Antibiotics: An overview

Antibiotics are a type of medicine which are used to treat bacterial infections.

Every day we come into contact with thousands of bacterial cells. We are colonized with lots of different types of bacteria which live on us, and inside of us; everywhere from the grooves of your fingerprint, to the nooks and crannies of your intestines. If you count up all of the bacteria, they actually outnumber us (by "us" we mean our human cells) about 10 to 1. To stay healthy, we need to maintain a healthy ecosystem of bacteria, called normal flora (not all bacteria are bad!), while selectively getting rid of the harmful, “pathogenic” bacteria which can cause an infection.

Pathogenic bacteria is a relative term. Some bacteria can cause illness in you no matter what. Other bacteria cause illness when they wander from their normal location (e.g. intestines) and try to live in a new location (e.g. bladder), which is what happens when you develop a urinary tract infection (UTI). The body’s immune system responds to an infection by trying to fight and destroy the invading bacteria!

To help the immune system, we sometimes use antibiotics, which are chemicals (specifically a swarm of small molecules) that enter and stick to important parts (think of targets) of the bacterial cell, and interfere with its ability to survive and multiply. If the bacteria are susceptible to the antibiotic, then they will stop growing or simply die.

These important parts include:

When an antibiotic molecule sticks to its target, it will disable or destroy that protein or enzyme. If enough of the antibiotic is present, the bacterial cell is crippled and either stops growing (bacterio-static effect) or simply dies (bacteri-cidal effect).

Just to be clear, antibiotics don’t affect viruses, fungi, or parasites - they only bind to bacterial cell targets so they only affect bacterial cells. In fact, they specifically target bacteria rather than human cells.

Back in 1928 (right before the great depression), Alexander Fleming first discovered the antibiotic Penicillin when he noticed that bacteria in his lab wouldn’t grow near some fungus, which had accidentally found its way into his experiments. The fungus was making a small molecule which leaked into the petri gel around it, and Fleming called the stuff - “mold juice”. He realized that the mold juice was killing the bacteria in the area! The next big surprise for Mr. Fleming came when he later found out that the fungus was the same bluish-green fungus that grows on old bread. The discovery earned him the Nobel Prize in 1945, and helped humanity develop a key antibiotic which has saved countless lives.

In his Nobel Prize acceptance speech, Fleming warned the world of the dangers of misusing antibiotics. He had already noted bacteria in his lab becoming resistant to penicillin, just a few years after its discovery! After decades of antibiotic misuse, today we find ourselves facing bacteria which has become resistant to most, if not all antibiotics.

Let's take a look at a couple of examples of antibiotics: Penicillin and Azithromycin.

Penicillin is a fabulous antibiotic because it isn't toxic to humans at concentrations that can kill bacteria and it can kill a lot of different types of bacteria.

So how does it work?  Penicillin weakens the bacterial wall by:

In short, penicillin causes the bacteria to weaken its own cell wall (imagine being forced to punch yourself!), and prevents the bacteria from being able to repair itself. With a weak wall, water seeps in, and the bacteria swells up and explodes.

Azithromycin is a broad spectrum antibiotic which is often used to treat a wide variety of infections; everything from pneumonia to sexually transmitted diseases.

So how does it work?

Azithromycin prevents the bacteria from multiplying by:

In short, azithromycin prevents bacteria from multiplying, making it much easier for the immune system to handle the infection.

Over the years, a number of antibiotics have been discovered in nature or synthesized in the lab. Some antibiotics target only specific bacteria and are called “narrow spectrum” antibiotics, whereas other antibiotics target many types of bacteria and are called “broad spectrum” antibiotics.

Developing completely new classes of antibiotics (as opposed to variations on existing antibiotics) is very difficult. It’s easy to find chemicals that kill bacteria, but not so easy to find substances that could be used as medicines, even if researchers were given infinite resources! Researchers are basically shooting in the dark. In fact, the most recent discovery of a novel antibiotic class was in 1987, more than 30 years ago (Silver, L., 2011)! While there are a few new antibiotics currently in development, researchers don’t know if they’ll ever become usable as medicine.

This void in the discovery of new antibiotics is problematic. When a bacteria becomes resistant to a specific drug within a drug class, it gains some level of resistance to drugs within the same class. For example, if a bacteria became resistant to ampicillin, it would also have some level of resistance to other penicillin-like antibiotics.