Overview of Gram-Positive Bacteria – Infections

By

Larry M. Bush

, MD, FACP, Charles E. Schmidt College of Medicine, Florida Atlantic University

Reviewed/Revised Mar 2023

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Gram-positive bacteria are classified by the color they turn after a chemical called Gram stain is applied to them. Gram-positive bacteria stain blue when this stain is applied to them. (Other bacteria stain red. They are called gram-negative.)

Gram-positive and gram-negative bacteria stain differently because their cell walls are different. They also cause different types of infections, and different types of antibiotics are effective against them.

All bacteria may be classified as one of three basic shapes: spheres (cocci), rods (bacilli), and spirals or helixes (spirochetes Bejel, Yaws, and Pinta Bejel, yaws (frambesia), and pinta are infections caused by Treponema, which are spiral-shaped bacteria called spirochetes. These infections are spread by any close contact with the skin… read more ). Gram-positive bacteria may be cocci or bacilli. (See figure .)

Some Gram-positive bacteria cause disease. Others normally occupy a particular site in the body, such as the skin. These bacteria, called resident flora Resident Flora Healthy people live in harmony with most of the microorganisms that establish themselves on or in (colonize) nonsterile parts of the body, such as the skin, nose, mouth, throat, large intestine… read more , do not usually cause disease.

Gram-positive bacilli cause certain infections, including the following:

• Anthrax Anthrax Anthrax is a potentially fatal infection with Bacillus anthracis, a gram-positive, rod-shaped bacteria (see figure ). Anthrax may affect the skin, the lungs, or, rarely, the digestive… read more

• Diphtheria Diphtheria Diphtheria is a contagious, sometimes fatal infection of the upper respiratory tract caused by the gram-positive, rod-shaped bacteria (see figure ) Corynebacterium diphtheriae. Some types… read more

• Erysipeloid Erysipeloid Erysipeloid is a skin infection caused by the gram-positive bacteria Erysipelothrix rhusiopathiae. People are infected when they have a puncture wound or scrape while they are handling… read more

• Listeriosis Listeriosis Listeriosis is infection caused by the gram-positive bacteria Listeria monocytogenes, usually when contaminated food is eaten. People may consume the bacteria in contaminated dairy products… read more

Gram-positive cocci cause certain infections, including the following:

• Enterococcal infections Enterococcal Infections Enterococcal infections are caused by a group of gram-positive, sphere-shaped (coccal) bacteria called enterococci, which normally reside in the intestine of healthy people but sometimes cause… read more

• Pneumococcal infections Pneumococcal Infections Pneumococcal infections are caused by the gram-positive, sphere-shaped (coccal) bacteria (see figure How Bacteria Shape Up) Streptococcus pneumoniae (pneumococci). These bacteria commonly… read more

• Staphylococcal aureus infections Staphylococcus aureus Infections Staphylococcus aureus is the most dangerous of all of the many common staphylococcal bacteria. These gram-positive, sphere-shaped (coccal) bacteria (see figure ) often cause skin infections… read more

• Streptococcal infections Streptococcal Infections Streptococcal infections are caused by any one of several species of Streptococcus. These gram-positive, sphere-shaped (coccal) bacteria (see figure ) cause many disorders, including… read more

• Toxic shock syndrome Toxic Shock Syndrome Toxic shock syndrome is a group of rapidly progressive and severe symptoms that include fever, rash, dangerously low blood pressure, and failure of several organs. It is caused by toxins produced… read more

Gram-positive bacteria have increasingly become resistant to antibiotics. For example, methicillin-resistant Staphylococcus aureus (MRSA) Methicillin-resistant Staphylococcus aureus (MRSA) Staphylococcus aureus is the most dangerous of all of the many common staphylococcal bacteria. These gram-positive, sphere-shaped (coccal) bacteria (see figure ) often cause skin infections… read more bacteria are resistant to most antibiotics that are related to penicillin. Methicillin is a type of penicillin Penicillins Penicillins are a subclass of antibiotics called beta-lactam antibiotics (antibiotics that have a chemical structure called a beta-lactam ring). Carbapenems, cephalosporins, and monobactams… read more . MRSA strains are commonly involved in infections acquired in health care facilities and can cause infections acquired outside health care facilities (community-acquired infections).

