This year marks the 100^th anniversary of the awarding of the Nobel Prize for Physiology or Medicine to German physician Robert Koch. Koch received the prize for developing methods for isolating pure colonies of microorganisms. His principles for identifying the cause of an infectious disease, known as Koch’s Postulates, remain a standard in medicine today.

As valuable as Koch’s contributions were to the advancement of science they have limited our understanding of the infectious process. Koch’s postulates state that each infection is caused by one specific organism, which can be identified by being grown in the laboratory. While this is generally true in the case of acute infections, it is almost never true in chronic infections, a fact that is only now being recognized.

The antibiotic era grew out of Koch’s work. If an infection is due to a specific organism – streptococcus, for example – an antibiotic such as penicillin can be used to help the body eliminate the agent and regain health. This approach does work effectively in acute infections. A strep throat can be cleared in a matter of days using penicillin. Acute cystitis (a bladder infection) can be eliminated with as little as one dose of the proper antibiotic. Acute sinusitis responds nicely to antibiotic treatment.

This is not the case in chronic infections, however. Chronic tonsillitis (recurring or persistent throat infections) does not respond well to antibiotics. Over 400,000 tonsillectomies are performed annually in the United States, most because of chronic tonsillitis.

Chronic cystitis (persistent or recurrent bladder infections), chronic sinusitis, chronic prostatitis, chronic decubiti (bedsores), and other persistent infections fare no better with antibiotic treatment. Nevertheless, physicians continue to prescribe the same treatment – higher doses of broader spectrum antibiotics for longer periods of time. This rarely results in a cure and commonly contributes to the emergence of microorganisms that are resistant to the drugs being prescribed.

The reason that antibiotics work well in acute infections but rarely, if ever, clear chronic infections is the existence of biofilms, a phenomenon that Koch and subsequent generations of physicians and microbiologists did not understand or appreciate.

The growth of a pure strain of a microorganism in a laboratory is an aberration. Pure, free-floating strains of bacteria rarely exist in nature. Instead, they grow in colonies. If you have ever slipped on a slick rock while wading across a stream or cleaned a slimy film from a sink, countertop, or bathtub you have encountered a biofilm. When you floss and brush your teeth to prevent plaque build-up you are fighting a biofilm.

Biofilms consist of colonies of microorganisms that have attached themselves to a surface and surrounded themselves with a protective cover of slime made up predominately of sugars. Once surrounded, the bacteria, fungi, and other organisms are largely impervious to the effects of antibiotics and the actions of the body’s immune system. They are able to survive indefinitely. Bits of the biofilm can break off and establish new colonies in additional locations.

We are familiar with colonization of insects. We have long recognized that bees in a hive have specialized duties: the queen, the drones, and the workers. We have known for millenia that ants are social insects that work together for the benefit of the community. Only recently have we realized that “simple” one-celled organisms such as bacteria and yeasts adapt to communal living, with specialized roles and patterns of behavior.

While biofilms can consist of a single strain of bacteria, they are commonly comprised of multiple bacterial species and can simultaneously harbor fungi, algae, and protozoa. Biofilms are uniquely structured to allow their survival. Channels are formed within which nutrients can circulate. Organisms in different regions of the biofilm exhibit different patterns of behavior. Those close to the surface adopt characteristics that help them protect the community as a whole. Organisms deeper in the biofilm typically enter a state of hibernation in which they are completely resistant to antibiotic attack.

The recognition that biofilms exist and an appreciation for their resistance to assault by antimicrobial agents or the body’s immune system should profoundly affect our approach to chronic infections. Biofilms are responsible for or involved in nearly all chronic infections. The Center for Disease Control estimates that sixty-five percent of all human infections involve biofilms, although some authorities believe that up to eighty percent of infections are due to biofilms.

The fact that biofilms are extremely resistant to the effects of antibiotics explains, to a great degree, why chronic infections are so difficult to eradicate. Biofilms are at least 500 times more resistant to antibiotics than free-floating organisms, and they are well suited to produce strains of bacteria that are themselves resistant to the effects of the drugs.

Specific examples of infections involving biofilms have emerged over the past decade. One is chronic tonsillitis. In this condition a grayish-white coating is commonly seen. Until recently, this was believed to consist of cellular debris. It is now known that the films are actually biofilms that have been found to contain as many as nine different types of bacteria. Tonsils that do not appear infected but require removal because they are abnormally large and are restricting airflow have also been found to contain biofilms.

Another is chronic cystitis. Bladder infections are extremely common. One out of every two women will experience a bladder infection at least once in her lifetime. Twenty to forty percent of those will be plagued by recurrent infections. Physicians have traditionally believed that each subsequent infection arose in the same manner as the first, from bacteria migrating from the intestinal tract into the bladder. Research has now shown that bacteria are capable of actually invading cells in the bladder wall where they establish biofilms. These biofilms, which are resistant to antibiotic treatment, periodically release bacteria that inflame the bladder lining and trigger the symptoms of a bladder infection.

Examples of biofilm related infections abound. Chronic prostatitis, chronic sinusitis, chronic otitis media (middle ear infection), Legionnaire’s disease, and infections in catheters and prosthetic devices are all caused by biofilms. Dental implants and root canal sites also commonly harbor biofilms. Such infections may smolder for months, years, or even a lifetime. They may not be fatal, but quality of life can be severely compromised.

Since the publication of a landmark article in the May 21, 1999 issue of the journal Science interest in biofilms has increased rapidly. Research is now underway to develop drugs that are capable of breaking up biofilms and making the microorganisms within them vulnerable to antibiotics and the body’s immune response. Fortunately, non-pharmacologic substances that are capable of destroying biofilms have already been discovered.

Dental plaque is the most commonly encountered biofilm in the human body. Propolis, a sticky, glue-like substance produced by bees when building their hives has been shown to be effective in eliminating plaque build-up when used in toothpaste. Likewise, numerous essential oils such as clove, thyme, tea tree, peppermint, spearmint, almond and others are effective at breaking up dental plaque.

Many years ago I discovered that an Ayurvedic product, Septilin (also called ImmunoCare), was highly effective in clearing chronic tonsillitis, eliminating the need for surgery. (Ayurveda is the traditional herbal medical system of India.) While its action against biofilms has not been specifically studied, over one hundred clinical studies document the formulation’s effectiveness in a wide array of chronic infections including chronic otitis media, chronic tonsillitis, gingivitis, chronic sinusitis, infected burns, chronic bronchitis, and chronic urinary tract infections.

Recently I have found another product, Microstat, that is specifically formulated to break up and destroy biofilms. I have found it to be consistently effective in clearing long-standing infections.

Effective disease management is largely dependent upon a correct understanding of the mechanisms involved. A fundamental misunderstanding of the nature of chronic infections has led to a dismal record in clearing them. Having discovered their true nature it is now possible to bring relief to millions of afflicted individuals. Once again, the truth has set us free.