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

Reviewer: Nika Kotnik

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

Antibiotiki: v zakulisju omogočajo obstoj moderne medicine.

We use them to cure infectious diseases,

Uporabljamo jih za zdravljenje nalezljivih bolezni,

but also to safely facilitate everything from surgery to chemotherapy

pa tudi za varno okrevanje po vsem: od operacije, kemoterapije

to organ transplants.

do presaditve organov.

Without antibiotics,

Brez antibiotikov,

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

lahko rutinski medicinski posegi privedejo do smrtno nevarnih okužb.

And we’re at risk of losing them.

In obstaja tveganje, da jih izgubimo!

Antibiotics are chemicals that prevent the growth of bacteria.

Antibiotiki so spojine, ki preprečujejo rast bakterij.

Unfortunately, some bacteria have become resistant

Na žalost so nekatere bakterije postale odporne

to all currently available antibiotics.

na vse trenutno znane antibiotike.

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

Ob istem času, smo prenehali odkrivati nove.

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

Kljub temu obstaja upanje, da prehitimo težavo.

But first, how did we get into this situation?

Ampak najprej, kako smo sploh pristali v tej situaciji?

The first widely used antibiotic was penicillin,

Prvi antibiotik v splošni uporabi je bil penicillin,

discovered in 1928 by Alexander Fleming.

ki ga je 1928 odkril Alexander Fleming.

In his 1945 Nobel Prize acceptance speech,

L. 1945 je v sprejemnem govoru za Nobelovo nagrado

Fleming warned that bacterial resistance had the potential to ruin

Fleming opozoril, da ima bakterijska odpornost uničujoč potencial za

čudež antibiotikov.

the miracle of antibiotics.

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

Imel je prav: v 1940-ih and 50-ih

resistant bacteria already began to appear.

so se bakterijske odpornosti že pričele pojavljati.

From then until the 1980s,

Od takrat in do osemdesetih let 20. stoletja,

pharmaceutical companies countered the problem of resistance

so se farmacevtska podjetja uspešno borila proti problemu rezistenc

by discovering many new antibiotics.

z odkrivanjem številnih novih antibiotikov.

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

Sprva je bilo to zelo uspešno in zelo dobičkonosno.

Over time, a couple things changed.

Čez čas se je nekaj spremenilo.

Na novo odkriti antibiotiki so bili pogosto učinkoviti

Newly discovered antibiotics were often only effective

for a narrow spectrum of infections,

le proti nekaterim vrstam okužb,

whereas the first ones had been broadly applicable.

medtem ko so bili prvotni za splošno uporabo.

This isn’t a problem in itself,

To samo po sebi ni problem,

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

vendar pomeni, da je prodano manj odmerkov enakega zdravila -

making them less profitable.

zaradi česar so manj dobičkonosni.

In the early days, antibiotics were heavily overprescribed,

V začetku so bili antibiotiki predpisani prekomerno,

including for viral infections they had no effect on.

tudi za virusna obolenja, na katera niso imeli nobenega vpliva.

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

Pregled nad pisanjem receptov se je povečal, kar je dobro, a znižal prodajo.

At the same time, companies began to develop more drugs

Hkrati so podjetja pričela razvijati nova zdravila,

that are taken over a patient’s lifetime,

ki jih mora pacient jemati celo življenje:

like blood pressure and cholesterol medications,

zdravila za zniževanje zvišanega krvnega tlaka in holesterola,

and later anti-depressants and anti-anxiety medications.

in kasneje antidepresive in zdravila proti občutku tesnobe.

Ker se jih uživa konstantno, so ta zdravila bolj dobičkonosna.

Because they are taken indefinitely, these drugs more profitable.

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

Od sredine osemdesetih let, ni bilo odkritih novih tipov antibiotikov.

But bacteria continued to acquire resistance and pass it along

Toda bakterije še naprej pridobivajo odpornost in jo predajajo naprej

by sharing genetic information between individual bacteria

z deljenjem genetskega materiala z drugimi bakterijami,

ali celo drugimi vrstami.

and even across species.

Now bacteria that are resistant to many antibiotics are common,

Danes so nove bakterije odporne na mnoge znane antibiotike,

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

in vse več je sevov bakterij, ki so odporni na vse znane antibiotike!

So, what can we do about this?

Torej, kaj lahko storimo glede tega?

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

Nadzorovati moramo uporabo obstoječih antibiotikov, ustvariti nove,

combat resistance to new and existing drugs,

nadaljevati boj proti novim in obstoječim rezistencam,

and find new ways to fight bacterial infections.

in poiskati nov način za bojevanje proti bakterijskim okužbam.

