Antibiotics vs. Antivirals

The clinical introduction of antibiotics was one of the most important medical achievements of the twentieth century.⁴ In addition to preventing and fighting bacterial infections, antibiotics have permitted doctors to treat cancer, transplant organs, and perform open-heart surgery, among other procedures.⁴ Another lifesaving resource in modern medicine is antivirals, which are capable of preventing and fighting viral infections. These two classes of medications are distinct, though the conditions for which they are used often have similar symptoms. Increasing understanding of the differences between antibiotics vs. antivirals is also an important public health goal. 

The earliest antibiotics were traditional poultices from moldy bread used to treat open wounds in Serbia, China, Greece, and Egypt. ⁴ Antibiotics are among the most widely used pharmaceuticals in the world, with more than 250 antibiotics approved for human and animal medicine to kill or inhibit the growth of various bacteria.¹² Antibiotics are chemical compounds derived from natural, semi-natural or synthetic sources. ¹² These compounds can be separated into broad groups based on their chemical structure, the scope of their activities, and the mechanism by which they kill bacteria.¹² According to their chemical makeup, antibiotics can be classified into the following groups: lactams, macrolides, fluoroquinolones, tetracyclines, and sulfonamides.¹² The spectrum of activity of antibiotics is also divided into three classes: narrow-spectrum, broad-spectrum, and extended-spectrum.¹² Additionally, antibiotics are categorized based on their work, including the ability to kill bacteria and inhibit their growth.¹² 

Viruses are among the top of the World Health Organization’s current list of ten global health threats.¹¹ These complex organisms have caused millions of deaths globally throughout human history.⁵ Antivirals, a specialized class of pharmaceuticals, are one of the fascinating aspects of virology since they have successfully leveraged basic science to generate very effective therapeutics for many severe viral infections.^5,9 These medications are divided into two categories based on their mechanism of action: those that stimulate the immune system to fight viruses and those that attack viruses directly.⁵ Antiviral therapies’ potential effectiveness is greatly influenced by the pathogenesis, transmission, and epidemiological features of the virus.⁹ Viruses with a relatively short incubation period and generation time, as well as a quick rate of transmission, tend to be poor candidates for antiviral treatment because timely diagnosis and initiation of therapy is challenging.⁹ When comparing antibiotics vs. antivirals, the two types of medication have some similar strategies and limitations at a high level but differ greatly in their targets and their specific mechanisms. 

Despite advancements in technology and improvements in quality assurance, only a limited number of novel antiviral medications have been developed. ⁸ However, it is essential to highlight that the development of pharmaceutical drugs is a complex, multi-stage process that includes target identification and screening, lead generation and optimization, clinical trials, and drug registration with the FDA.⁷ Current antiviral medications and vaccines are ineffective against new and recurring viral infections.⁵ Finding therapeutic targets that inhibit the virus without harming the host’s cells is challenging.⁵ Long-term usage might result in unpleasant side effects such as gastrointestinal difficulties, exhaustion, headaches, neuropathy, and liver damage.¹ Furthermore, viruses, particularly RNA viruses, have rapidly acquired resistance to existing antiviral therapy due to their immense genetic variety.¹⁰ Since antivirals are the only therapeutic technique capable of breaking the viral replication cycle, newer antiviral treatments must be developed to fight this issue.^5,9  

Resistance to therapy has also been observed with antibiotics.⁶ The need for novel antibacterial medications to multidrug-resistant (MDR) bacterial infections is a significant global health concern, notably acknowledged by many global health officials across numerous organizations.² Developing novel antibacterial therapeutics that are effective against MDR is challenging due to difficulties in producing products with promising pharmacokinetics and pharmacodynamics qualities and acceptable toxicity profiles.² The problem of drug resistance is exacerbated by improper use of antibiotics vs. antivirals in place of the other, whether due to clinical uncertainty, misdiagnosis, or insufficient training. 

References 

1. “Antivirals: Antiviral Medication, What They Treat & How They Work.” Cleveland Clinic, https://my.clevelandclinic.org/health/drugs/21531-antivirals.  

2. Butler, M. S., Gigante, V., Sati, H., Paulin, S., Al-Sulaiman, L., Rex, J. H., Fernandes, P., Arias, C. A., Paul, M., Thwaites, G. E., Czaplewski, L., Alm, R. A., Lienhardt, C., Spigelman, M., Silver, L. L., Ohmagari, N., Kozlov, R., Harbarth, S., & Beyer, P. (2022). Analysis of the Clinical Pipeline of Treatments for Drug-Resistant Bacterial Infections: Despite Progress, More Action Is Needed. Antimicrobial agents and chemotherapy, 66(3), e0199121. https://doi.org/10.1128/AAC.01991-21 

3. Frieri, M., Kumar, K., & Boutin, A. (2017). Antibiotic resistance. Journal of infection and public health, 10(4), 369–378. https://doi.org/10.1016/j.jiph.2016.08.007 

4. Hutchings, M. I., Truman, A. W., & Wilkinson, B. (2019). Antibiotics: past, present and future. Current opinion in microbiology, 51, 72–80. https://doi.org/10.1016/j.mib.2019.10.008 

5. Kausar, S., Said Khan, F., Ishaq Mujeeb Ur Rehman, M., Akram, M., Riaz, M., Rasool, G., Hamid Khan, A., Saleem, I., Shamim, S., & Malik, A. (2021). A review: Mechanism of action of antiviral drugs. International journal of immunopathology and pharmacology, 35, 20587384211002621. https://doi.org/10.1177/20587384211002621 

6. Laws, M., Shaaban, A., & Rahman, K. M. (2019). Antibiotic resistance breakers: current approaches and future directions. FEMS microbiology reviews, 43(5), 490–516. https://doi.org/10.1093/femsre/fuz014Richman, D. D., & Nathanson, N. (2016). Antiviral Therapy. Viral Pathogenesis, 271–287. https://doi.org/10.1016/B978-0-12-800964-2.00020-3 

7. Mohs, R. C., & Greig, N. H. (2017). Drug discovery and development: Role of basic biological research. Alzheimer’s & dementia (New York, N. Y.), 3(4), 651–657. https://doi.org/10.1016/j.trci.2017.10.005 

8. Monto, A. S. (2006). Vaccines and Antiviral Drugs in Pandemic Preparedness. Emerging Infectious Diseases, 12(1), 55-60. https://doi.org/10.3201/eid1201.051068 

9. Richman, D. D., & Nathanson, N. (2016). Antiviral Therapy. Viral Pathogenesis, 271–287. https://doi.org/10.1016/B978-0-12-800964-2.00020-3 

10. Vere Hodge, A., & Field, H. J. (2011). General Mechanisms of Antiviral Resistance. Genetics and Evolution of Infectious Disease, 339–362. https://doi.org/10.1016/B978-0-12-384890-1.00013-3 

11. World Health Organization. Ten Health Issues Who Will Tackle This Year, World Health Organization, https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019.  

12. Yang, Q., Gao, Y., Ke, J., Show, P. L., Ge, Y., Liu, Y., Guo, R., & Chen, J. (2021). Antibiotics: An overview on the environmental occurrence, toxicity, degradation, and removal methods. Bioengineered, 12(1), 7376–7416. https://doi.org/10.1080/21655979.2021.1974657