Alternative Treatment For Bacterial Infection in Response to Antibiotic Resistance
Abstract: Antibiotic resistance is a continual foe. Despite continual effort to combat infection using antibiotics, little effort has been allotted to finding alternative treatments. Numerous alternatives exist, and present research, though scarce, shows promise. Viable treatments include: herbal and plant extracts, folk remedies, exploiting the placebo effect, and use of already existing over the counter products. This extended commentary attempts to collect the multi-faceted research done in the area of alternative treatments and condense these studies into a quick reference. The examples provided are only a glimpse of what is possible, but are backed by thorough research- many by the rigors of clinical trials.
Introduction
Nature has been taking care of itself in a sort of circle of life: a natural judge, jury, and
executioner. Yet humans seem to face a huge battle on a daily basis between
themselves and bacteria. Antibiotics continue to be created to try to get ahead of ever changing bacteria. Nature just continues as it has for
millennia. Why not return to nature then for answers to the seeming losing
battle humans are fighting? From
herbs to over-the-counter drugs, answers to antibiotic resistance may lie in
alternative treatments. It is time
to open the horizons of medicine and explore these amazing treatments. The following paper will explore what
is known about alternative treatments by identifying the problem that
bacterial resistance to antibiotics poses, summarizing what research has been done thus far
in modern medicine, explaining each remedy, and, finally, pulling the findings
together to evaluate where to proceed from this point in research of
alternative remedies.
Background
Bacterial resistance to
antibiotics is a growing concern that is leaving pharmaceutical companies lost
for ideas. Antibiotic after
antibiotic is produced, but the same result seems to occur soon after: little
effectiveness because of bacterial resistance to the new drug. Physicians are left to continue trying
tried and true methods such as amoxicillin and penicillin, with little
results. Why? Too many years of
misuse and overprescribing of antibiotics. While some hope to cling to that widely travelled, but
dangerous, road of antibiotic treatment, there is another avenue to turn onto:
alternative treatment, more
specially, natural remedies and currently existing over the counter treatments,
which have the potential to hold great promise for combating bacteria.
Herbal remedies have been shown to exhibit antibacterial properties. In the study Antibacterial Properties of Chinese Herbal Medicines against Nosocomial Antibiotic Resistant Strains of Pseudomonas aeruginosa in Taiwan, over fifty herbs were tested for antibacterial properties in strains of antibiotic resistant bacteria. It was found that “26 of the 58 plant extracts showed antimicrobial activity against all of the test strains. Ten out of the 26 plant extracts possessed broad-spectrum antibacterial properties (96%) against the tested organisms” (Ching-Shen, et al., 2007, p.6). If simple plant extracts can exhibit such power against bacteria, why not explore these remedies further? Research may provide alternatives, and maybe a little much needed hope.
Somethings
to consider are the other positives of not utilizing synthetic remedies:
economical and ecological implications. Natural treatments are closer to nature and thus leave less of a ecological footprint. Granted, resources for these treatments would have to be used
responsibly and not over harvested. Synthetic potions can also be much more costly to develop and mass
produce, which these costs are passed onto the consumer with a little extra
being put into the pockets of pharmaceutical companies. In tough economic times, health should
not have to be what is sacrificed.
Folk remedies
provide some positive light. In one research report, “Effect of Folk Remedy, Bainiku-akis, a Concentrate of Prunus mume Juice, on Helicobacter pylori Infection in
Humans,” researchers concluded that there is an "antibacterial
effect of Bainikuekisu on H. pylori in the
human stomach” (Nakajima et al., 2006, p.1). This is an age
old native remedy for diarrhea, yet it deserves to not be tossed in the
discard pile with all remedies of old.
While often
thought to be taboo, the placebo effect might have a place in the discussion of
alternative approaches to treating bacterial infection. In several studies, it has been found
that placebos actually show very little difference in their effects when
compared to active treatments of antibiotics. One such study will be noted later in this commentary. The mental side of recovery is simply
amazing and should be researched further because the side effects of
antibiotics can sometimes be nearly as insufferable as the infection itself.