(See also Overview of Bacteria Overview of Bacteria Bacteria are microscopic, single-celled organisms. They are among the earliest known life forms on earth. There are thousands of different kinds of bacteria, and they live in every conceivable… read more .)

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Methicillin-Resistant Staphylococcus Aureus (MRSA)

Department of Molecular Virology and Microbiology

Master

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The Research

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Surveillance of drug-resistant strains of MRSA

As strains of staph continue to adapt and change over time, it is critical for healthcare workers to track these changes. They need to know which strains are present within a community at any point in time, to which antibiotics the strains are resistant, and the severity of disease caused by the circulating strains. Two researchers affiliated with the Department of Molecular Virology Microbiology at Baylor College of Medicine, Drs. Edward Mason and James Versalovic and their colleagues have been conducting surveillance of both HA-MRSA and CA-MRSA in pediatric patients at Texas Children’s Hospital beginning in 2001. By analyzing strains isolated from these patients, the scientists have found that CA-MRSA accounts for an increasing percentage and number of infections. This information can help doctors select the optimal antibiotic treatment for infected patients.

Genetics changes in MRSA

Scientists would further like to understand the genetic changes in MRSA that allow the bacterium to cause serious illness in otherwise healthy individuals. To begin to answer this question, MVM scientists and others at Baylor College of Medicine initiated a project to obtain the DNA sequence of a strain of CA-MRSA called USA300. They chose the USA300 strain, one of two strains that cause the majority of CA-MRSA cases, because it has emerged as the predominant strain causing skin infections, as well as more serious infections, in both pediatric and adult patients in many states. Before 2000 this strain was rarely found in the community; today it accounts for 70 percent of CA-MRSA patients at Texas Children’s Hospital. Another reason for the interest in the USA300 strain is that it appears to be more virulent than other strains.

Drs. Sarah Highlander and Joseph Petrosino and colleagues at the Baylor Human Genome Sequencing Center sequenced the genome of this MRSA-resistant strain from a pediatric patient along with a community-associated staph strain that is susceptible to methicillin. They then compared the DNA sequences. They also compared the DNA sequence of these strains with the previously published staph genomes of isolates obtained elsewhere.

Based on the results of this analysis, the scientists concluded that the USA300 strain that they sequenced was very similar to other staph strains. This suggests that the increased virulence of the USA300 strain is due to subtle genetic changes within its genome. One intriguing finding of their study is that the bacterium has picked up a plasmid that contains a gene that confers resistance to bacitracin, an antibiotic commonly found in over-the-counter skin ointments.

With the genetic information describing USA300 in hand, the scientists can now zoom in on the regions that differ from other strains to pinpoint genes that may account for the ability of USA300 to cause serious illness in some people.

Mechanism of resistance to methicillin

Beta-lactam antibiotics are the most widely used class of drugs for the treatment of bacterial infections. They include penicillin and its derivatives, such as methicillin and amoxicillin. The beta-lactam ring portion of the antibiotic targets the penicillin-binding proteins (PBP), found in the bacterial cell membrane, which function in the synthesis of the cell wall. Binding of the antibiotic to the PBPs prevents the PBPs from performing their essential role and results in the death of the bacterial cell.

Dr. Timothy Palzkill, professor of Pharmacology and Chemical Biology and Molecular Virology and Microbiology, and his research team have been studying mechanisms of resistance to methicillin and other beta-lactam antibiotics. Gram-positive bacteria acquire resistance to beta-lactam antibiotics through the production of a protein called PBP2a, which is able to avoid the inhibitory effects of the antibiotics. This is the mechanism by which MRSA is able to persist despite treatment with multiple beta-lactam antibiotics.

