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Antimicrobial substances are used to prevent bacterial infection or treat bacterial diseases. The basic principle is to inhibit bacteria by killing them or inhibiting their growth. Antibiotics are ineffective against fungi and viruses, so they cannot treat viral diseases such as colds, flu, COVID-19, measles, chicken pox, hepatitis, herpes, and HPVOften, antibiotics are prescribed together with a cold, but this is to treat a secondary bacterial infection caused by a cold, so if antibiotics are prescribed for a cold without a secondary infection, it is overprescribed.

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When buying Antibiotics on the internet, make sure that you are asked to answer several questions in the form of a reliable health form and that a qualified doctor checks your order.

Antimicrobials are commonly used as antibiotics in a broad sense. This definition includes antimicrobial and antifungal agents. The document also describes antibacterial agents other than antibiotics that inhibit bacteria.

In this document, the word antibiotic is used in the sense of an antimicrobial agent. When used, it has the effect of killing bacteria or inhibiting their growth by pharmacological mechanisms. Some drugs are effective against microorganisms such as specific molds or protists, but not against viruses. Antiviral drugs are effective against viruses.

Antibiotics are classified into cell wall synthesis inhibitors, cell membrane disruptors, protein synthesis inhibitors, nucleic acid synthesis inhibitors, and folate synthesis inhibitors according to the mechanism of action and the mode of action of the antibiotic. See the classification section below for details.


Antibiotics are evaluated as a technology that has dramatically improved human medical technology and life expectancy. Prior to the Scientific Revolution, practitioners of medicine explained the causes of disease mainly in ideological and metaphysical ways. It was a time when a nonsensical theory led to a just theory by today’s standard that diseases are caused by bad air called ‘long-term theory’, so I said it all. Even if they did not know the pathogen, they had knowledge about cleaning the living environment and body, and indirectly taking care of hygiene by burning things used by patients when an infectious disease broke out, but it was not a direct answer.

This is because it was impossible to observe pathogens such as bacteria and viruses that cause infectious diseases because science and technology had not developed, and the concept of such pathogens was not even thought of. The same was true of early modern medicine. After the Scientific Revolution that followed the Industrial Revolution, the era of bacteriology was finally opened by Robert Koch and Louis Pasteur in Europe. Thanks to this development, for the first time in human history, in August 1928, British medical scientist Alexander Fleming discovered an antibiotic called penicillin, and hundreds of millions of people’s lives could be saved with the benefits of scientific progress.

Before antibiotics were introduced into modern medicine, vast numbers of people died from infections that were minor by today’s standards. Pneumonia, tuberculosis, soft tissue infections ( cellulitis ), boils, bacterial diarrhea, and sepsis are typical. In the past, the survival rate of not only infants but also mothers was very low, because bacterial infection occurred during childbirth and puerperal fever occurred, and mothers often died without even trying. Even in Korean history, there was a time when several kings, who could be seen as the core of state power, died because of a back injury, or in other words, a boil that barely opened on their backs. To put it plainly, it was only a hundred years ago that a minor wound that required Fucidin or Madecassol by today’s standards led to the amputation of arms and legs, and even death.

Due to the abuse of antibiotics, the occurrence of antibiotic-resistant bacteria increases, and there is a concern that so-called “super bacteria”, which cannot be treated with any antibiotics, will threaten the survival of mankind. In fact, since antibiotics were introduced into medicine, new resistant bacteria are emerging, and the World Health Organization is also concerned about this. However, most of these resistance-acquired pathogens are rarely highly toxic, and they do not cause a big problem for normal people, although they are not a problem for patients with chronic diseases, the elderly who have been hospitalized for a long time, or patients with immunodeficiency.

Based on this, some non-experts say, ‘Antibiotics are always bad. You should never use it!’, but you should accept “If possible, we should reduce the use of unnecessary antibiotics”, and you should not believe that non-experts are pushing pseudoscience. Of course, oriental doctors take antibiotics when necessary, and there are many herbal medicines that have antibiotic effects in the first place. Whatever is appropriate is important.

