I am currently reading ‘The Drugs Don’t Work’ by Professor Dame Sally Davies, Dr Jonathan Grant and Professor Mike Catchpole (yes, I know I’m several years late to this particular party). I might do a book review for the blog once I’ve finished it – but an interesting question emerged in the early chapters. The author seem to make a point of referring to ‘antimicrobials’ rather than ‘antibiotics’ in the early part of the book, but later on, antibiotics appears as a common term. Which got me to thinking about what is the most appropriate generic term for what most people would term ‘antibiotics’ (what your GP gives you when you’ve got a snuffle, I mean potentially serious bacterial infection)?
I think most experts agree that ‘antibiotics’ is not a good catch-all term to encompass antibacterials, antivirals, and antifungals. The tight definition of an antibiotic is a substance produced by a micro-organism to kill or inhibit another micro-organism. Plus, antibiotics are closely associated with antibacterials, so doesn’t do a good job of capturing antifungals and antivirals.
There are lots of different ways to approach this, but a working scheme for me also needs to find a home for biocides (chemicals applied for disinfection) and antiseptics (chemicals applied to the skin). So, I’ve come to the scheme above. As you can see, I have made anti-infectives subsidiary to antimicrobials, on a par with biocides and antiseptics.
I’d be interested in hearing what others think about this! Please comment away.
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Reflections on Infection Prevention and Control 
Would antimicrobial be generic across the field as opposed to just bacteria? Fungi etc?
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Yes, absolutely. But I think it’s a little too generic, since it also encompasses biocides and antiseptics. So, I think that anti-infective is the best catch-all for substances given to treat infections (antibacterials – which includes antibiotics and synthetic derivatives, antivirals, and antifungals).
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I like this scheme as I always feel unsure about the best names to use when teaching, so list alternative terms, which is boring and confusing for students. But I wonder, how good is the distinction between anti-infectives & antiseptics i.e. surely you can use some antiseptics “to treat infection”?
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Since antibiotics are closely associated with antibacterials, can we just use the latter term directly? I think adding the “anti-infective” layer also looks confusing. Here is what I think (may be naively?) the schema should look like:
antimicrobial -> biocides, antiseptics, anti-bacterial, anti-viral, anti-fungal
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I think its a very useful schematic Jon. Trust you to make sense of it all!
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I agree with your classification – the problem is that antibacterials was a term/claim introduced by the household care industry during the 1990s which – as far as I could see was intended an alternative to disinfectant. The public were beginning to see disinfectants as “too strong” – and because of this they were breeding superbugs! The idea was that antibacterial killed germs in a much gentle way and thus did not cause resistance to develop!! They also believe that antibacterial kill viruses. Educating the medai and public on this would be high impossible
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I also forgot to say – that I always use the term “microbiocides”. The EU has intriouced the Biocidal product regulations – which requires all biocides to be registered. The term biocide under BPR also includes persticides. There is a very passionate European lobby against use of pesticides as you know – so I make sure that I use the term MICRObiocide which ellcits a slightly more rational response!
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I think that ‘antibiotic’ should be at the same level as ‘anti-infective’, but distinct from it, and that both can lead to antibacterials, antivirals and antifungals. Both are anti-infectives, but should be distinguished to recognise the fact that the source of an antibiotic is specific, whereas (as far as I am aware) the source of an anti-infective is not. In addition, anti-parasitics are missing from the scheme and, I think, should be at the same level as antibacterials, antivirals and antifungals.
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Greetings
Interesting topic. However, I believe that your scheme is perfectible, as it places the size of the targeted organism as the broadest classification level when it is not, and the last refers to their initial method of production, which is obsolete.
Etymologically, “antimicrobial” designates something that adversely (anti-) acts on *microscopic* living organisms (microbes): using it as broadest classification level generates incongruity because it excludes parts of the narrower classification levels that it is supposed to contain. This incongruity is obvious in the case of the antiparasitic drugs, a class of anti-infective drugs that is missing in your classification scheme: the size range of adult parasitic nematodes and arthropods goes from microscopic to macroscopic, and many parasites that are macroscopic during their adult stage have microscopic larval stages.
The initial method of production is obsolete because, after having elucidated their molecular structure, most of the substances that once were produced by fermentation now are totally synthesized. This is true even for complex molecules possessing several enantiomeric carbons as part of their pharmacophore.
I believe that the broadest classification level is “biocide” (substances that kill living organisms), a narrower level would be the main intended use (e.g., anti-infective, disinfectant, antiseptic, food preservative), followed by the broad type of target organism (e.g., antiviral, antibacterial, antifungal, antiparasitic), and followed by a narrower type of target organism (e.g. antimycobacterial, antiprotozoal, anthelminthic, insecticide).
BTW, bacteriostatic drugs are included in the “biocide” classification category, because their mechanisms of action prevent the visible growth of the colony by increasing bacterial death rate to a level that is not substantially higher than its growth rate. They can be viewed as “time-dependent” bactericidal drugs.
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