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

Prevodilac: Miloš Milosavljević Lektor: Ivana Korom

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

Antibiotici: iza kulisa, oni omogućavaju modernu medicinu.

We use them to cure infectious diseases,

Koristimo ih za lečenje zaraznih bolesti,

but also to safely facilitate everything from surgery to chemotherapy

ali i za omogućavanje svega od hirurgije preko hemoterapije

to organ transplants.

do transplantacije organa.

Without antibiotics,

Bez antibiotika,

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

čak i rutinski medicinski postupci mogu prouzrokovati infekcije opasne po život.

And we’re at risk of losing them.

A postoji rizik da ih izgubimo.

Antibiotics are chemicals that prevent the growth of bacteria.

Antibiotici su hemikalije koje sprečavaju rast bakterija.

Unfortunately, some bacteria have become resistant

Na žalost, neke bakterije su postale otporne

to all currently available antibiotics.

na sve postojeće antibiotike.

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

U isto vreme, prestali smo da otkrivamo nove.

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

Ipak, postoji nada da možemo prevazići ovaj problem.

But first, how did we get into this situation?

Ali prvo, kako smo dospeli u ovu situaciju?

The first widely used antibiotic was penicillin,

Prvi široko korišćeni antibiotik bio je penicilin,

discovered in 1928 by Alexander Fleming.

koji je 1928. otkrio Aleksander Fleming.

In his 1945 Nobel Prize acceptance speech,

U svom govoru 1945, povodom dobijanja Nobelove nagrade,

Fleming warned that bacterial resistance had the potential to ruin

Fleming je upozorio da bakterijska otpornost ima potencijal da uništi

the miracle of antibiotics.

čudo antibiotika.

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

Bio je u pravu: '40-ih i '50-ih godina,

resistant bacteria already began to appear.

rezistentne bakterije su već počele da se pojavljuju.

From then until the 1980s,

Od tada do osamdesetih godina,

pharmaceutical companies countered the problem of resistance

farmaceutske kompanije su odgovorile na problem rezistentnosti

by discovering many new antibiotics.

time što su otkrile mnoge nove antibiotike.

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

Isprva je to bio veoma uspešan - i profitabilan - poduhvat.

Over time, a couple things changed.

Tokom vremena, par stvari se promenilo.

Newly discovered antibiotics were often only effective

Novootkriveni antibiotici često su delovali samo

for a narrow spectrum of infections,

na uski spektar infekcija,

whereas the first ones had been broadly applicable.

dok su oni prvi bili široko primenljivi.

This isn’t a problem in itself,

To nije problem sam po sebi,

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

ali to znači da manje doze ovih lekova mogu da se prodaju -

making them less profitable.

čineći ih manje profitabilnim.

In the early days, antibiotics were heavily overprescribed,

U početku su lekari prekomerno prepisivali antibiotike,

including for viral infections they had no effect on.

takođe i za virusne infekcije na koje nemaju efekta.

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

Nadzor oko prepisivanja recepata se povećao, što je dobro

ali se time smanjila prodaja.

At the same time, companies began to develop more drugs

U isto vreme, kompanije su počele da pronalaze još lekova

that are taken over a patient’s lifetime,

koje pacijent uzima tokom života,

like blood pressure and cholesterol medications,

kao što su lekovi za krvni pritisak i holesterol

and later anti-depressants and anti-anxiety medications.

i kasnije antidepresivi i anksiolitici.

Because they are taken indefinitely, these drugs more profitable.

S obzirom da se koriste na neodređeno vreme, ovi lekovi su profitabilniji.

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

Sredinom '80-ih, nisu bile otkrivene nove hemijske klase antibiotika.

But bacteria continued to acquire resistance and pass it along

A bakterije su i dalje sticale rezistentnost i prenosile je dalje

by sharing genetic information between individual bacteria

deleći genetske informacije između pojedinačnih bakterija

and even across species.

i čak i sa drugim vrstama.

Now bacteria that are resistant to many antibiotics are common,

Danas su bakterije otporne na više antibiotika uobičajene

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

i sve je više vrsta bakterija koje su otporne na sve lekove.

So, what can we do about this?

Šta možemo učiniti povodom toga?

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

Potrebno je da kontrolišemo upotrebu postojećih antibiotika, napravimo nove,

combat resistance to new and existing drugs,

izborimo se protiv rezistentnosti na nove i postojeće lekove

and find new ways to fight bacterial infections.

i pronađemo nove načine za borbu protiv bakterijskih infekcija.

