Antibiotics are often hailed as miracle drugs, capable of curing once-deadly infections and saving countless lives. However, its overuse and misuse in humans, animals, and agriculture have severe and often overlooked consequences. 

• While the world is acutely aware that such practices drive antimicrobial resistance (AMR), the most concerning is the significant disturbance antibiotics induce to the human microbiome— a disruption that spreads to almost every organ system in the human body. 

About Microbes

The human body is home to a vast, intricate community of microorganisms collectively known as the microbiome. 

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• Comprises: This includes bacteria, fungi and viruses. Human bodies host approximately 38 trillion microbial cells, outnumbering our own cells, which total around 30 trillion. 
• Importance: The diversity and balance of human microbial communities are vital. The gut microbiome, in particular, plays a crucial role in maintaining health. 
  • Gut Microbes: They also play a crucial role in regulating metabolism.
    • It helps in digestion, supports the immune system, produces essential nutrients like vitamin K and certain B vitamins, and protects against pathogens (an infectious microorganism or agent, such as a virus, bacterium, protozoan, prion, viroid, or fungus). 
    • The gut microbiome interacts with various organs through complex networks known as gut-organ axes, which influence the overall health and functioning of the body. 
  • Skin Microbiomes: They protect against harmful microorganisms and support skin health. 
  • Respiratory Tract Microbiomes: They help defend against respiratory infections and maintain respiratory health. 

About Antibiotics

An antibiotic is a type of antimicrobial substance active against bacteria. 

• Refers: It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of such infections. They may either kill or inhibit the growth of bacteria.
• Concern: 
  • Evolving for Resistant: Antimicrobial Resistance (AMR) occurs when pathogens evolve, become resistant to drugs, and stop responding to antimicrobial drugs. 
    • While it is the nature of pathogens to evolve, this ever-increasing crisis is exacerbated by unsound medical, and animal husbandry practices. 
  • Colonisation Resistance: One particularly concerning aspect of antibiotic use is its impact on colonisation resistance. This is the ability of the native gut microbiome to protect against colonisation by pathogenic microorganisms. 
    • Beneficial bacteria consume available nutrients, limiting resources for pathogens. Antibiotic use can reduce colonisation resistance, allowing harmful bacteria to take hold and proliferate, increasing the risk of infections.
  • Data by the World Health Organization (WHO): As per WHO, the bacterial AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths. 
    • AMR makes infections harder to treat, renders other medical procedures and treatments such as surgery, cesarean sections and cancer chemotherapy much more risky. 
    • Infectious diseases specialists and critical-care experts have warned over AMR, calling for rational prescription of antibiotics, and curbs on the use of drugs to promote growth in animals and plants. 
• About Antibiotic Resistance: It refers to the ability of bacteria or other microbes to withstand the effects of antibiotics, rendering them ineffective in treating infections. 
  • For example, extensively drug-resistant Pseudomonas aeruginosa is highly resistant to multiple antibiotics. 
• Measures to Address Antimicrobial Resistance (AMR) in India:
  • National Programme on AMR Containment (2012): This program strengthens the AMR surveillance network by establishing labs in State Medical Colleges to monitor and address antimicrobial resistance.
  • National Action Plan on AMR (2017): This plan takes a One Health approach, involving various ministries and departments to tackle antimicrobial resistance collectively.
  • AMR Surveillance and Research Network (AMRSN) (2013): This network collects data to identify trends and patterns of drug-resistant infections in India, aiding in evidence-based decision-making.
  • Antibiotic Stewardship Program (AMSP): Implemented as a pilot project across India, this program aims to control the misuse and overuse of antibiotics in hospital wards and intensive care units.
  • Ban on Inappropriate Fixed Dose Combinations (FDCs): The Drug Controller General of India (DCGI) has prohibited 40 fixed-dose combinations that were found to be inappropriate, promoting the responsible use of medications.

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Arising Concern of Dysbiosis

While antibiotics are essential for treating bacterial infections, their irrational use can wreak havoc on the microbiome. 

• About Dysbiosis: Antibiotics do not discriminate between harmful pathogens and beneficial bacteria and wipe out a large portion of the gut bacteria (especially the broad-spectrum antibiotics). This disruption is known as dysbiosis. 
• Various Concerns:  It can have severe and long-lasting effects. Even a single course of antibiotics can produce dysbiosis that lasts for months or even years.
  • • Dysbiosis can cause more severe conditions like inflammatory bowel disease and irritable bowel syndrome. 
    • Dysbiosis can impair immune function, making the body more susceptible to infections and autoimmune diseases. 
  • Impact on Gut-organ Axes: 
    • The gut-brain axis links the gut microbiome with the brain, where dysbiosis can alter neurotransmitter levels and brain chemistry, affecting mood, cognition, and mental health conditions like anxiety and depression. 
    • The gut-liver axis involves the transport of bacterial metabolites and toxins from the gut to the liver. Dysbiosis can increase gut permeability (‘leaky gut’), allowing more toxins to reach the liver and exacerbating liver conditions such as non-alcoholic fatty liver disease. 
    • The gut-skin axis involves the influence of the gut microbiome on skin health, where dysbiosis can exacerbate conditions like acne, eczema, and psoriasis by altering systemic immune responses and skin barrier function. 
    • The gut microbiome influences metabolic processes, including energy harvesting from food and the regulation of glucose and lipid metabolism. Dysbiosis can disrupt these processes, contributing to conditions like obesity, diabetes, and metabolic syndrome.
  • Impact on Other Organs: Antibiotic use can potentially lead to respiratory conditions such as asthma and chronic obstructive pulmonary disease. The genitourinary microbiome, which includes the vaginal and urinary microbiomes, protects against infections and maintains urinary and reproductive health. Dysbiosis in these areas can result in conditions like bacterial vaginosis and urinary tract infections.
• Need To Do: It is crucial to use antibiotics judiciously. Implementing alternative practices, such as better hygiene, vaccination, and the use of bacteriophages, can reduce the reliance on antibiotics.
  • Bacteriophages: These are also known as phages and are viruses that infect and replicate only in bacterial cells. They are ubiquitous (found everywhere) in the environment and recognized as the earth’s most abundant biological agent.

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Conclusion

Antibiotics have revolutionised medicine, but their misuse poses serious threats. Antibiotics are a prime example of the medicine-poison paradox. Preserving the balance of the human microbiome is essential for maintaining health. We must carefully consider the use of antibiotics before taking them.

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