Dr. Palzkill and coworkers conducted a study in which they found that the protein BLIP-II was able to weakly bind and inhibit PBP2a, making it susceptible to beta-lactam antibiotics. They are continuing this line of research by searching for mutations that increase the affinity of BLIP-II to PBP2a.

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MRSA Publications by MVM Faculty

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More Information

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• Information about symptoms, prevention, and treatment of MRSA from the CDC as well as specific information for athletes, healthcare providers, and school officials
• Information about MRSA from the National Institutes of Health
• More information about MRSA from the National Institutes of Health
• MRSA information from the Texas Department of State Health Services

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Glossary

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Learn more about some of the technical terms found on this page by visiting our glossary of terms.

Antibiotics and bacteria: an arms race

As noted by the World Health Organization, the resistance of pathogenic bacteria to antibiotics is becoming increasingly rampant in the world. Based on pessimistic forecasts, in 20 years, humanity may be powerless in the face of bacterial infections.

At the conference “Nano-biotechnologies in advanced space experiments” (2012), Evgeny Kulikov from the Institute of Microbiology named after S. N. Vinogradsky RAS noted that if in 19In the 1945s and 1965s, only the first cases of antibiotic resistance of bacteria were observed, and in the 1970s and 1980s there was no sharp increase in resistance to pathogens, then since the beginning of the 1990s, antibiotic-resistant strains have become more and more. As recovery time increases, so does the cost of patient recovery. The data cited in the Kulikov report for the EU, Iceland and Norway (no statistics for Russia) indicate that an additional 900 million euros are required each year to cope with hospital infections, and another 600 million euros to pay for the related disability of the population.

The WHO report on mutations in pathogenic bacteria also expresses serious concern: “The world is facing a post-antibiotic era, when people will again die from injuries, because many infections will be invincible.”

Dr. Keii Fukuda, one of WHO’s directors of health security, believes that effective antibiotics were one of the pillars of public confidence in guaranteed health and life expectancy. Now, however, that confidence has been shaken. And this is largely due to the fact that the very treatment of a patient in a hospital can result in infection with multi-resistant pathogens: the patient “picks up” nosocomial strains. And they are always present where antibiotics are used, and the more antibiotics are used, the microbes become “armed” against them.

What is the reason for the arms race between antibiotics and pathogens? Recall that antibiotics (from the ancient Greek “anti” – against, “bios” – life) are drugs for the treatment of infectious diseases that have high biological activity against certain groups of microorganisms and malignant tumors. All of them are of natural origin (obtained from fungi, microbes, plants, living tissues, as well as their modifications) and are able to destroy pathogenic bacteria, stop their growth and reproduction (by the way, pathogens make up only about 1 percent of all bacteria existing in the world).

Microscopically enlarged image of intestinal bacteria

Back in 1884, the Danish scientist Gram proposed his own method for studying bacteria, which is still used today. To stain the cell membrane of the bacterial wall, a special aniline dye and iodine solution are used to fix the color. Bacteria that are strongly stained after washing are called gram-positive, and those that are discolored are called gram-negative. Pathogens, depending on the shape, are divided into cocci (round), rods and convoluted. For example, there are gram-positive cocci: staphylococci (pyogenic), streptococci (cause inflammatory purulent processes in humans and animals). Gram-negative cocci: meningococci (causative agents of meningitis), gonococci (causative agents of gonorrhea), pneumococci (causative agents of pneumonia). Convoluted pathogens (eg, spirochetes, spirilla) are gram-negative, as, say, the causative agent of syphilis is twisted spiral-shaped bacteria (pallid treponema). Sticks are the causative agents of anthrax, diphtheria, tuberculosis and other diseases.

