Antimicrobial
An antimicrobial is an agent that kills microorganisms or stops their growth. Antimicrobial medicines can be grouped according to the microorganisms they are used to treat. For example, antibiotics are used against bacteria, and antifungals are used against fungi. They can also be classified according to their function. Antimicrobial medicines to treat infection are known as antimicrobial chemotherapy, while antimicrobial drugs are used to prevent infection, which known as antimicrobial prophylaxis.
The main classes of antimicrobial agents are disinfectants, which kill a wide range of microbes on surfaces to prevent the spread of illness, antiseptics which are applied to living tissue and help reduce infection during surgery, and antibiotics which destroy microorganisms within the body. The term antibiotic originally described only those formulations derived from living microorganisms but is now also applied to synthetic agents, such as sulfonamides or fluoroquinolones. Though the term used to be restricted to antibacterials, its context has broadened to include all antimicrobials. In response, further advancements in antimicrobial technologies have resulted in solutions that can go beyond simply inhibiting microbial growth. Instead, certain types of porous media have been developed to kill microbes on contact. The misuse and overuse of antimicrobials in humans, animals and plants are the main drivers in the development of drug-resistant pathogens. It is estimated that bacterial antimicrobial resistance was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths.
History
Antimicrobial use has been common practice for at least 2000 years. Ancient Egyptians and ancient Greeks used specific molds and plant extracts to treat infection.In the 19th century, microbiologists such as Louis Pasteur and Jules Francois Joubert observed antagonism between some bacteria and discussed the merits of controlling these interactions in medicine. Louis Pasteur's work in fermentation and spontaneous generation led to the distinction between anaerobic and aerobic bacteria. The information garnered by Pasteur led Joseph Lister to incorporate antiseptic methods, such as sterilizing surgical tools and debriding wounds into surgical procedures. The implementation of these antiseptic techniques drastically reduced the number of infections and subsequent deaths associated with surgical procedures. Louis Pasteur's work in microbiology also led to the development of many vaccines for life-threatening diseases such as anthrax and rabies. On September 3, 1928, Alexander Fleming returned from a vacation and discovered that a Petri dish filled with Staphylococcus was separated into colonies due to the antimicrobial fungus Penicillium rubens. Fleming and his associates struggled to isolate the antimicrobial but referenced its therapeutic potential in 1929 in the British Journal of Experimental Pathology. In 1942, Howard Florey, Ernst Chain, and Edward Abraham used Fleming's work to purify and extract penicillin for medicinal uses earning them the 1945 Nobel Prize in Medicine.
Chemical
Antibacterials
Antibacterials are used to treat bacterial infections. Antibiotics are classified generally as beta-lactams, macrolides, quinolones, tetracyclines or aminoglycosides. Their classification within these categories depends on their antimicrobial spectra, pharmacodynamics and chemical composition. Prolonged use of certain antibacterials can decrease the number of enteric bacteria, which may have a negative impact on health. Consumption of probiotics and healthy eating may help to replace destroyed gut flora. Stool transplants may be considered however for patients who are having difficulty recovering from prolonged antibiotic treatment, such as recurrent Clostridioides difficile infections.The discovery, development and use of antibacterials during the 20th century have reduced mortality from bacterial infections. The antibiotic era began with the therapeutic application of sulfonamide drugs in 1936, followed by a "golden" period of discovery from about 1945 to 1970, when a number of structurally diverse and highly effective agents were discovered and developed. Since 1980, the introduction of new antimicrobial agents for clinical use has declined, in part because of the enormous expense of developing and testing new drugs. In parallel, there has been an alarming increase in antimicrobial resistance of bacteria, fungi, parasites and some viruses to multiple existing agents.
Antibacterials are among the most commonly used and misused drugs by physicians, for example, in viral respiratory tract infections. As a consequence of widespread and injudicious use of antibacterials, there has been an accelerated emergence of antibiotic-resistant pathogens, resulting in a serious threat to global public health. The resistance problem demands that a renewed effort be made to seek antibacterial agents effective against pathogenic bacteria resistant to current antibacterials. Possible strategies towards this objective include increased sampling from diverse environments and application of metagenomics to identify bioactive compounds produced by currently unknown and uncultured microorganisms as well as the development of small-molecule libraries customized for bacterial targets.
Antifungals
Antifungals are used to kill or prevent further growth of fungi. In medicine, they are used as a treatment for infections such as athlete's foot, ringworm and thrush and work by exploiting differences between mammalian and fungal cells. Unlike bacteria, both fungi and humans are eukaryotes. Thus, fungal and human cells are similar at the molecular level, making it more difficult to find a target for an antifungal drug to attack that does not also exist in the host organism. Consequently, there are often side effects to some of these drugs. Some of these side effects can be life-threatening if the drug is not used properly.As well as their use in medicine, antifungals are frequently sought after to control indoor mold in damp or wet home materials. Sodium bicarbonate blasted on to surfaces acts as an antifungal. Another antifungal solution applied after or without blasting by soda is a mix of hydrogen peroxide and a thin surface coating that neutralizes mold and encapsulates the surface to prevent spore release. Some paints are also manufactured with an added antifungal agent for use in high humidity areas such as bathrooms or kitchens. Other antifungal surface treatments typically contain variants of metals known to suppress mold growth e.g. pigments or solutions containing copper, silver or zinc. These solutions are not usually available to the general public because of their toxicity.
Antivirals
Antiviral drugs are a class of medication used specifically for treating viral infections. Like antibiotics, specific antivirals are used for specific viruses. They should be distinguished from viricides, which actively deactivate virus particles outside the body.Many antiviral drugs are designed to treat infections by retroviruses, including HIV. Important antiretroviral drugs include the class of protease inhibitors. Herpes viruses, best known for causing cold sores and genital herpes, are usually treated with the nucleoside analogue acyclovir. Viral hepatitis is caused by five unrelated hepatotropic viruses and may be treated with antiviral drugs depending on the type of infection. Some influenza A and B viruses have become resistant to neuraminidase inhibitors such as oseltamivir, and the search for new substances continues.
Antiparasitics
Antiparasitics are a class of medications indicated for the treatment of infectious diseases such as leishmaniasis, malaria and Chagas disease, which are caused by parasites such as nematodes, cestodes, trematodes and infectious protozoa. Antiparasitic medications include metronidazole, iodoquinol and albendazole. Like all therapeutic antimicrobials, they must kill the infecting organism without serious damage to the host.Broad-spectrum therapeutics
Broad-spectrum therapeutics are active against multiple classes of pathogens. Such therapeutics have been suggested as potential emergency treatments for pandemics.Non-pharmaceutical
A wide range of chemical and natural compounds are used as antimicrobials. Organic acids and their salts are used widely in food products, e.g. lactic acid, citric acid, acetic acid, either as ingredients or as disinfectants. For example, beef carcasses often are sprayed with acids, and then rinsed or steamed, to reduce the prevalence of Escherichia coli.Heavy metal cations such as Hg2+ and Pb2+ have antimicrobial activities, but can be toxic. In recent years, the antimicrobial activity of coordination compounds has been investigated.
Traditional herbalists used plants to treat infectious disease. Many of these plants have been investigated scientifically for antimicrobial activity, and some plant products have been shown to inhibit the growth of pathogenic microorganisms. A number of these agents appear to have structures and modes of action that are distinct from those of the antibiotics in current use, suggesting that cross-resistance with agents already in use may be minimal.