In the case of serious bacterial diseases with a risk of death, such as bacterial pneumonia or pyelonephritis, there are cases in which injections are initially administered, and when there is a slight improvement, it is changed to oral medications. At this time, a bacterial culture is performed on the blood to confirm the type of bacteria and their susceptibility (susceptibility to drugs), but this takes quite a bit of time – it takes about 1-2 weeks and often fails – ’empirical’ antibiotics Use Depending on the area of ​​infection and symptom pattern, use the drug with the highest probability of treatment first, and if the symptoms do not subside after a few days, change to the second drug. In fact, blood culture can be seen as a bulwark when various attempts are ineffective. If it’s a bacterial infection, 95% of it will improve with empirical treatment.

Some doctors consider the development of antibiotics and the establishment of their usage as the greatest achievement of modern medicine. What would happen if there were no antibiotics right now?

  • A rapid increase in mortality during intestinal surgery (appendix, cancer, hemorrhoids, perianal fistula, etc.)
  • Mortality spikes in dental extractions
  • Sexually transmitted disease outbreak, no solution
  • died of malaria infection
  • tuberculosis outbreak
  • Pneumonia is the number one cause of death in the elderly
  • An outbreak of bacterial diarrhea such as dysentery and cholera
  • Leg amputation is likely due to cellulitis infection among soldiers
  • Death due to cutaneous or subcutaneous infection

Besides this, there are countless others.

Side effects and precautions

Antibiotics basically act specifically only on bacteria, so in most cases, there is no direct effect on animals or plants. However, since bacteria are not always pathogenic bacteria, they can also kill beneficial bacteria for animals, impede their body functions, or force the natural selection of resistant bacteria, which indirectly affects animals including humans.

While they are highly sensitive to antibiotics, pathogens that cause inflammation and cause chronic diseases are relatively resistant, so the use of clumsy antibiotics does not cure bacterial infections, but rather destroys the composition of microorganisms in the body and worsens health.

  • There are antibiotics that have similar antibacterial activity against gram-positive bacteria and gram-negative bacteria, and antibiotics that are effective against gram-positive bacteria but are rodenticides against gram-negative bacteria. When prescribing antibiotics, of course, this is fully considered and prescribed.
  • Anything related to the use of antibiotics should never be carried out other than the doctor’s judgment.
    • A prescription must be obtained from a doctor or a veterinarian in the case of animals, and do not arbitrarily purchase antibiotics. This is because antibiotics are strictly prescription medicines, and overuse of antibiotics leads to antibiotic resistance. In fact, due to the misuse of antibiotics, bacteria that are resistant to existing antibiotics may appear.
    • Observe the dosage, duration of administration, etc. according to the prescription. Most antibiotics are very effective, so if you take one or two doses, the symptoms themselves will disappear. However, since the causative bacteria remain in the body, a prescription is given to maintain the concentration of antibiotics in the body for a certain period of time until the pathogens are completely destroyed. So when antibiotics go in, a prescription comes out for about a week. If this is not followed and there are pathogens that are resistant, the resistant bacteria survive and treatment becomes more difficult.
    • Among those who pursue survivalism, there are often those who want to stock up on antibiotics. Most of them are at the level of over-the-counter drugs, but in case of polarity, they buy antibiotics for treating tropical fish that can be obtained without a doctor’s prescription. As mentioned above, keep in mind that taking antibiotics without a doctor’s prescription is extremely dangerous. Theoretically, if the composition is the same, the medicinal effect will not be different, but the composition is slightly different. When talking about the composition of medicines, it is often discussed about the main ingredient (Active Ingredient) when talking about the core efficacy. Inactive Ingredient) is bound to be different. In the case of supplementary ingredients, even medicines consumed by the same person may differ depending on the brand or the way they are eaten, much less the medicine for tropical fish, in which the method of maximizing the efficacy is inevitably different. Tropical fish and humans inevitably have different antibiotic administration methods and dosages. And because different types of antibiotics have different types of bacteria that are effective, stocking up on only one type can be rather disastrous.
  • Among the unwanted side effects, diarrhea occurs with a high probability. This is because normal bacteria in the intestine such as Escherichia coli are killed as a bonus when using antibiotics, and this causes diarrhea due to the proliferation of abnormal bacteria or changes in intestinal osmotic pressure and acidity. Depending on the mechanism, it may be observed with sufficient fluid intake, or additional antibiotics may be taken. It is also recommended to take prebiotics or probiotics to restore the beneficial bacteria in the intestines after being cured with antibiotics.
  • Depending on the antibiotic, the side effects and severity vary widely, and in the case of injections, the speed at which they are met is different depending on the type of antibiotic and disease. Some antibiotics have the possibility of causing hepatotoxicity, renal toxicity, and ototoxicity, and in some cases, they must be maintained at a constant concentration for 24 hours to be effective. Let’s just make it fit the way we set it up. In particular, when it is necessary to maintain a certain concentration if the concentration is reduced, dying bacteria proliferate again, prolonging the treatment period, or if you are unlucky, resistant bacteria may develop. In this case, the medicine is replaced, the treatment period is prolonged, and in serious cases, death.
  • Antibiotics that are effective when entering the human body do not guarantee effectiveness outside the human body or have no effect at all. This is true of many drugs besides antibiotics because there are many drugs that show effects after being metabolized into other substances through liver metabolism. Occasionally, there are people who grind antibiotics into powder and then dissolve them in water to clean the wound but don’t do that. There are papers that don’t work.
  • In most cases, antibiotic-resistant bacteria are a problem, but apart from this, there are cases of experiencing unexpected side effects due to antibiotic hypersensitivity. In general, mild side effects will improve within a few days after stopping antibiotic administration, but care must be taken that sometimes sequelae may remain and cause great suffering. If you suspect any side effects, stop taking the medication immediately and consult your doctor.
  • Overuse of antibiotics aggravates obesity and type 2 diabetes. Source: Time magazine.
  • The death of beneficial bacteria in the intestine increases the risk of reduced immunity, oral infections, and allergies, and affects symptoms of depression and anxiety.