In turn, antibiotics are either narrow-spectrum (only against gram-positive or gram-negative bacteria) or broad-spectrum (affect both). The most important classes of antibiotics for therapeutic purposes: b-lactam (penicillins, cephalosporins – act on gram-positive and gram-negative bacteria), amino-glycoside (streptomycin, amikacin, gentamicin – mainly on gram-negative bacteria), tetracyclines (on gram-positive and gram-negative, chlamydia, protozoa) , macrolides (antibacterial and antifungal – for gram-positive, fungi, some protozoa), polypeptide and depsipeptide (polymyxins, acitracins – mostly gram-negative bacteria).

penicillin molecule

All this knowledge became available to mankind after 1928, when the British microbiologist Alexander Fleming, one might say, accidentally discovered penicillin. The scientist already then suggested that the emergence of a miraculous antibacterial weapon could cause a symmetrical response: microbes will find ways to adapt to antibiotics. So it turned out over time. For example, where penicillins ceased to act (in the treatment of tonsillitis, scarlet fever, wounds, and some sexually transmitted infections), cephalosporins, which, like penicillins, belong to the so-called beta-lactam group of antibiotics, had to be used. First-generation cephalosporins began to be used to treat the respiratory tract, urinary system, and postoperative complications. Then came the second generation cephalosporins (treatment of intestinal infections) and then, as a result of the “arms race”, the third generation – they are used in cases where the drugs of the first two generations are powerless due to bacterial resistance. In the late 1980s, another subset of the broad-spectrum beta-lactam antibiotic group, the carbapanems, appeared to help treat hospital complications such as pneumonia, bloodstream infections, urinary tract infections, neonatal sepsis, and infections in intensive care unit patients. Initially, carbapanems were the most powerful weapon – they helped 100 percent of the time. But this did not last long: now in some countries, about half of the patients were resistant to these drugs. In particular, carbapanems were powerless against a superbug that synthesizes the highly toxic NDM1 enzyme, which is resistant to almost all beta-lactam drugs. This monster bacterium was discovered a few years ago in British patients returning from India and Pakistan after cosmetic surgery. And this is only a small part of the history of the confrontation between antibiotics and pathogens, which has been going on for several decades.

Traditionally, antibiotic resistance has been associated primarily with so-called hospital-acquired infections. Hospital wards are a special environment where the war between drugs and bacteria is particularly heated, which gives the latter opportunities for accelerated evolution. However, in recent years the battlefield has expanded. Andrey Letarov , head of the Laboratory of Microbial Viruses at the S. N. Vinogradsky Institute of Microbiology, Russian Academy of Sciences, recalls in an interview with a Radio Liberty correspondent that “several years ago, when we talked about antibiotic resistance, only hospital infections were mentioned. However, resistance manifests itself and in “home” patients. If earlier resistance was marginal and manifested itself in a few percent of cases, now the percentage of resistance can reach 80″.

This also affects medical practice. When a therapist prescribes a macrolide antibiotic for pneumonia to a home patient (given to those who are allergic to penicillins and cephalosporins), then its effect is necessarily controlled after 2-3 days. If such an antibiotic is ineffective, it is changed to another. In particularly difficult cases, several different drugs are combined, that is, the trial and error method becomes a reality.

Disinfection of a school class against staphylococci, Georgia

Resistance to antibiotics have learned to produce a variety of infections. For example, a WHO report notes that a widespread E. coli infection that has traditionally been treated with fluoroquinolones, broad-spectrum antibiotics, is now also showing resistance. The failure of the treatment of gonorrhea with third-generation cephalosporins has been confirmed in Austria, Australia, Canada, France, Japan, Norway, Slovenia, South Africa, Sweden and the UK. Some sources indicate that up to 60 percent of staphyloccal infections that cause purulent inflammatory foci and intoxication in Europe are methicillin-resistant (MRSA). Patients with MRSA (methicillin-resistant Staphylococcus aureus) are 64 percent more likely to die than those who are susceptible to antibiotics. In the US, about 2 million people suffer from antibiotic-resistant pathogenic bacteria, and 23,000 die annually from infections because multibacterial drugs are not able to help.