Lastly, over
the counter products may hold promise for the treatment of infection, without
the antibiotic price tag. In a
study that will be revisited towards the end of this paper, it was found that
an over the counter, or OTC, product, benzoyl
peroxide, produced greater relief on its own than two different antibiotic
treatments: all while being much more cost effective.
It is
increasingly clear that alternatives are far past due. Research has been scarce, but what does
exist provides a fresh look at the many possibilities that exist for treating
bacterial infection in a world of increasing antibiotic resistance. The following is a collection of just a
few of the categories of alternatives that are present, if only antibiotics are
pushed aside for a moment as the only effective way to fight an ever more
formidable enemy: bacteria.
Medicinal Plants: Tea Tree Oil, St. John's Wart, Spice Extracts
Often plants are
taken for granted. Crops feed
livestock and humans, flowers grace tables as elegant décor, spices add flavor
to food, and garnishes of lemons and parsely add the
extra touch to drink and entrees. But could plants also hold answers to the question of alternatives to
antibiotics? According to the report entitled “Medicinal Plants for the
Prevention and Treatment of Bacterial Infections,” there are over 155 plant
species from Thailand alone that have antimicrobial properties (Mahady, 2005). This is an immense number when considering the resources the entire
planet may hold. While it would be
tedious and overly long to list even a major portion of all the species that
have anti-microbial properties, a few are worth mentioning.
One species of plant
that may sound fairly familiar is tea tree oil (TTO). Melaleuca alternifolia
is the plant that produces this oil (Mayo Clinic, 2009). Tea Tree Oil, or TTO,
is often associated with getting soft hair and smooth, scar-free skin. But tea tree oil provides another
resource: antimicrobial properties. Yes, the same substance put in luxury shampoo can actually fight microorganisms. Of the microbes studies have found TTO
shows activity against, one is none other than Staphylococcus aureus: the common staph infection. Furthermore, it was found that more
specifically, TTO could be part of a potential effective treatment of MRSA, as MRSA
showed no resistance to small quantities of TTO. The one negative is that like antibiotics, Tea Tree Oil will
likely not be a long term fix as untreated populations of MRSA do show signs of
producing mutant populations with resistance to tea tree oil (Mahady, 2005).
A second species
is Hypericum perforatum. A petroleum ether extract of this
plant, often known as St. John’s Wart, shows activity against gram-positive
bacteria, especially MRSA (Mahady, 2005). This is no newcomer to the medical
field. Actually, St. John’s Wart
was used in medicine centuries ago for skin infections (NCCAM, 2005). This is a remedy used centuries ago
that is still a viable option in modern medicine. With these findings, curiosity about the viability of
age-old remedies being used in medicine today grows.
One last group to
note might be that of an immense number of simple food and spice extracts. Oils from anise,
basil, carrot, celery, coriander, dill weed, fennel, oregano, parsley and
rosemary- just to name a few- offer inhibition of the growth of E. coli. Of these, oregano offers the greatest
amount of activity (Mahady, 2005). Aren’t these many things one could find
in the kitchen? All of these oils
were tested in vitro, so further research is necessary to establish a clinical
regimen that includes these essential oils in order to effectively combat
bacteria.
While by no means an all inclusive list, this provides a peek at what is possible
if only research is conducted in the natural world. If simple kitchen spices can provide an offense in the
battle against bacteria, then what isn’t possible, if only a little looking
around is done? And this is only
the beginning.
Folk Remedy: Japanese apricot Prunus nume
One of the remedies
being explored is that of an apricot. Well, more specifically the Japanese apricot Prunus
nume. Bainiku-ekisu is a concentrate created from the juice of
this fruit. What does fruit juice
have to do with bacteria though? A lot, particularly in the treatment spectrum.
