

are one promising new avenue to combat bacterial infections.

son unha nova vía moi prometedora para combater as infeccións bacterianas.

Developing vaccines for common infections, meanwhile,

Mentres tanto, desenvolver vacinas para as infeccións comúns

can help prevent disease in the first place.

pode axudar, en primeiro lugar, a previr enfermidades.

The biggest challenge to all these approaches is funding,

O maior reto para todas estas estratexias é o financiamento,

which is woefully inadequate across the globe.

que é, lamentablemente, insuficiente en todo o mundo.

Antibiotics are so unprofitable that many large pharmaceutical companies

Os antibióticos son tan pouco rendibles que moitas grandes empresas farmacéuticas

have stopped trying to develop them.

deixaron de intentar desenvolvelos.

Meanwhile, smaller companies that successfully bring new antibiotics

Paralelamente, as pequenas empresas que sacan novos antibióticos ao mercado

to market often still go bankrupt, like the American start up Achaogen.

acaban moitas veces crebando, coma a empresa emerxente americana Achaogen.

New therapeutic techniques like phages and vaccines

As novas estratexias terapéuticas, coma os fagos e as vacinas,

face the same fundamental problem as traditional antibiotics:

encóntranse co mesmo problema fundamental ca os antibióticos tradicionais:

if they’re working well, they’re used just once,

se funcionan ben, úsanse unha soa vez,

which makes it difficult to make money.

o que dificulta gañar cartos.

And to successfully counteract resistance in the long term,

E, para contrarrestar con éxito a resistencia a longo prazo,

necesitaremos usar os novos antibióticos con moderación,

we’ll need to use new antibiotics sparingly—

lowering the profits for their creators even further.

o que fará que os seus creadores teñan aínda menos beneficios.

One possible solution is to shift profits away from the volume of antibiotics sold.

Unha posible solución é facer que as ganancias non dependan

da cantidade da antibióticos vendida.

For example, the United Kingdom is testing a model

Por exemplo, o Reino Unido está probando un modelo

where healthcare providers purchase antibiotic subscriptions.

no que o profesional médico compra subscricións a antibióticos.

While governments are looking for ways to incentivize antibiotic development,

Malia que os gobernos buscan maneiras de incentivar a creación de antibióticos,

these programs are still in the early stages.

estes programas están aínda nas etapas iniciais.

Countries around the world will need to do much more—

Todos os países do mundo deberán tomar máis medidas,

but with enough investment in antibiotic development

pero co suficiente investimento no desenvolvemento de antibióticos

and controlled use of our current drugs,

e o uso controlado dos fármacos actuais,

we can still get ahead of resistance.

aínda podemos vencer a resistencia.