The situation in developing countries is even more serious. In the African Region, there is significant E. coli resistance to the latest generation of cephalosporins and fluoroquinolones. In some areas of this region, 80 percent of cases of Staphylococcus aureus are MRSA. In Southeast Asia, where one-fourth of the world’s population lives, there is a high resistance of E. coli and Klebsiella pneumoniae to third-generation cephalosporins and fluoroquinolones. In the Pacific region, up to 80 percent of these infections are resistant to antibiotics. And these are just some examples, not related to all pathogenic microorganisms.

With the advent of antibiotics, people’s perception of the world has changed: we have learned to control bacterial infections, we have ousted death from life. It is no longer possible to inject yourself in the garden and die because of it. Everyone is used to thinking that there are no invincible infections. “With the advent of antibiotics, people’s attitude has changed: we have learned to control bacterial infections, we have forced death out of life. It has become impossible to inject yourself in the garden and die from this. ” Now this attitude has to be abandoned. According to Letarov, the situation with antibiotic resistance in Russia is not fundamentally different from the rest of the world: over the past few years, resistance has increased from individual cases to tens of percent of cases of diseases. Moreover, tuberculosis, successfully defeated in the Soviet years, has reappeared in Russia. And this happened not only because the systemic prevention adopted in Soviet times stopped working, but also because of the emergence of antibiotic-resistant strains.

Why resistance develops

Andrey Letarov notes that, on the one hand, antibiotics are not always used correctly in treatment. Often, patients do not endure the course prescribed by the doctor to the end – they stop drinking medicines as soon as improvement occurs, but meanwhile not all microbes in the body have time to die and make themselves felt after some time – the infection returns again and requires a second course, and then possibly becoming chronic. This gives pathogens the opportunity to learn how to better resist antibiotics. Disinfectants in hospitals also “teach” microbes to adapt: ​​mutations in the DNA of bacteria can resist drugs, and evolved mutant bacteria are becoming more dangerous for hospital patients. There is another significant source of resistant bacteria: in agriculture (livestock, poultry), antibiotics are often used almost uncontrollably. They can also process plant products, especially if they are transported from continent to continent and it is necessary to increase the shelf life. As a result, products containing antibiotics end up on the table. Without knowing it, we become passive consumers of these drugs, albeit in minimal doses. No one knows what the cumulative cumulative effect will be for a person receiving regularly such seemingly insignificant doses. Think about the rapidly growing population of the Earth (today it is more than 7 billion people) and the global nature of international migration – it is obvious that bacteria have more opportunities to exchange information and, in the course of genetic transfer, produce more and more invulnerable strains.

Professor of Chemical Biology Richard Lee from St. Jude Children’s Research Hospital in Memphis, which discovered the semi-synthetic antibiotic spectinamides in 2014, told Radio Liberty that the source of increasing antibiotic resistance is Third World countries with poor health care: “Obviously, in 70+ years of antibiotic use, bacteria have managed However, as long as there are still poor countries in the world, such as, say, India, where many locals buy a handful of pills on the market and take them all at once (this is how the problem of bacterial infections is solved), there is a large order in the use We won’t give antibiotics.”

Someone traveling in India sees a doctor or ends up in a hospital with diarrhea, and then returns to Europe or the US “enriched” with mutant bacteria

The New Delhi enzyme NDM-1 (metal-beta-lactamase-1) is one of many proteins that block the action of carbapanems. This gene spreads from one strain to another through horizontal transfer and reproduces monster bacteria. In fact, it may look like this: someone traveling in India, sees a doctor or ends up in a hospital with diarrhea, and then returns to Europe or the United States, “enriched” with mutant bacteria. The disease may recur, and such a patient may well end up now in a hospital at home, spreading dangerous variations of pathogens even further.

Control

How to deal with volatile pathogens? The most obvious way is to develop new, better antibiotics. This process looks something like this. Natural producers of antibiotics are actinomycetes, mold fungi, bacteria. Their main habitat is the soil. So, in order to isolate the microorganisms that form antibiotics, soil samples are taken, they are dried and seeded on special nutrient media. Today, new producers are being tested, for example, myxobacteria, which produce a large number of antimicrobial agents. Plants, animals, and even microbes are being explored as possible producers of new antimicrobials. Perhaps new antimicrobial resources also hide the depths of the ocean.