Though in the
clinical study the concentrate was shown to have antibacterial properties
against Helicobacter pylori, a clinical regimen to optimize the results of this
treatment would have to be defined before it can be used mainstream due to a
lack of definitive long-term results (Nakajima, et al., 2006). This is a call for researchers to take
an opportunity such as this working remedy, and find how to make it most
effective for treating infection and replacing a portion of antibiotics that no
longer are effective against Helicobacter
pylori infection. The problem
is developing that regimen, and it will take years and resources to possibly
make a defined treatment available. But these findings are a good first step in the right direction.
Root Extract: Cilinervis
Before breaking full
force into the depths of bacterial research, a quick trip down the road of
parasites might be in order. Malaria seems like a disease of old, but it still is very prominent in
the world today. While outbreaks
are generally found more often in developing and third-world
countries, Malaria is not confined only to those areas, but rather a world-wide
issue (CDC, 2010). As Malaria now
is joining the arms race with bacterial infections, it is important to find an
answer to the treatment question when current pharmaceuticals fail.
Plants and the
parasite that causes malaria are fairly similar (Moon & Sim,
2008). Due to this similarity, it
is possible that plant products may be able to demonstrate anti-malarial
properties. In a study by Moon
& Sim, it was found that the extracts from the
roots of Pleuropterus ciliinervis showed
high anti-malarial activity in vitro. Pleuropterus ciliinervis carries
a methanol product in its roots, and this extract is the substance that carries
the promise of activity against malaria. In a similar test, this time a clinical study on rats, the prominence of
activity against malarial parasites decreased, but the effects upon the
infection continued to be substantial (2008). What this means is that malaria, which is a growing problem
due to resistance to most first and second line drugs, may be treated with a
naturally based remedy that is not within the category of those substances the
infection is resistant to already. It offers a little flicker of hope in the fight against malaria.
While malaria is caused by a parasite, rather than bacteria, the
implications of finding treatments that do not include synthetic methods
is a breakthrough for both fields. This adds to the growing pile of evidence for the importance of further
and more intense research into natural answers to the bacteria and antibiotic
resistance questions.
Marine Natural Products
“Under the sea, under the sea, down where it’s better, down where it’s wetter…” (Ashman, 1989). It’s the childhood song that parents and children alike get stuck in their heads. While Sebastian was simply trying to convince Ariel to keep her head under the surface, he may have been right about something else: maybe some answers to the bacteria arms race actually lies down there amongst the sand and the sponges. Nature has always provided the balance between forces. Humans have been trying to regain that balance through synthetic means, but now some light is being shed on the idea of returning to that natural order. One place that researchers have begun looking is lying beneath one of the most plentiful resources in the world: water. Underneath the vast seas live extremely diverse species of marine fauna and flora. Greater is the potent defenses these life forms have against the very bacteria that plague humans today. While listing all of the marine products that have been identified just in the past decade would take an immense amount of pages, mentioning a few might be a good start to understanding the benefits of returning to the best defense of all: nature, and more specifically the marine environment.
One product that has
been identified is Axinellamines. Axinellamines
are a product of certain sea sponges, specifically the Axinella
and Stylotella aurantium
sponges, as well as certain Caribbean sea sponges.
These components of these sponges actually have antibacterial properties,
particularly against Helicobacter pylori,
as well as preventing fungal spread and abnormal t-cell production (Mancin, et al., 2007). Helicobacter pylori are
one of the main types of bacteria responsible for gastrointestinal
infection. To be able to find a
natural product that is active against these bacteria is quite a new beginning
for the medical community.
A second substance
determined to have antibacterial properties is glycolipidic
tetrasaccharide caminoside.
Another product of a sea sponge (Caminus sphaeroconia), glycolipidic tetrasaccharide caminoside has
shown promising activity combating Staphylococcus
aureus and Enteroccus. S. aureus are the bacteria that cause those renowned
staph infections. Also, this substance has been shown as possibly possessing
properties that would affect E. coli, without disturbing natural intestinal
flora (Mancini, et al., 2007). Antibiotics are well known for the side effect of killing off intestinal
flora, friend or foe. This
destruction of the good flora increases the chances of another infection and/or
a much more significant infection.
