Military Medicine and its Relationship with Antibiotic Therapy

This article was exclusively written for The European Sting by Mr. Pedro Henrique Della Garza Oiticica Moreira, a Brazilian academic in the 6th Semester of Medical School of the Universidade Federal de Juiz de Fora – Campus Governador Valadares. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

---

While Alexander Fleming’s discovery of the effect of Penicillium notatum against Staphylococcus in 1928 was a milestone in the fight against bacterial infections, the scientific effort to produce what we know today as penicillin came only because of the allied interest in World War II. Through the British and United States (US) technical effort association, within five years of research there was already large-scale production of the antimicrobial, and by June 6, 1945, the soldiers who landed in Normandy already carried penicillin. This is just one example of the close relationship of military history to the development of medicine and antibiotic therapy (Quinn, 2013; Adedeji, 2016). The transfer of the military to the conflict area leads to the recolonization of their microbiota and, especially for those sent to tropical regions, the acquisition of multiresistant bacteria has become a challenge both in maintaining the troop on mission and in its return because of the consequent dispersion of the pathogen in the home country (mainly for those transported in serious condition) (Frickmann et al, 2018). The US Army confirmed in 2018 that while no casualties were reported by resistant bacteria in the military sent to Iraq, at least five critically ill patients sharing the same hospital that them are suspected of having died on account of this relationship; Yun et al (2006) had published an article reporting the high rate of skin and mucous colonization of soldiers sent to Iraq. Military personnel in conflict zones are exposed to environments of physical stress, human agglomeration and poor hygiene resources that naturally trigger infections and epidemics, as well as disfavoring the spontaneous decolonization of resistant pathogens (Münch et al, 2017). Added to this are combat injuries (shocks, penetrating trauma, exposed wounds, and foreign body implantations) and field hospital surgeries with little chance of adequate prophylaxis leading to risks for both the injured military and the health worker taking care of them (Granzer et al, 2016). The depletion of resources in this environment also leads to difficulty in diagnosis and infections, if not properly treated, may increase the risk of selection of resistant bacteria (Frickmann et al, 2018). All this combined with the memories of the horrors of World War I (pre-Antibiotic Era) field hospitals where 90% of the wounds were infected and high rates of tetanus and gangrene were common – with reports such as “I remember the smell of the wounds more than anything”- (Runcie, 2015), makes the subject of antibiotic resistance very dear for military medicine. Associations such as the Massachusetts Institute of Technology (MIT) and the US Army for bacteriophage development and the establishment of a global microorganism surveillance database promoted by the US Army Research Laboratory exemplify how allying civilians and military is an alternative to the common challenge of microbial resistance (as done in World War II). References

434. Quinn. (2013). Rethinking antibiotic research and development: World War II and the penicillin collaborative. American journal of public health, 103(3), 426–434.
435. A. Adedeji. (2016). THE TREASURE CALLED ANTIBIOTICS. Annals of Ibadan postgraduate medicine, 14(2), 56–57.
436. Frickmann, A. Podbielski, & B. Kreikemeyer. (2018). Resistant Gram-Negative Bacteria and Diagnostic Point-of-Care Options for the Field Setting during Military Operations. BioMed research international, 2018, 9395420.

US Army. (2018). Army Medicine in Thick of War on Antibiotic-Resistant Bacteria.

825. C. Yun, C. K. Murray, S. A. Roop et al. (2006). Bacteria recovered from patients admitted to a deployed U.S. military hospital in Baghdad, Iraq. Military Medicine, 171 (9) 821–825.
826. Münch, R. M. Hagen, M. Müller et al. (2017), Colonization with multidrug-resistant bacteria — on the efficiency of local decolonization procedures. European Journal of Microbiology and Immunology, 7 (2), 99–111.
827. Granzer, R. M. Hagen, P. Warnke et al. (2016). Molecular Epidemiology of Carbapenem-Resistant. European Journal of Microbiology and Immunology, 6 (2), 109–117.
828. Frickmann, T. Köller, R. M. Hagen et al. (2018). Molecular epidemiology of multidrug-resistant bacteria isolated from Libyan and Syrian patients with war injuries in two Bundeswehr hospitals in Germany. European Journal of Microbiology and Immunology, 8 (1), 1–1.
829. Runcie. (2015). Infection in a pre-antibiotic era. Journal of Infectious Diseases and Preventive Medicine, 3, 125.

US Army, (2018). Engineered viruses could protect Soldiers, fight antibiotic resistance. About the author Pedro Henrique Della Garza Oiticica Moreira is a Brazilian academic in the 6th Semester of Medical School of the Universidade Federal de Juiz de Fora – Campus Governador Valadares where he is affiliated to IFMSA-Brazil and operates as Local Officer on Research Exchange – Director (LORE-D). Graduated from Juiz de Fora Military School and Army Cadet Preparatory School, was also a cadet at the Agulhas Negras Military Academy. He is currently part of the research group linked to the National Council for Scientific and Technological Development (CNPq) called “Science, Health and Society” studying the epidemiology applied to the Brazilian Armed Forces.