Ways to obtain new antibiotics are mutagenesis (artificial production of mutations using mutagens), cell and genetic engineering. Mutagenesis occurs during the use of mutant strains in which the synthesis of individual fragments of the antibiotic molecule is blocked. Cellular engineering helps to obtain hybrid antibiotics, for example, with new combinations of aglycone and sugars. Genetic engineering makes it possible to introduce into the genome of a microorganism information about an enzyme necessary to modify the produced antibiotic.

Robert Koch, German scientist who discovered the bacterium that causes tuberculosis

An example of new drug development using these complex technologies is spectinamides, an anti-tuberculosis (TB) drug. This infectious disease is caused by mycobacterium (Mtb), spreads through the air and usually affects the lungs, causing 1.3 million deaths each year. TB is treated with antibiotics, but more recently, multidrug-resistant (MDR) TB bacteria have made treatment difficult. It has to be fought for 2 years, using various combinations of antibiotics, which are very toxic. Such therapy may have serious side effects (eg, hepato- or nephrotoxic reactions). In addition to the multidrug-resistant bacterium, mycobacterium with prolonged effect of resistance (XTB) has also appeared, noted in 92 countries: some strains of CTV are resistant to all types of drugs. For six years, an international team of scientists led by Richard Lee worked on this problem. As a result, scientists have proved in mice the effectiveness of the new drug spectinamides for the treatment of tuberculosis with minimal side effects. Initially, scientists used a drug for the treatment of gonorrhea infections – spectinomycin, which blocks the ribosomes of pathogenic bacteria, and thereby stops their growth. The researchers analyzed the structure of the antibiotic and tried various modifications to get a new class. This semi-synthetic antibiotic is highly active against both MDR and XTB and is not “pushed out” by TB bacteria, making the drug more effective.

“The study shows how classic antibiotic compounds derived from natural products can be redesigned to create powerful semi-synthetic compounds that can overcome drug resistance mechanisms,” Li commented on the study. The new drug is now undergoing clinical trials.

Andrey Letarov believes that phage therapy can become an alternative to the development of new antibiotics: the treatment of bacterial infections with the help of viruses that these bacteria infect. The first experience of phage therapy was carried out even before the appearance of the first sulfanilamide preparations: the French scientist Felix d’Herelle treated dysentery, cholera in India and even several cases of plague in this way at the beginning of the 20th century. The return of interest in phage therapy occurred in the late 1980s, just at the same time as the emergence of antibiotic resistance in some microbes. The mechanism of action is that the phage penetrates the bacterial wall, piercing it with a special protein needle, which is then “disassembled”, the tail of the phage reaches the inner membrane of the bacterial cell and pumps DNA into it. Bacteriophages multiply inside bacteria and cause their lysis (dissolution). Microbes often surround themselves with a protective film that is impenetrable to antibiotics: such a film is not a hindrance to phages. Phage lysins (phages produce a special enzyme that destroys the cell membrane of bacteria) can be used as independent antibacterial drugs: they cope especially well with gram-positive bacteria. Sometimes phage preparations are even more effective than antibiotics (for example, in situations of hard-to-reach localization of bacteria), they treat staphylococcal infections (purulent-inflammatory diseases of the respiratory tract), including methicillin-resistant staphylococci, infections caused by Escherichia coli, and others. illness. However, the successful use of phages on a large scale is more difficult than the use of antibiotics, since the latter have a wider spectrum of action. In addition, the creation of modern phage therapy requires much deeper research preparation, and there is also the problem of the safety of phage preparations – a high degree of purification makes these preparations very expensive.

