Photo by National Cancer Institute on Unsplash

“Apocalypse” is an ancient Greek word literally translated as “disclosure of knowledge”. In a religious context, the word is often associated with the New Testament in which “The book of Revelation” revealed the “The ultimate of good over the evil and the end of the present age.”

In a modern context, the Oxford Dictionary defines “Apocalypse” as a noun describing “The complete final destruction of the world” or “an event involving destruction on a catastrophic scale”.

On September 21, when all 193 United Nations member states had a united front for the first time, agreeing unanimously to sign a declaration to combat “the biggest threat to modern medicine”- antibiotics resistance. The proliferation of antibiotic resistance is estimated to kill more than 700,000 people per year, and projected to kill as many as 10 million a year by 2050. According to the World Bank, this can cost between 1.1% and 3.8% of global GDP. Understandably, only three other health issues had been the subjects of such high level meeting in the UN general assembly history. All the signatories had officially committed themselves to encouraging innovation in antibiotic development, increasing awareness and developing technologies.

When word such as “Apocalypse” is used in the speeches of the experts, it is hard to imagine why the media and general public are not paying much attention to the warnings of “mankind edging towards to such catastrophe”. As a scientist, I am troubled by the potential loom of the “apocalypse”, and intend to quest for “disclosure of knowledge” and understand the possibility of antibiotic as “the ultimate good over evil”.

The accidental discovery of the first antibiotic substance benzylpenicillin from the mould Penicillium notatum by Alexander Fleming in 1928, had transformed the landscape of medicine and arguably mankind. Less than one hundred years after the landmark discovery, the future challenges of antibiotic efficacy is also looming. In 2014, nearly 60% of the samples of Escherichia coli, a common gut bacterium collected in patients in hospital, were unable to respond to the treatment of penicillin. In addition, a quarter of the bacteria colonies were also resistant to one or more other commonly used families of antibiotics.

Understanding the mechanism by which bacteria can successfully defend themselves against the different classes of antibiotics is the key to overcome the problems of resistant. Beta-lactam antibiotic, such as penicillin, has been successfully utilized to inhibit the biosynthesis of bacterial cell wall. The emergence of Beta-lactamase became the first major defense of bacteria. Other mechanism of bacteria resistance observed were the production of modifying enzyme than can render the common drugs such as aminoglycosides completely useless against pathogens.

In recent years, scientist had also demonstrated another significant and unique mode of evading antibiotics assaults by developing the multidrug efflux systems. The wealth of bacterial genomics information suggests even a single bacterium may possess multiple efflux transporters of different families, with overlapping substrate spectra. Although the advancement in research had unearthed the expression of bacterial multidrug efflux system usually controlled by transcriptional regulator, this still pose major challenges in developing effective antibiotics against such systems.

The most obvious culprit has been implicated for not developing new class of antibiotics since the late 1980’s. The pharmaceutical firms have been blamed for spending resources on more lucrative drugs such as hypertension and diabetes. The reality is that very few antibiotics are in the pipeline may not be necessary due to the lack of innovation or initiatives; many may argue this is simply due to the drying ammunition against nature.

The overuse of antibiotics in recent years perhaps is the true perpetrator of the propagation of the bacterial resistance. Between the year 2000 and 2014, the number of standard doses of antibiotics use had increased by 50%. Inappropriate prescriptions, non-compliance and non-adherence to the treatment regimes are commonly observed but often not taken seriously. Besides, it is also not a common knowledge that four-fifth of all antibiotics, by weight, are used for veterinary purposes and fed to the animals. The impact of the antibiotics delivered to the ecosystem and the food chain, surely is also detrimental and cannot be underestimate.

The discovery of penicillin indeed had transformed science and medicine into the twenty-first century. From organ transplantation to enhanced life expectancies, none of these would have been achievable without antibiotics. In his acceptance speech for the Nobel Prize in Physiology and Medicine in 1945, Fleming warned: “There is a danger that the ignorant man may easily under dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” Fleming had an inclination of the looming challenges, but most probably was oblivious of the potential “Apocalypse” that is feared to set mankind back by a hundred years. Many scientists believe the UN signatory of declaration to combat “the biggest threat to modern medicine” is too little too late!

“think, think, think” — Winnie the Pooh