Thirdly, there is Polyalkylpyridinium. Polyalkylpyridinium, or Poly-ops, is yet
another product of a sea sponge. These alkaloids provide antibacterial
properties against Salmonella, as well as other bacteria (Mancin,
et al., 2007). Salmonella will be
discussed in much greater detail later, but think of the implications of
finding a method of combating one of the commonly known infections spread
through cross-contamination and improper food handling. While this product will not prevent
infection, it provides an alternative to antibiotics which
have a long list of disadvantages and side effects.
One last, but by no means insignificant, substance to note is Halocidin. Halocidin is obtained from the hemocytes, which originate from stem cells and are part of a primitive immune system, of a tunicate (Mancini, et al., 2007). A tunicate is a simple sac-like creature that layers the sea floor and functions as a sort of bottom feeder (UCMP, 2006). The best part of discovering the properties of this substance: Halocidin shows hope for battling two of the most feared infections currently: MRSA and VRE (Mancini, et al., 2007).
MRSA is that infection that is spoken of in whispers in hospitals because an outbreak is catastrophic for immuno-compromised patients. MRSA, or Methicillin Resistant Staphylococcus Aureus, is a formidable enemy because it is just that: resistant to the first-line of defense health care offers. MRSA can be, and far too often in hospitals is, fatal (CDC, 2010). VRE, on the other hand, is Vancomycin-Resistant Enterococci. Again, these bacteria cause major problems for the medical community because common defenses have zero effect upon the infection, and time is always ticking (CDC, 2008). With more research and development of a remedy utilizing Halocidin, an answer to these two extremely dangerous bacteria may be closer than though possible.
Four
substances of many.The sea holds multitudes of possibilities for treatment of
bacterial infection, the research just needs to continue and possibly accelerate
to provide more alternatives to the public. Instead of turning to synthetic materials, why not give the
very thing that has been providing a world of homeostasis a chance to help
humans? Nature just might have a good answer to the human battle with bacteria.
Treating Salmonella
It is a fairly common
topic in conversation, particularly the evening news with the contaminated food
of the day. It is a fear that the
public has that is known only by name. What is this mystery thief in the night? Salmonella. Sounds familiar, especially with the
outbreaks in the recent years in various processing plants and produce. The advice seemingly always given at
the end of those renowned news stories is to visit one’s primary physician
should symptom A, B, or C appear within so many
hours. But what treatments are
available for this assumed foe? And moreover, are the remedies that a physician will immediately turn
to, antibiotics, really any more effective than alternatives?
Before venturing into
the treatment options for salmonella infection, or salmonellosis,
what is this condition generally characterized by? Salmonella infections are divided into two different
categories: gastroenteritis and Typhoid Fever. Gastroenteritis is by far more commonly heard of as this is the type of infection that is spread due to
improper food handling and preparation. This condition has an onset of anywhere from a few hours to two
days. It is characterized by:
nausea, vomiting, diarrhea, abdominal pain, fever, chills, headache, muscle
pains, and/or blood in stool. Typhoid Fever, on the other hand, has a much slower onset- five to
twenty-one days- and is found to occur predominantly in those returning from a
country that has a much higher rate of occurrence of the infection. Typhoid shares one common symptom with
its brother infection: diarrhea. Other signs include: mental confusion, coughing, raised rose colored
spotty rash on chest, intense fever (above 102°F), slowing of heartbeat, and/or
enlargement of liver and spleen (http:www.mayoclinic.com).
With a better idea now of what the
infection looks like, how is it treated? Generally, with
antibiotics. Why? Because
antibiotics have been the go-to medication since their birth as wonder-drugs. But consider for a moment that other options exist. What if one, or all, of those
alternatives is actually more effective than antibiotics? Furthermore, what if a placebo--the
very base of doing nothing--shows incredibly similar results to current
practices utilizing antibiotics? If a placebo can produce similar results to antibiotic treatment of
salmonella, then antibiotics lose their necessity as the singular answer to a
salmonella infection (or any bacterial infection for that matter until research
proves differently on a case-by-case basis).