The benefits of phage therapy are obvious, but it is not yet clear whether such treatment can be widely used in practice

Richard Li believes that the future lies with a combination of various therapies, one of which may well be phage: “The benefits of phage therapy are obvious, “But it is not yet clear whether such a treatment can be widely used in practice. Bacteria and phages have coexisted for millions of years, but we do not yet know how this symbiosis will be affected by the development of phage therapy.”

Economic brake

About 18 new antibiotics appeared in the USA in 1980–84, about 12 10 years later, at the beginning of the new century 4, and finally in 2010–2014 only one

Andrey Letarov notes that the creation of a new drug from the laboratory to the market is a long and costly process. In addition, classes of antibiotics derived from easily reproducible producers seem to have been exhausted. The development of a new antibiotic has been carried out by scientific teams for years, and it is very problematic to return the invested funds. Thus, the British Pharmaceutical Society notes that bringing a new drug from the moment of invention to the market takes an average of 12 years and costs from 50 million pounds to a billion. The problem is not only the high cost and time, but also the technical complexity of such developments. According to the European Medical Agency, about 90 new antibacterial agents, but none of them proved to be a fundamentally new mechanism of action. And the US agency FDA (Food and Drug Administration) notes that out of 61 antibiotics recommended for production from 1980 to 2009, 43 percent were then withdrawn from sale due to serious side effects. At the same time, the rate of withdrawal from the sale of other drugs – not antibiotics – is only 13 percent.

Naked statistics show how we are losing the arms race with bacteria: in the USA at 19About 18 new antibiotics appeared in 80-84 years, about 12 new antibiotics appeared 10 years later, at the beginning of the new century – 4 and, finally, in 2010-2014 – only one.

These figures certainly correlate with financial performance: over the past five years, antibiotics have shown an average annual growth of 4 percent compared to 16.7 and 16.4 percent, respectively, for antivirals and vaccines. While antibiotics remain the third-highest-grossing drug company after central nervous system and cardiovascular drugs, the best-selling antibiotic earned $2.01 billion in 2003, while the same company’s lipid made $9..2 billion (UK Science and Technology Committee data).

Much more profitable for pharmaceutical companies is the production of those drugs that patients take constantly or for quite a long time: for example, drugs that lower blood pressure, cholesterol levels, anticancer drugs, antidepressants.

Patients pay hundreds of thousands of dollars for cancer treatment. A course of antibiotics will cost a maximum of 4-5 thousand dollars

“Anti-cancer treatment that lasts three months costs hundreds of thousands of dollars. A course of antibiotics is taken on average for a week or two, and hospital treatment will cost a maximum of $4,000-5,000,” says Richard Li. “In both cases patients are being saved, there is no doubt about it, but pharmaceutical companies will be developing more expensive drugs.”

Governments around the world are now discussing measures that could increase the motivation of pharmaceutical companies to develop new antibiotics. These may be tax rebates or, for example, assigning exclusive rights to the manufacturer to sell a new drug and its analogues for five years. In the US and UK, there are plans to introduce financial leverage to help reduce the use of antibiotics for non-medical purposes (for example, high fines or restrictive taxes on animal husbandry).

WHO is developing its own plan to save humanity from bacterial infections, which will be announced at the 68th Assembly in May 2015. It will also call on governments to find economic leverage to stimulate antibiotic resistance research, increase investment in diagnostics, new drugs and vaccines.

Ordered: survive

What’s in the bottom line? Here is the opinion of Andrey Letarov: “Mankind is still far from a life from which antibiotics will be completely ousted. So I would not exaggerate. In the meantime, I would advise “little tricks” – use antibiotics as little as possible in everyday life, take care of yourself, be treated on time.”

Richard Lee believes more attention needs to be paid to prevention: “As the problem of antibiotic resistance becomes global, the best way to protect yourself from bacterial and viral infection is global prevention. We are all closely connected now, so it would be worth considering a global strategy. I predict antibiotic resistance will have an even greater economic impact with globalization in the future.Bacteria have been around for billions of years, they have learned to mutate, and the better we “arm” them, the stronger their “armor” becomes.0005

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