There is already a magic potion for prophylaxis

Richard Stead, CEO of QURES, discusses how nature’s own antimicrobial defence mechanisms could offer a new approach to prophylaxis, helping reduce antibiotic use and combat antimicrobial resistance.

In a previous article, I argued that the widespread use of empiric prophylactic prescribing is one of the major contributors to antimicrobial resistance (AMR). At the end of that article, I suggested that what medicine needed was a “magic potion” that could save lives while avoiding the development of AMR.

I apologise for revisiting some of the same ground, but it is important to remind readers what AMR is, how it develops, and why an alternative approach is urgently needed. The irony is that the “magic potion” may already exist. Nature got there first.

The challenge of empiric prescribing

The fundamental problem is that empiric prescribing is inherently probabilistic. Clinicians prescribe prophylactic treatments based on likelihood rather than certainty. To avoid the risk of undertreatment, they often choose broad-spectrum antibiotics that can target multiple potential pathogens.

This approach is followed with the best of intentions. The goal is to save lives, and it does! However, it also exposes vast numbers of patients to unnecessary antimicrobial pressure, which contributes to the development of AMR which, as we know, is growing out of control, so we must take every step to combat this growth..

Doctors often feel compelled to take action. Patients expect treatment, and clinicians understandably do not want to stand by and simply hope that an infection does not develop.

To be clear, I am not blaming medical professionals for AMR. Perhaps no single group is responsible. Human frailty plays a part, and while human error undoubtedly contributes to many of society’s problems, I will leave that discussion for another time.

Instead, let us focus on the central idea behind this article.

Prophylaxis: A health and safety approach

Prophylaxis is an excellent concept. It is, in essence, a health and safety measure; it requires anticipating what could go wrong and taking steps to minimise or eliminate the risk.

In medicine for combating infections, however, there are limited options available to achieve this goal. Broad-spectrum antibiotics have become the default solution.

I believe there is another way.

Nature’s built-in defence system

When the human body was designed, nature had already considered health and safety. Defence mechanisms were built in to prevent pathogens from entering vulnerable areas of the body.

The skin provides an excellent protective barrier that pathogens generally cannot penetrate. The body’s vulnerable entry points are the natural openings such as the mouth, eyes, nose, and reproductive tract.

To protect these areas, nature employs a remarkably elegant system.

Two molecules are present throughout the body and are derived from components of our diet. Individually, these molecules have little defensive capability. Even together, they remain inactive. However, they are primed and ready to respond to a trigger.

This trigger is a third molecule and is supplied by the invading pathogen itself.

When all three molecules are present, an immediate chemical reaction occurs, producing a powerful antimicrobial substance capable of destroying a wide range of pathogens. In effect, the pathogen contributes to its own destruction.

The simplicity and effectiveness of this mechanism demonstrate once again how often nature provides solutions that humans later rediscover.

This is not intended to diminish the many remarkable medical innovations that have saved millions of lives. Rather, it highlights the value of learning from biological systems that have evolved over millions of years.

Nature’s own prophylactic strategy

The antimicrobial molecule produced by this reaction is called hypothiocyanite. I have discussed it in previous articles, but revisiting its chemistry has led me to a new conclusion.

Nature itself appears to favour a prophylactic approach.

The presence of the first two molecules creates a state of readiness. They are constantly available, waiting for the arrival of a pathogen. This built-in preparedness is, in essence, nature’s own form of prophylaxis.  It kills only the arriving pathogen and there is no lingering Hypothiocyanite that the pathogens can learn to survive.

However, the system is designed primarily to deal with relatively low levels of pathogens. When microbial loads become higher, additional support may be required.

Extending nature’s defence

This is where my company, QURES, comes in.

We sought to replicate nature’s defence mechanism by developing a kit called OSCEAUN®. The kit contains the three molecules required to generate hypothiocyanite. When mixed together, they create the same pathogen-destroying molecule found in nature’s own defence system.

We are not proposing the use of OSCEAUN® as a prophylactic medication before surgery. Instead, we envisage its use immediately after a procedure.

Its role would be to suppress the growth of any potential infection, creating a valuable window of time during which the specific pathogen can be identified and the most appropriate antibiotic or antimicrobial selected.

A potential benefit for patients and AMR

Under this approach, patients gain reassurance that action has been taken. Clinicians gain time to make evidence-based treatment decisions. Most importantly, unnecessary exposure to broad-spectrum antibiotics should   be reduced.

The result is a better outcome for the patient while avoiding interventions that may contribute to antimicrobial resistance.

The wider benefits of OSCEAUN® and its potential impact on prophylactic prescribing have been explored in my earlier articles.

A final thought

Once again, this discussion highlights the importance of maintaining a balanced and varied diet. The body’s natural defence systems depend upon nutrients obtained from the foods we eat.

Nature has already provided many of the tools required to protect human and animal health. Perhaps the challenge is not inventing entirely new solutions but recognising and learning from those that already exist.  We need to prepare patients before and during procedures, then the time for recovery to ensure their prophylactic status is fully loaded and primed.

Let us not forget, these pathogens do not announce their arrival, so maintaining a high state of prophylactic readiness is important at all times.  In a subsequent article, I will outline those various elements in our diets that will keep us primed and ready to combat Infections and AMR.  I will hesitate to call it Hospital Food because that conjures up unpleasant images, but look out for maybe QURES FOOD. Or FOOD for QURES!