By Courtney Hayes, Student Pharmacist and Karen Kier, Pharmacist
On behalf of the ONU HealthWise team

During September 1928, Scottish bacteriologist Alexander Fleming discovered the basic substance that evolved into the isolation of the antibiotic penicillin in 1930 by Howard Florey and Ernst Chain. The use of penicillin was recognized as a life-saving medication for treating soldiers during World War II. The three scientists were awarded a Nobel Prize in 1945 for this important discovery.

In 1908, an Austrian chemistry student Paul Gelmo identified a sulfa structure, but it was not until 1931 that German pathologist Gerhard Domagk was able to synthesize the first sulfa antibiotic. In 1935, the first sulfa drug known as sulfanilamide made it to the U.S. market. 

Johns Hopkins Hospital in Baltimore, Maryland, was the first to identify a patient who had developed antibiotic resistance to sulfa drugs. It took less than 2 years after the introduction of the drug to the development of resistance. Resistance to penicillin was documented in laboratory studies in 1940, but the first reported patient showing resistance to the antibiotic was in 1942.

Sulfa and penicillin are still viable antibiotic options for managing infections, but resistance continues to be a significant factor for treatment failures. Today, there are some strains of bacteria that are 100% resistant to penicillin and sulfa, making them ineffective.

Antibiotic resistance is a major concern for the United States and the world. During the last decade, the FDA has approved 17 new antibiotic drugs. This number sounds impressive, but only a small number of these 17 drugs are new first-in-class or novel discoveries. These novel drugs can be important in fighting infections that have become resistant to other antibiotics. The trend for fewer novel antibiotics being discovered has some alarming implications. 

As flu and cold season starts in the next few months, it is a reminder of one of the major reasons for antibiotic resistance. The use of antibiotics when someone has a viral infection such as a cold or the flu is the greatest risk of antibiotics developing resistance. Other important factors include when patients do not finish the full course of the antibiotic or save some antibiotic to use at a later date. Another risk factor is the use of antibiotics in animals for both prevention and treatment of infections. 

Some new research indicates there are some other factors that may contribute to antibiotic resistance. Many people take medications like acetaminophen (Tylenol®) or ibuprofen (Motrin ® or Advil®), but new research shows these medications may affect how bacteria respond to antibiotics.

In a study by the University of South Australia and the University of Adelaide, researchers focused on commonly used non-antibiotic medications and how they affect the development of antimicrobial resistance in a common bacteria such as E. coli when taken with the antibiotic ciprofloxacin. The E. coli strands were grown in the lab and exposed to one of the following combinations of medications: ciprofloxacin alone, one non-antibiotic medication plus ciprofloxacin, or combinations of two non-antibiotic medications plus ciprofloxacin. Different drugs were studied, including acetaminophen, ibuprofen, diclofenac, furosemide, metformin, atorvastatin, tramadol, temazepam, and pseudoephedrine (Sudafed®).

Researchers found ibuprofen and acetaminophen significantly increased mutation rates of E. coli, resulting in higher levels of ciprofloxacin antibiotic resistance compared to taking ciprofloxacin alone. The researchers concluded that taking ibuprofen or acetaminophen may contribute to antibiotic resistance when the bacteria is exposed to antibiotics at the same time as other medications. It is important to note that you should not stop taking prescribed medications such as acetaminophen and ibuprofen based on this study without talking to a healthcare provider. This information is very new and not studied in humans, so it is important to talk to your pharmacist or your healthcare provider before stopping or starting any medications while taking antibiotics. With infections, acetaminophen and ibuprofen are commonly used to reduce fevers and relieve pain. 

Scientists are learning that some common medicines may help bacteria become harder to kill with antibiotics. This does not mean you should stop taking these medicines. Instead, it reminds us that using all medication wisely is important for keeping antibiotics working when we need them. It is important to take antibiotics as prescribed and finish the full course of medication. 

Additionally, it is best to avoid taking over-the-counter medication, like ibuprofen and acetaminophen, unless medically necessary and to discuss all medications with a healthcare provider. Continuing healthy habits that reduce infection risk, including proper hand hygiene, vaccinations, staying hydrated, and managing chronic diseases effectively are beneficial.

We still have more to learn about preventing antibiotic resistance.

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