Correspondence
Antibiotic resistance needs global solutions We read with great interest the Commission by Ramanan Laxminarayan and colleagues1 about the need for global solutions to deal with the challenges posed by antibiotic resistance. The number of drug-resistant bacteria is rapidly increasing at an alarming rate. In fact, antibiotic resistance is one of the most serious threats in the history of medicine, and new antibiotics and alternative strategies should be sought as soon as possible to tackle this complex problem. We believe that traditionally used medicinal plant species harbour endophytes. Endophytes are microbes (bacteria and fungi) that live in plants without causing any disease symptoms, and are known to help the host plant in various ways, including protecting it from pathogens. Plants with antimicrobial properties are likely to have endophytes that produce novel antimicrobial bioactive compounds. Reports from published work show that the natural products derived from endophytes have antibacterial,2 antifungal, 3 and even antiviral 4 properties; therefore, endophytes could serve as an alternative source of novel antibiotics and could be useful in tackling antibiotic resistance. In many countries, plants are used in traditional medicine systems. If these medicinally important plant species are studied systematically for their endophytes and the natural products derived from endophytes, then these might provide several leads that could play an important part in dealing with antibiotic resistance. However, we should not preclude the importance of endophytes from species of monocotyledons, dicotyledons, gymnosperms, ferns, mosses, green algae, and red algae that are not reported as having medicinal uses. www.thelancet.com/infection Vol 14 July 2014
In addition to a clear plan, systematic coordinated efforts, both national and international, are needed to explore the potential of endophytes to produce novel antibiotics for various types of antibiotic-resistant bacteria (panel).5 Meaningful collaboration at local, national, regional, and international level is the key to success, and to achieve this, the scientific community could consider the establishment of an international consortium. In this regard, we call upon all leading scientists and policy makers (both at national and international level) who are involved directly or indirectly in the research to find new antibiotics (by using alternative strategies), to establish such a consortium to explore the potential of endophytes in producing novel antibiotics. This international consortium could be a part of a global plan to tackle antibiotic resistance and share the responsibilities of finding solutions. We declare no competing interests.
Tahmina Monowar, *Subhash J Bhore [email protected] Department of Biotechnology, Faculty of Applied Sciences, AIMST University, Bedong-Semeling Road, 08100 Bedong, Kedah, Malaysia (TM, SJB); and Department of Microbiology, Faculty of Medicine, AIMST University, Kedah, Malaysia (TM) 1
2
3
4
5
Laxminarayan R, Duse A, Wattal C, et al. Antibiotic resistance—the need for global solutions. Lancet Infect Dis 2013; 13: 1057–98. Ding L, Maier A, Fiebig HH, Lin WH, Hertweck C. A family of multicyclic indolosesquiterpenes from a bacterial endophyte. Org Biomol Chem 2011; 9: 4029–31. Miller CM, Miller RV, Garton-Kenny D, et al. Ecomycins, unique antimycotics from Pseudomonas viridiflava. J Appl Microbiol 1998; 84: 937–44. Ding L, Münch J, Goerls H, et al. Xiamycin, a pentacyclic indolosesquiterpene with selective anti-HIV activity from a bacterial mangrove endophyte. Bioorg Med Chem Lett 2010; 20: 6685–87. CDC. Antibiotic resistance threats in the United States, 2013. Atlanta: Centers for Disease Control and Prevention, 2013. http://www.cdc.gov/drugresistance/ threat-report-2013/ (accessed Nov 15, 2013).
Panel: Antibiotic resistance threats categorised into three levels of concern5 Urgent • Clostridium difficile • Carbapenem-resistant Enterobacteriaceae • Multidrug-resistant Neisseria gonorrhoeae Serious • Multidrug-resistant Acinetobacter spp • Multidrug-resistant Campylobacter spp • Fluconazole-resistant Candida spp* • Extended spectrum β-lactamase producing Enterobacteriaceae • Vancomycin-resistant Enterococcus spp • Multidrug-resistant Pseudomonas aeruginosa • Multidrug-resistant non-typhoidal Salmonella spp • Multidrug-resistant Salmonella Typhi • Multidrug-resistant Shigella spp • Methicillin-resistant Staphylococcus aureus • Multidrug-resistant Streptococcus pneumoniae • Multidrug-resistant tuberculosis Of concern • Vancomycin-resistant S aureus • Erythromycin-resistant group A Streptococcus spp • Clindamycin-resistant group B Streptococcus spp *All data are for bacteria, except for Candida (which is a fungus).