In a clinical study of
44 pediatric patients, three treatments were utilized to test the effectiveness
of antibiotics in treating gastroenteritis type salmonella infections. Two treatments were antibiotics, ampicillin and amoxicillin; the third was a placebo. No change was found in the severity or
frequency of diarrhea in patients treated with antibiotics. Recovery time also did not vary between
placebo and antibiotics. Furthermore, patients treated with antibiotics were actually more
susceptible to bacterial relapse: 53% of each antibiotic treatment groups
suffered from returning symptoms. The very symptom the antibiotics were attempting
to alleviate- diarrhea- was the most common to reoccur with relapse (Nelson, et
al., 1980).
Since the placebo actually
produced more positive results in the big picture of the study, it is
exceedingly important to explore alternatives to antibiotics as these often expensive drugs do not produce any more significant
results than simply believing oneself healthy. This is not to say that salmonella infections should be left
untreated, but why not explore alternative therapies-such as the natural
products mentioned above- to treat this condition? After all, even if the remedy itself doesn’t work, it is
possible the mental treatment from thinking the treatment is working just might
be enough, as it was shown to be in this study.
Treating Acute Otis Media (Ear Infection)
What is one of the major illnesses a parent must watch their child fight? Ear infections, or Acute Otis Media. In recent generations, the natural reaction is to bring the child to the doctor and find oneself walking out with a prescription for the doctor’s choice antibiotic. But is this truly the best option for children, especially in the face of bacteria’s growing resistance to commonly used antibiotics? While antibiotics generally show greater results in treating ear infections, other remedies show comparable results, often with fewer side effects.
In a collection of
clinical studies, documented by Vouloumamou, et al., comparing
the effectiveness of antibiotics, placebos, and watchful waiting, it was noted
that antibiotics generally show better results in combating ear infections. Furthermore, persistence of symptoms
beyond two to four days was unlikely with antibiotic treatment, unlike other
treatments (2009). It is a huge
advantage for antibiotics as a quick recovery time is what is often most
strived for due to less time being lost from work and school. If children are able to feel better
sooner, parents are able to go back to work much earlier than in situations
such as the wait and see method where recovery time is longer, thus causes a
greater loss to income from a cut in time at work. Moreover, older children miss less school if they are sick
for a shorter period of time. Ear
infections are no picnic, and it is very hard for children to concentrate in
school if they have the constant pain in one or both ears. This causes students to fall behind if
they are sick for extended periods of time. So the remedy that promises the fastest return to health is
usually the preferred choice. Antibiotics,
as shown in several studies, provide this promise.
Albeit a great
advantage stemming from quicker recovery, antibiotics come with a longer list
of side effects simply from the nature of the beast, so to speak. In clinical trials, antibiotic
treatments were found to be quickly followed by
diarrhea, unlike other treatments where gastrointestinal side effects were unlikely
(Vouloumamou, et al., 2009). So though children’s ears are feeling
better much faster with antibiotics, the side effects that far outlast the
brunt of the infection are also a concern because these new symptoms can cause
children to still miss school, or take more time out of being in the
classroom. The negatives may not
necessarily outweigh the positives so it is important to look at both sides of
the coin.
Furthermore, in these clinical studies, it was also found that though antibiotics achieved better results, the gap between antibiotic treatment and other treatments was insignificant at best. Therefore, further clinical studies on the effectiveness of alternative treatment, such as simply watchful waiting, are necessary to find the best answer for parents and children when an ear infection happens. Due to small gaps between the effectiveness of antibiotics and other treatments and side effects of antibiotic remedies, further research will determine which treatment truly is a better option for treating children suffering from Acute Otis Media.
So though antibiotics
currently seem to be more effective, alternatives are out there and just might
be a better answer for parents and children alike. Children cannot afford to miss school, nor parents to miss
work. With side effects and
recovery time of the three treatments (antibiotics, placebos, and watchful
waiting) put side by side, antibiotics are pretty much even keel with the
others, and thus is not necessarily the superior cure or always the best
answer. There are multiple factors
to consider when using antibiotics, particularly with children as allergy and
drug resistant bacteria can be fatal at a higher rate than steadfast adults.
