OCTOBER 26 — Imagine taking antibiotics for a urinary tract infection, only for the infection to return weeks later. Or having a wound that refuses to heal despite repeated treatment. For some patients, the problem is not simply that antibiotics have stopped working. It is that bacteria have found clever ways to protect themselves. One of their most effective survival strategies is building a protective layer known as a biofilm.

Antibiotic resistance is among the world’s most serious public health challenges. In 2021, bacterial resistance to antibiotics was estimated to have directly caused 1.14 million deaths worldwide and contributed to another 4.71 million deaths.

Researchers have warned that, without stronger action, antibiotic-resistant infections could directly cause more than 39 million deaths globally between 2024 and 2050. These figures highlight the urgent need for better ways to prevent and treat infections. However, scientists are discovering that fighting bacteria is not always about developing stronger antibiotics. Sometimes, the challenge is finding a way to reach them.

How bacteria build their own fortress

Have you ever noticed a slippery layer on a wet stone or the surface of a neglected water container?

That slimy coating can contain what scientists call a biofilm. Biofilms form when bacteria attach themselves to a surface and produce a sticky protective layer made of sugars, proteins and genetic material. Think of it as a fortress built by bacteria to shield themselves from danger.

Inside this fortress, bacteria can become difficult for antibiotics and the body’s immune system to reach. Some bacteria also enter a resting state, making them less vulnerable to medicines that normally target actively growing bacteria. Interestingly, these bacteria are not necessarily resistant to antibiotics in the usual sense. Instead, their protective surroundings make treatment less effective.

If scientists can break down this protective barrier, existing antibiotics may regain some of their effectiveness. Biofilms are associated with several health problems, including persistent wounds, recurring urinary tract infections, dental plaque and certain lung infections.

Tiny particles with enormous potential

This is where nanotechnology offers an exciting possibility. Nanotechnology involves working with materials so small that they cannot be seen with the naked eye. Scientists are investigating nanoparticles, extremely tiny structures that can carry medicines directly to difficult-to-reach areas.

Imagine a miniature delivery vehicle transporting antibiotics through a bacterial fortress. One example involves liposomes, tiny bubble-like structures made from fatty materials that can carry medicines. By packaging antibiotics inside these particles, researchers hope to improve how effectively the medicines reach bacteria protected within biofilms. Rather than simply increasing antibiotic doses, which can cause additional problems, this approach aims to deliver medicines more precisely.

From laboratory research to real patients

Nanotechnology-based antibiotic delivery is not entirely new. In 2018, the United States Food and Drug Administration approved Arikayce, an inhaled antibiotic packaged inside liposomes, for certain patients with a difficult-to-treat lung infection.

In a clinical trial, 29 per cent of patients receiving the treatment had no detectable bacteria in their sputum samples over three consecutive months, compared with nine per cent receiving standard treatment alone. Although this medicine is intended for a specific lung infection, its development demonstrates the potential of nanoparticle-based drug delivery.

Scientists are now exploring ways to combine nanoparticles with substances capable of breaking down bacterial biofilms. For example, an enzyme called alginate lyase can help break down the sticky material produced by certain bacteria, including Pseudomonas aeruginosa, which can cause serious lung infections.

Researchers are studying whether nanoparticles can protect this enzyme and help deliver it to bacterial biofilms. Some laboratory experiments have also combined these approaches with antibiotics such as ciprofloxacin, producing encouraging results in disrupting bacterial biofilms. However, most of these newer approaches remain experimental and require further safety testing and clinical trials before they can be used routinely in patients.

A promising future, but prevention remains essential

Nanotechnology could eventually help doctors make better use of antibiotics already available, particularly against persistent infections. Nevertheless, nanoparticles are not a miracle cure, and many scientific challenges remain.

The most important message for the public is that antibiotics must be used responsibly. Antibiotics should only be taken when prescribed by a qualified healthcare professional, and they should never be shared or used to treat viral infections such as the common cold.

Bacteria have developed remarkable ways to survive. With advances in science, researchers are learning how to overcome their defences. Perhaps one day, some of our most powerful weapons against dangerous bacteria will be particles too small for us to see.

* Dr Erazuliana Abd Kadir is a senior lecturer at Pusat Kanser Tun Abdullah Ahmad Badawi, Universiti Sains Malaysia.

** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.