We read with great interest the recent Commission by Ramanan Laxminarayan and colleagues1 about antibiotic resistance and the need for global solutions. This problem has many different facets that can vary between regions and countries. In south Asia it is easy to buy antibiotics over the counter without a prescription, which obviously leads to overuse of these drugs and paves the way to resistance. But one could argue that in countries such as Nepal, where there might not be doctors in remote areas, antibiotic use without a doctor’s prescription could be essential to cure an illness, and perhaps even to save a life. But clearly, guidelines need to be formed and implemented, both for antibiotics that require a prescription and for those that do not. Doctors in Nepal and India are finding it more difficult to treat common infections, such as those in neonates and of the urinary tract, with the older generation of antibiotics. We increasingly use, when available, the 549
Antibiotic resistance needs global solutions We read with great interest the Commission by Ramanan Laxminarayan and colleagues1 about the need for global solutions to deal with the challenges posed by antibiotic resistance. The number of drug-resistant bacteria is rapidly increasing at an alarming rate. In fact, antibiotic resistance is one of the most serious threats in the history of medicine, and new antibiotics and alternative strategies should be sought as soon as possible to tackle this complex problem. We believe that traditionally used medicinal plant species harbour endophytes. Endophytes are microbes (bacteria and fungi) that live in plants without causing any disease symptoms, and are known to help the host plant in various ways, including protecting it from pathogens. Plants with antimicrobial properties are likely to have endophytes that produce novel antimicrobial bioactive compounds. Reports from published work show that the natural products derived from endophytes have antibacterial,2 antifungal, 3 and even antiviral 4 properties; therefore, endophytes could serve as an alternative source of novel antibiotics and could be useful in tackling antibiotic resistance. In many countries, plants are used in traditional medicine systems. If these medicinally important plant species are studied systematically for their endophytes and the natural products derived from endophytes, then these might provide several leads that could play an important part in dealing with antibiotic resistance. However, we should not preclude the importance of endophytes from species of monocotyledons, dicotyledons, gymnosperms, ferns, mosses, green algae, and red algae that are not reported as having medicinal uses. www.thelancet.com/infection Vol 14 July 2014
In addition to a clear plan, systematic coordinated efforts, both national and international, are needed to explore the potential of endophytes to produce novel antibiotics for various types of antibiotic-resistant bacteria (panel).5 Meaningful collaboration at local, national, regional, and international level is the key to success, and to achieve this, the scientific community could consider the establishment of an international consortium. In this regard, we call upon all leading scientists and policy makers (both at national and international level) who are involved directly or indirectly in the research to find new antibiotics (by using alternative strategies), to establish such a consortium to explore the potential of endophytes in producing novel antibiotics. This international consortium could be a part of a global plan to tackle antibiotic resistance and share the responsibilities of finding solutions. We declare no competing interests.
Tahmina Monowar, *Subhash J Bhore [email protected] Department of Biotechnology, Faculty of Applied Sciences, AIMST University, Bedong-Semeling Road, 08100 Bedong, Kedah, Malaysia (TM, SJB); and Department of Microbiology, Faculty of Medicine, AIMST University, Kedah, Malaysia (TM) 1
2
3
4
5
Laxminarayan R, Duse A, Wattal C, et al. Antibiotic resistance—the need for global solutions. Lancet Infect Dis 2013; 13: 1057–98. Ding L, Maier A, Fiebig HH, Lin WH, Hertweck C. A family of multicyclic indolosesquiterpenes from a bacterial endophyte. Org Biomol Chem 2011; 9: 4029–31. Miller CM, Miller RV, Garton-Kenny D, et al. Ecomycins, unique antimycotics from Pseudomonas viridiflava. J Appl Microbiol 1998; 84: 937–44. Ding L, Münch J, Goerls H, et al. Xiamycin, a pentacyclic indolosesquiterpene with selective anti-HIV activity from a bacterial mangrove endophyte. Bioorg Med Chem Lett 2010; 20: 6685–87. CDC. Antibiotic resistance threats in the United States, 2013. Atlanta: Centers for Disease Control and Prevention, 2013. http://www.cdc.gov/drugresistance/ threat-report-2013/ (accessed Nov 15, 2013).
Panel: Antibiotic resistance threats categorised into three levels of concern5 Urgent • Clostridium difficile • Carbapenem-resistant Enterobacteriaceae • Multidrug-resistant Neisseria gonorrhoeae Serious • Multidrug-resistant Acinetobacter spp • Multidrug-resistant Campylobacter spp • Fluconazole-resistant Candida spp* • Extended spectrum β-lactamase producing Enterobacteriaceae • Vancomycin-resistant Enterococcus spp • Multidrug-resistant Pseudomonas aeruginosa • Multidrug-resistant non-typhoidal Salmonella spp • Multidrug-resistant Salmonella Typhi • Multidrug-resistant Shigella spp • Methicillin-resistant Staphylococcus aureus • Multidrug-resistant Streptococcus pneumoniae • Multidrug-resistant tuberculosis Of concern • Vancomycin-resistant S aureus • Erythromycin-resistant group A Streptococcus spp • Clindamycin-resistant group B Streptococcus spp *All data are for bacteria, except for Candida (which is a fungus).
We read with great interest the recent Commission by Ramanan Laxminarayan and colleagues1 about antibiotic resistance and the need for global solutions. This problem has many different facets that can vary between regions and countries. In south Asia it is easy to buy antibiotics over the counter without a prescription, which obviously leads to overuse of these drugs and paves the way to resistance. But one could argue that in countries such as Nepal, where there might not be doctors in remote areas, antibiotic use without a doctor’s prescription could be essential to cure an illness, and perhaps even to save a life. But clearly, guidelines need to be formed and implemented, both for antibiotics that require a prescription and for those that do not. Doctors in Nepal and India are finding it more difficult to treat common infections, such as those in neonates and of the urinary tract, with the older generation of antibiotics. We increasingly use, when available, the 549