Antibiotic resistance

Antibiotics kill most bacteria that are susceptible, but there are bacteria that can tolerate certain antibiotics without dying due to rare mutations. This is called resistance to the antibiotic, and the problem is that the more antibiotics are used, the more resistant bacteria inevitably increase.

Just as organisms are eliminated by natural selection or survive and become dominant species, resistant bacteria survive alone and spread offspring when their relatives die due to antibiotics. In addition, because of the nature of bacteria, one generation is very short, so the rate of reproduction is extremely fast. In other words, the speed of adapting to the environment is very fast. Eventually, when antibiotics are used, only resistant bacteria remain, which is the fate of all antibiotics. Therefore, scientists must continue to develop new antibiotics and use antibiotics only when absolutely necessary to delay the emergence of resistant bacteria as much as possible.

However, the reality is not easy, and it takes more than a decade and a lot of money to develop antibiotics that can be used for humans, while the abuse of antibiotics is spreading out of control. Right now, products containing antibiotics in household soap for hand washing are openly sold in supermarkets, and the misuse and abuse of antibiotics are so serious that even doctors habitually prescribe antibiotics for colds, a viral disease, as “prevention”. Eventually, at the beginning of the 21st century, bacteria resistant to carbapenems (carbapenem-resistant Enterobacteriaceae ), the last bastion, appeared, and pan-resistant bacteria immune not only to carbapenems but also to all other commercially available antibiotics (a total of 26 antibiotics) appeared.

Currently, clinical trials of new antibiotics that can respond to carbapenem-resistant bacteria are in progress, but commercialization is far away, and mankind’s desperate struggle with pan-resistant bacteria will inevitably become a reality in the near future ( related report )… This is the view of pessimists.

As an optimism that opposes this, there is an opinion that “pan-resistant bacteria will not spread to that extent.” In fact, at the beginning of the 21st century, staphylococcus aureus resistant to vancomycin, the last weapon at the time, appeared and made doctors nervous, but since then, this bacterium has appeared only ten times, and none of the patients died. Based on this, a cautious optimism emerged that “pan-resistant bacteria do not seem to reproduce well”, but in an environment of limited resources and time, bacteria have no choice but to exchange antibiotic resistance with some other advantage, and as a result, antibiotic-resistant bacteria claims that there is something abnormal about it and that it has low fertility.

