Goldilocks and the antibiotics, are we just right?? 金髮姑娘和抗生素，我們用對了嗎？

The recent publication The antibiotic course has had its day had stirred a lot of debate on antibiotics dosage.

最近出版的抗生素療程已到盡頭的一天引起了很多關於抗生素劑量的爭論。

For a quick summary of the paper, you can go to @mcw ‘s post on HERE and @dber ‘s post HERE have a look.

有關那文章的快速摘要，您可以到 @mcw 的帖子HERE和 @dber 的帖子HERE 去看看。

My personal thoughts

I will first state that, I agree with the article regarding the fact that many of our antibiotics prescriptions were made with decisions from the past that were not studied in full details for optimize used conditions. More researches should be focused on to determining the dosage for each antibiotics to achieve a complete and effective cure!!

我個人的想法

我將先聲明，我認同這篇文章所指出許多抗生素處方療程是由過去經驗的決定作出的，沒有全面細節地研究以改善使用條件。更多的研究應集中在確定每種抗生素的劑量以實現完全有效的治療！

As a microbiologist and working on drug screening research, I also agree with their idea dealing with the Target Selection and Collateral Selection and why it is important to shorten the antibiotics course. As a matter of fact, multi-drug resistant bacteria are developed through a stepwise accumulation of different resistance genes through a process call horizontal gene transfer.

作為微生物學家，從事藥物篩選研究工作，我也同意他們文中所指目標選擇和輔助選擇的想法，以及縮短抗生素課程的重要性。事實上,很多藥耐細菌是通過逐步積累不同抗性基因, 及通過基因水平轉移而増加其藥耐性。

The rise of Multidrug resistance

Horizontal gene transfers refers to the transfer of genetic material between organisms, (genetics material are usually transfer from parents to children, this is vertical). Transferring of genetic materials via horizontal gene transfer is a fast track for evolution. Through multiple uptakes, and accumulations of different antibiotics resistance genes, a normal flora – bacteria that lives on us can become bacteria that resist many antibiotics.

多重耐藥性的上升

基因水平轉移是指生物之間的遺傳物質轉移（遺傳物質通常是從父母轉移到兒童，這是垂直轉移）。通過基因水平轉移的遺傳物質是進化的高速公路。通過多次攝取和不同抗生素耐藥基因的積累，居住在我們身上的正常菌群可能會成為許多抗生素藥耐性的細菌。

The development of different antibiotic resistance genes can arise from different bacteria. And the development of drug resistant genes is favored by having extra copies of genes. Mutations on a gene can bring advantageous effect to the bacteria, or a destruction effect, especially if the mutation leads to the failure of the protein production or a less functional protein. Having extra copies of the genes mean the bacteria can have room for errors. Bacteria with smaller genomes indicates a less likely chance for having multiple copies of genes, and this can explain why in the paper the author challenged why Streptococcus pyogenes with a 1.84mb genome didn’t develop resistance to penicillin. As a reference, E. coli, has a genome size of 4.6mb, S. aureus with 2.8mb, P. aeruginosa with 6.3mb.

不同抗生素耐藥基因的發展可能來自不同的細菌。耐藥基因的發展受惠於基因副本複製數量。基因上的突變可以對細菌產生有利性作用或破壞性作用，特別是如果突變導致蛋白質產生的失敗或功能較差的蛋白質。有更多的基因副本意味著細菌可能有錯誤的餘地。具有較小基因組的細菌暗示有多個副本的基因的可能性較小，這可以解釋為什麼在本文中，作者質疑為什麼與1.84mb基因組的化膿性鏈球菌不會產生對青黴素的耐藥性。作為參考，大腸桿菌的基因組大小為4.6mb，金黃色葡萄球菌為2.8mb，銅綠假單胞菌為6.3mb。

We must also be aware of the fact that antibiotics once intake via oral route/ injections, it will have systemic circulation throughout our body. We have around 10 times more microbes living inside us than our body cells. So by exposing the bacteria to the antibiotics stress, we are forcing the bacteria to face the Collateral Selections. One or two bacteria might be able to develop itself a drug resistant gene. The longer time we have the antibiotics in our system, it will kill off more and more of the sensitive bacteria, resulting in the selection for the drug resistant bacteria. Those resistance genes may then be uptake and accumulated by opportunistic pathogens, and evolving them into a multidrug resistant bug.

我們還必須意識到，抗生素一旦通過口服途徑/注射進食，就會在我們身體內產生全身循環。我們身上的微生物比我們的身體細胞多了10倍。因此，通過將細菌暴露於抗生素的壓力，我們迫使細菌面對抵押品選擇。一個或兩個細菌可能能夠發展自身耐藥基因。我們在我們的系統中使用抗生素的時間越長，它會殺死越來越多的敏感細菌，導致更多耐藥細菌能繁殖。那些抗性基因然後可能被機會性病原體吸收和累積，並將其演變成多重耐藥性的病原體。

This is why we must prescribe a not too short antibiotics course, so that we can suppress the infection causing pathogen. At the same time not prescribing a too long antibiotics course, which normal flora develop into drug resistance and persist in our body.

這就是為什麼我們必須開一個不太短的抗生素療程，這樣我們就可以抑制感染引起的病原體。同時不能用太長的抗生素療程，這可能引至正常的菌群發展成耐藥性，並持續徘徊在我們的身體,等待至病機會。

We must find the “Ahhhh, this antibiotic course is just right!!”

我們必須找到“啊，這個抗生素療程時間是對的!!”

This is also one of the key message from the paper. Also lets not try to adjust our prescription dose by ourselves, as we are far from professional as Doctors that prescribe us the drugs. It is also their duty to re-define the new “Just right” dose.

這也是文中的重要信息之一。大家也要記得,不要私自調整醫生的處方劑量，因為我們不是專業醫生。重新定義新的“正確”劑量是他們的責任。

Source:
http://www.bmj.com/content/358/bmj.j3418
https://www.ncbi.nlm.nih.gov/books/NBK333426/
http://www.nature.com/nature/journal/v406/n6799/full/406959a0.html?foxtrotcallback=true

Image source:
pixabay

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This is my first post for bilingual science post in here, in order to help promote steemSTEM Project (@steemstem), which is a community-support project to promote STEM (Science, Technology, Engineering and Mathematics) articles on Steemit.

這是我在這里首次發表雙語科學文章，以幫助推廣steemSTEM項目（@steemstem），這是一個社區支持項目，旨在推廣STEM（科學，技術，工程和數學）在Steemit的文章。

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乾杯〜