Treating Acne
Acne isn’t necessarily an infection by traditional standards, but comparable. An English clinical study concentrated on the differences between treatments using benzoyl peroxide, an over the counter remedy sold under brand names such as Clearasil, and antibiotics, tetracycline and minocycline (Cortlandt Forum, 2005). This study brings up an interesting point. Are antibiotics, if equal in effectiveness to over the counter remedies, the most cost effective option for the general public, especially in trying economic times? This is a question to be explored eventually, but first the effectiveness question must be answered. The English study mentioned above provides an answer that somewhat contradicts the message pharmaceutical companies and many physicians present: antibiotics are not the answer.
Over the counter, or
OTC as is often used in everyday conversation, drugs are a potential
alternative to antibiotics due to equal effectiveness in clinical studies. In an English study published in the Cortlandt Forum that took young adults that suffered from
moderate acne vulgaris (which is commonly known as
just acne), OTC and antibiotic remedies were compared. The OTC drugs tested contained benzoyl peroxide and the antibiotics included were minocycline and tetracycline. While all remedies showed positive results, benzoyl peroxide actually provided more significant results
than either of the antibiotics alone. With 60% of participants exhibiting fewer lesions, benzoyl
peroxide proved superior to antibiotic therapy, with only 55% and 54% of
participants finding relief from treatments of minocycline
or tetracycline respectively. Only
one therapy afforded a greater percentage of participants reporting a reduction
of acne: a combination of benzoyl peroxide and
tetracycline, which increased marked improvement to 66% of participants (2005).
These findings raise a few
questions, some of which have already been mentioned above. One to revisit now would be the
question of economic responsibility. While antibiotic resistance continues to grow and evolve into an ever
more formidable beast, why are antibiotics still being used for conditions that
are better served by other remedies? Furthermore, why are antibiotics used when
other treatments are easier on the general public’s budget? OTC products containing benzoyl peroxide are actually twelve times more cost
effective than antibiotic treatments (“OTC Lotion Matches Antibiotics in
Treating Acne,” 2005). If alone,
OTC treatments are more effective and better on the wallet, why not choose to
use those products just around the next aisle corner instead of unnecessary use
of antibiotics?
Conclusion
The above paper
identified the present research in the field of alternative treatments and
presented conclusions that could be drawn thus far. Studies noted included herbal, placebo, and over-the-counter
remedies.
If so many alternatives exist, then why hasn’t there been more progress in bringing them to market? The best answer might be simply cost. Research budgets are often too small to take on the task, and without research the necessary evidence to make a treatment a viable option to be made mainstream is simply not there. So the first step is more research. The existing studies have provided a base, and now it is time to build on that foundation. And do so before it is too late. Time is of the essence when it is a matter of health and life.
References
Ashman, H. (1989). Under the Sea [Performed by Samuel E. Wright] On The Little Mermaid [Motion Picture]. United States: Walt Disney Pictures.
http://www.cdc.gov/ncidod/dhqp/ar_vre.html
Ching-Shen,
L., Thau-Ming, C., Cheng-Hong, Y., Hsueh-wei, C., Chia-Hong, C.,
& Li-Yeh, C. (2007).
Antibacterial Properties of Chinese Herbal Medicines against Nosocomial Antibiotic Resistant Strains of Pseudo,onas aeruginosa
in Taiwan. American
Journal of Chinese Medicine, 35 (6), 1047-1060. Retrieved from
Academic Premier Search database.
Mayo Clinic. (2010). Tea Tree Oil (Melaleuca alternifolia).
http://www.mayoclinic.com/health/tea-tree-oil/NS_patient-teatreeoil
Antimalarial activity in mice of resveratrol derivative from Pleuropterus ciliinervis. Annals of Tropical Medicine & Parasitology, 102 (5), 447–450. Retrieved from Academic Premier Search database
Univeristy
of California Museum of Palentology.
(2006). Introduction to the Urochordata.
http://www.ucmp.berkeley.edu/chordata/urochordata.html
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