The largest consumer of antibiotics is agriculture,

Najveći potrošač antibiotika je poljoprivreda,

which uses antibiotics not only to treat infections

koja ih koristi ne samo za tretiranje infekcija

but to promote the growth of food animals.

već i za podsticaj rasta životinja za ishranu.

Using large volumes of antibiotics

Korišćenje velikih količina antibiotika

increases the bacteria’s exposure to the antibiotics

pojačava izloženost bakterija antibioticima

and therefore their opportunity to develop resistance.

i samim tim njihove šanse da razviju otpornost.

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

Mnoge uobičajene životinjske bakterije,

kao što je salmonela, mogu zaraziti i ljude

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

i verzije otporne na lekove mogu nam biti prenete kroz lanac ishrane

and spread through international trade and travel networks.

i proširiti se putem međunarodne trgovine i putnih mreža.

In terms of finding new antibiotics,

Što se tiče pronalaženja novih antibiotika,

nature offers the most promising new compounds.

priroda nam nudi nova jedinjenja sa velikim potencijalom.

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

Organizmi poput drugih mikroba i gljivica evoluirali su milionima godina

to live in competitive environments—

kako bi preživeli u konkurentnim okruženjima -

meaning they often contain antibiotic compounds

što znači da često sadrže antibiotska jedinjenja

to give them a survival advantage over certain bacteria.

koja im daju prednost u preživljavanju nad određenim bakterijama.

We can also package antibiotics with molecules that inhibit resistance.

Takođe možemo da spakujemo antibiotike sa molekulima koji inhibiraju otpornost.

One way bacteria develop resistance is through proteins of their own

Bakterija može razviti otpornost pomoću sopstvenih proteina

that degrade the drug.

koji oslabljuju lek.

By packaging the antibiotic with molecules that block the degraders,

Pakovanjem antibiotika sa molekulima koji blokiraju oslabljivače,

the antibiotic can do its job.

antibiotik može da obavi posao.

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

Bakteriofagi, virusi koji napadaju bakterije ali ne utiču na ljude,

are one promising new avenue to combat bacterial infections.

predstavljaju potencijalni novi put za borbu protiv bakterijskih infekcija.

Developing vaccines for common infections, meanwhile,

Proizvodnja vakcina za uobičajene infekcije, u međuvremenu,

can help prevent disease in the first place.

može pomoći u sprečavanju zaraze.

The biggest challenge to all these approaches is funding,

Najveći problem svih ovih pristupa je finansiranje,

which is woefully inadequate across the globe.

koje je jako neadekvatno svuda u svetu.

Antibiotics are so unprofitable that many large pharmaceutical companies

Antibiotici su toliko neprofitabilni da mnoge velike farmaceutske kompanije

have stopped trying to develop them.

više ne pokušavaju da ih naprave.

Meanwhile, smaller companies that successfully bring new antibiotics

U međuvremenu, manje kompanije koje uspešno izbace nove antibiotike

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

na tržište često bankrotiraju, kao američki Achaogen.

New therapeutic techniques like phages and vaccines

Nove terapeutske tehnike poput bakteriofaga i vakcina

face the same fundamental problem as traditional antibiotics:

suočavaju se sa istim fundamentalnim problemima kao tradicionalni antibiotici:

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

ako funkcionišu, iskoriste se samo jednom,

which makes it difficult to make money.

što zaradu čini slabom.

And to successfully counteract resistance in the long term,

A da bismo se uspešno suprotstavili rezistentnosti na duži rok,

we’ll need to use new antibiotics sparingly—

nove antibiotike moramo koristiti umereno -

lowering the profits for their creators even further.

što još više snižava zaradu njihovim tvorcima.

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

Jedno moguće rešenje je odvojiti profit od količine prodatih antibiotika.

For example, the United Kingdom is testing a model

Na primer, Velika Britanija testira model u kome

where healthcare providers purchase antibiotic subscriptions.

pružaoci zdravstvene zaštite nabavljaju recepte za antibiotike.

While governments are looking for ways to incentivize antibiotic development,

Mada vlade traže načine da stimulišu proizvodnju antibiotika,

these programs are still in the early stages.

ti programi su još uvek u ranim fazama.

Countries around the world will need to do much more—

Zemlje širom sveta će morati da urade mnogo više -

but with enough investment in antibiotic development

ali sa dovoljnim investicijama u proizvodnju antibiotika

and controlled use of our current drugs,

i sa kontrolisanom upotrebom postojećih lekova,

we can still get ahead of resistance.

još uvek možemo pobediti rezistentnost.