Antibiotic resistance arises through mutations in DNA. This results in a situation in which more energy is consumed than non-resistant bacteria. Even in the absence of antibiotics, these resistant bacteria often consume more energy than normal bacteria. This inefficiency in energy consumption is fatal to the survival of the species since the survival of bacteria in ecology depends on how well they can outnumber their rivals in a way that gives them absolute numerical superiority. Therefore, researchers are skeptical about whether multidrug-resistant bacteria can survive by gaining an advantage over competitors in the natural environment outside hospitals.

Additionally, it is hypothesized that division is delayed by the time it takes for bacteria to pass on antibiotic resistance to the next generation, resulting in elimination from the competition. Bacteria that have developed resistance to antibiotics must copy DNA related to antibiotic resistance when they divide, so the growth rate slows down even slightly. Since the time interval between generations of bacteria is extremely short, even a slight slowdown in the rate of division greatly increases the chances of being eliminated.

For example, suppose we have a bacterium that divides once every 20 minutes (usually Escherichia coli divides every 20 minutes). Suppose that instead of gaining antibiotic resistance, the bacterium increased its division rate from 20 minutes to 20 minutes and 30 seconds. It may seem like a small difference, but in the absence of antibiotics, non-resistant bacteria can divide 72 times a day, while resistant bacteria can divide only 70 times. This may seem like a small difference, but bacteria double in number each time they divide. In other words, two more divisions in one day mean that the population of non-resistant bacteria will increase four times as much as resistant bacteria after one day, and this ratio will increase by 16 times in two days and 64 times in three days.

However, like all other organisms, the number of bacteria cannot increase indefinitely due to food and environmental constraints, and two groups compete for resources necessary for survival. fall In the presence of antibiotics, resistant bacteria boast superior viability than other bacteria, but in the absence of antibiotics, they are just laggards that divide more slowly.

Also, bacteria resistant to antibiotics are inevitably vulnerable to bacteriophages. Bacteriophage is a type of virus and is a true natural enemy of bacteria (bacteria), and it is speculated that the reason why it is difficult for bacteria resistant to antibiotics to thrive in the wild (i.e. in vitro environment) is because they are easily attacked by bacteriophages.

If these claims are true, it seems likely that resistant bacteria will naturally die out in favor of normal bacteria, unless everyone, or the environment itself, is plagued by antibiotics. However, the problem is that the seemingly impossible condition of an antibiotic-infested environment is actually very common around us. Because of this, irresponsible optimism is prohibited, always anticipating the worst and doing everything possible to delay the emergence of resistant bacteria.

Countermeasures against antibiotic resistance and side effects

  • First of all, it is the biggest way to reduce antibiotics and at the same time reduce the intake of meat and processed foods as a preventive measure to prevent infection with resistant bacteria. And since infection is mainly done in hospitals, let’s wash our hands in vulnerable places.
  • Korea is classified as the country with the highest level of misuse of antibiotics among OECD countries, and even in the most recent 2017 OECD statistics, it is ranked at the top without any significant development. (See Health at a Glance 2019)
  • When taking and handling antibiotics, follow the instructions of a doctor, veterinarian, pharmacist, etc., and do not arbitrarily. In addition, when prescribing antibiotics, the custom of indiscriminately prescribing antibiotics should be discarded, and bacteria in the body should be overcome by improving the living environment, health, and immunity. At least, taking lactic acid bacteria helps to reduce these unnecessary prescriptions of antibiotics, but since antibiotics are still prescribed first, the pharmaceutical industry needs to conduct follow-up studies, reflect on themselves, and re-establish countermeasures.
  • In the former Soviet Union, where it was difficult to import antibiotics, bacteriophages were used to treat infections instead. However, unlike showing some effects outside the body, there are not many cases where the drug is effective when administered to people, so there is still a long way to go.

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Tom Perry, M.D., attended Tulane University and graduated Magna Cum Laude with a B.S. degree in Parasitology. He received his M.D. degree in 1983 from the University of Virginia School of Medicine, where he gained extensive research experience, including studies conducted through the National Institutes of Health.