The growth in cases of hospital infections caused by bacteria, especially in Intensive Care Units (ICU), has led to the reintroduction of one of the only weapons in the world to combat resistant bacteria: the drugs polymyxins E (colistin) and B. They are they had stopped being used for decades, mainly because they were nephrotoxic and caused kidney damage. With this, they managed to circumvent the attack mode of the bacteria, which “forgot” about them.
On the other hand, bacteria were creating resistance to some classes of antibiotics through their biochemical mechanisms, causing these medications to lose their function of killing them. "And today there are several classes of antibiotics available on the market, with penicillins being the most common. However, only polymyxins have managed to eliminate super-resistant bacteria", laments Patrícia Moriel, clinical pharmacist and professor at the Faculty of Pharmaceutical Sciences (FCF ).The professor has been investigating the topic for years in search of inhibiting bacteria. "The path that is being followed is the choice of an antibiotic to which they are sensitive", she highlights.
For the specialist, the lack of antibiotics to eliminate the most resistant bacteria and the lack of prospects for new medicines are worrying. To give you an idea, common bacteria have the ability to duplicate themselves approximately every 20 minutes.
According to the professor, today in hospitals many patients die from bacterial infections, and not for the same reason they were admitted. Several reasons lead to this greater susceptibility to acquiring bacteria. But normally, hospital bacteria are already more resistant due to their contact with multiple treatments.
At FCF, there is currently a movement of basic research by professors of pharmaceutical chemistry in the area of molecular modification, to identify new molecules. But for this new molecule to generate a medicine, it will take a long time. The interests of the pharmaceutical industry must also be considered.
Counterattack
Patrícia reports that, to inhibit the growth of bacteria, hospitals are now creating patient safety groups and hand hygiene protocols. It is also necessary to take into account that there is a proper way to take antibiotics. There are those to be taken in a single dose, three days, seven days and ten days, and it is necessary to religiously follow what the doctor prescribed.
Furthermore, at this moment the participation of a clinical pharmacist is very important, highlights Patrícia, as he is the professional who will advise how to ingest the medicine: whether with water, milk, on an empty stomach, with food. Each medicine requires a different form of administration and, when in doubt, people should take the medicine with water, he advises.
Some drugstore chains are more recently promoting courses for their pharmacists to learn more about clinical pharmacy. With this vision, better care is given to the patient and this care produces an effect that ends up returning to the establishment itself.
Other aspects to be observed are interactions between medications, which can reduce their effects; not interrupting the antibiotic, even if the person's clinical condition improves; and the schedule, which must be followed exactly to maintain the concentration of substances in the blood.
Legislation
In 2011, legislation was published by the National Health Surveillance Agency (Anvisa) regarding the irrational use of antibiotics. Previously, people went to the drugstore and were able to buy them without a prescription. Today the Regional Pharmacy Council (CRF) is trying to encourage actions so that the pharmacy is a health establishment, not a point of commerce, points out Patrícia.
Today Anvisa recommended that the sale be linked to the retention of the medical prescription. "It happens that many drugstores end up selling without a prescription. Part of the population finds this interesting, but they need to wake up to this reality. If there is legislation, there is a reason for that", he argues.
When this legislation emerged, FCF did work to identify how it would act on resistance to these bacteria in the community. Urinary infections were studied before and after the implementation of the legislation. It was observed that ciprofloxacin is widely prescribed for urinary tract infections. However, 30% to 35%, in the case of bacteria from Campinas, are resistant to this drug, which encourages the appearance of recurrent urinary infections.
"We should have epidemiological data for each city and clinical protocols. Some protocols in Brazil do not recommend treatment with ciprofloxacin. And it was the most prescribed in our region”, comments the specialist. “We need to try to isolate patients with these bacteria so that there is no proliferation and that the community in general does not use them indiscriminately.”