Največji porabniki antibiotikov so v kmetijstvu,

The largest consumer of antibiotics is agriculture,

ki ne uporabljajo antibiotikov samo za zdravljenje okužb,

which uses antibiotics not only to treat infections

but to promote the growth of food animals.

ampak tudi za pospeševanje rasti pri rejnih živalih.

Using large volumes of antibiotics

Uporaba velikih količin antibiotikov

increases the bacteria’s exposure to the antibiotics

poveča izpostavljenost bakterij antibiotikom,

and therefore their opportunity to develop resistance.

to pa je priložnost za razvoj odpornosti.

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

Veliko v živalih prisotnih bakterij, npr. salmonela, lahko okužijo tudi človeka,

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

in njihove odporne različice nas lahko okužijo skozi prehranjevalno verigo,

and spread through international trade and travel networks.

in se razširijo s pomočjo mednarodne trgovine in s potovanji.

In terms of finding new antibiotics,

V iskanju novih antibiotikov,

nature offers the most promising new compounds.

narava ponuja najbolj obetavne nove spojine.

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

Organizmi kot drugi mikrobi in glive, so se razvijali in živeli milijonie let

to live in competitive environments—

v tekmovalnem okolju -

meaning they often contain antibiotic compounds

kar pomeni, da pogosto vsebujejo antibiotične substance,

ki jim dajejo preživetveno prednost pred nekaterimi bakterijami.

to give them a survival advantage over certain bacteria.

We can also package antibiotics with molecules that inhibit resistance.

Antibiotike bi lahko pakirali tudi s substancami, ki zavirajo odpornost.

En način bakterijske odpornosti se zgodi, ko bakterija uporabi lasten protein

One way bacteria develop resistance is through proteins of their own

that degrade the drug.

za razgradnjo zdravila.

By packaging the antibiotic with molecules that block the degraders,

S pakiranjem antibiotikov z molekulami, ki blokirajo njihovo razgradnjo

the antibiotic can do its job.

antibiotik lahko opravi svojo nalogo.

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

Fagi - virusi, ki napadajo bakterije, ampak ne vplivajo na ljudi,

are one promising new avenue to combat bacterial infections.

ponujajo nove priložnosti v boju z bakterijskimi okužbami.

Developing vaccines for common infections, meanwhile,

Razvoj cepiv za pogoste okužbe, bi medtem

can help prevent disease in the first place.

lahko preprečil že sam nastanek bolezni.

The biggest challenge to all these approaches is funding,

Največji izziv vseh teh pristopov je financiranje,

which is woefully inadequate across the globe.

ki je zelo neprimerno po vsem svetu.

Antibiotics are so unprofitable that many large pharmaceutical companies

Antibiotiki so tako nedobičkonosni, da so jih mnoge velika farmacevtska podjetja

have stopped trying to develop them.

prenehala razvijati.

Meanwhile, smaller companies that successfully bring new antibiotics

Medtem, manjša podjetja, ki antibiotik uspešno pripeljejo na trg,

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

še vedno bankrotirajo, kot primer ameriški “start up” Achaogen.

New therapeutic techniques like phages and vaccines

Novi terapevtiki, kot so fagi in cepiva,

velikokrat doživijo enako usodo kot tradicionalni antibiotiki:

face the same fundamental problem as traditional antibiotics:

če so učinkoviti, so uporabljeni le enkrat,

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

which makes it difficult to make money.

zaradi česar je ustvariti zaslužek težavno.

And to successfully counteract resistance in the long term,

In da se uspešno zoperstavimo odpornostim na dolgi rok,

we’ll need to use new antibiotics sparingly—

bomo morali uporabljati antibiotike zmerneje -

lowering the profits for their creators even further.

in s tem še bolj znižali dobiček svojih ustvarjalcev.

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

Ena od rešitev je preusmeritev dobička stran od količine prodanih antibiotikov.

For example, the United Kingdom is testing a model

Na primer Združeno kraljestvo preizkuša model

where healthcare providers purchase antibiotic subscriptions.

kjer izvajalci zdravstvenih storitev kupijo naročnino na antibiotike.

While governments are looking for ways to incentivize antibiotic development,

Medtem ko vlade iščejo načine kako spodbuditi razvoj antibiotikov,

these programs are still in the early stages.

so ti programi še vedno v zgodnjih fazah.

Countries around the world will need to do much more—

Države po vsem svetu bi morale narediti veliko več -

but with enough investment in antibiotic development

vendar z dovolj investicijami v razvoj antibiotikov

and controlled use of our current drugs,

in kontrolirano uporabo trenutnih zdravil,

we can still get ahead of resistance.

smo lahko še vedno v prednosti pred odpornostmi.