Alternatives to antibiotics

To meet the increasing threat of antibiotic resistance, a paradigm shift in the treatment of infectious disease is needed and alternatives to antibiotics ought to be considered. Until today, there are already several non-antibiotic approaches to the treatment and prevention of infection

Before the discovery of antibiotics, serum from immune individuals was transferred to infected people as a mode of treatment. The procedure was at that time associated with toxic side-effects, although it seemed rather effective. Today, a sophisticated variant of this strategy, known as antibody therapy, is considered a rather promising alternative to antibiotics. However, a drawback with this and many other alternatives is that they are not suitable for treating severe infections that need to be handled rapidly.

Antibiotics do unfortunately not discriminate between pathogenic bacteria and bacteria of the normal flora. Side effects, like diarrhea, are therefore common since a disrupted normal flora provides opportunistic bacteria with a chance to colonize. Probiotics are products containing live microorganisms that can help to establish or maintain the normal flora and thus prevent or treat mild infections, for example of the gut.

Human beings have been interested in protecting themselves from illness throughout history, and a revolutionary scientific observation was done on the subject in the 1790s. At this time, the British physician Edward Jenner performed the world’s first vaccination by inoculating a little boy with pus obtained from cowpox lesions on a milkmaid’s hand. A few weeks later, he was triggered with the related, dreaded smallpox virus, but remained unaffected; the boy was immune, protected through vaccination. Numerous vaccines preventing viral or bacterial diseases have been developed since Jenner’s discovery, and most of you have probably been vaccinated at multiple occasions yourselves. Widespread vaccination may slow down the emergence and spread of antibiotic resistant bacteria by lowering the incidence of infections and the need for antibiotics.

Finding potential alternatives to antibiotics is to some extent related to identifying natural enemies of pathogenic bacteria. Plants and animals produce substances known as antimicrobial peptides as a defense against intruding pathogens. The usability of antimicrobial peptides in human medicine is being evaluated, as are the applicability of what is known as bacteriophage therapy.

Bacteriophages are viruses that infect bacteria, which potentially could be utilized for therapeutic purposes. However, there are numerous obstacles that need to be circumvented before these or other alternatives could substitute antibiotics, or even reach the market.

© Uppsala University