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00:05:41Hello, this is.
00:05:50Tsarenko, chief resuscitator of the Ministry of Health
00:05:53of the Russian Federation. Sergey, what are antibiotics? Well, it's
00:05:57something against life, antibiosis? Well, that's terrible, we
00:06:00are also alive. I thought that antibiotics are medicine, no? Well,
00:06:03absolutely right, yes, but there are
00:06:06two types of animal world, prokaryotes
00:06:10and eukaryotes. We, thank God, are eukaryotes. That is, with
00:06:13a nucleus, and those without a nucleus, bacteria, the nucleus is what is inside
00:06:17us, it is our essence inside the cell, that which is inside
00:06:20the cell, when there is no nucleus, these are
00:06:23prokaryotes, bacteria, against them are antibiotics, although in general there are also antibiotics
00:06:27against tumors, but mostly they are against bacteria. Who produces them?
00:06:30Did chemists make them? Where do these substances come from in general?
00:06:34Well, for a start, they were actually found in
00:06:37nature, it's a way for
00:06:40bacteria to coexist
00:06:43with each other. Some bacteria produce antibiotics to expel other
00:06:46bacteria from their living
00:06:48niches, a struggle for
00:06:52food, for living space, and
00:06:55so on. And what does medicine have to do with it? We also have microbes on us, inside
00:06:58us, and antibiotics inside
00:07:01us too. Well, our bacteria also produce them, but actually
00:07:05our bacteria certainly don't produce the most powerful antibiotics
00:07:09that live in us.
00:07:12Uh... mostly these antibiotics are produced by bacteria
00:07:15living in the soil, so they are found
00:07:18there. After that, there are two options:
00:07:22modify them partially chemically,
00:07:25and the third way is to create an antibiotic
00:07:28entirely artificially, similar to the one found in
00:07:32nature. And these are some factories, microbiological industry or
00:07:35a chemical factory that makes this substance, it's some kind of molecule, right?
00:07:39It's a molecule. You are an intensivist. Do
00:07:43you encounter antibiotics in your medical practice?
00:07:45This is generally one of the main
00:07:48points of attention for me
00:07:52as an intensivist, because without
00:07:54antibiotics, modern
00:07:58intensive care will die. We use antibiotics in
00:08:02several situations. First, it's prophylactic antibiotic administration,
00:08:05for example, a patient is going for a planned surgical operation. This
00:08:09involves an incision of the skin before the surgical intervention.
00:08:12Therefore, perioperative antibiotic prophylaxis exists as
00:08:16a reasonable measure to reduce potential, but this
00:08:20is only in hospitals, that is, antibiotics, as I understand,
00:08:23are not taken preventively at home. No, this concerns
00:08:27a specific surgical intervention, and this
00:08:30antibiotic is administered about half an hour before the operation, with the expectation
00:08:34that it will only act during the surgical intervention. This
00:08:38is a single administration, it is a single or in extreme cases a double administration repeated during the operation.
00:08:41If the operation is long, and what if the antibiotic doesn't
00:08:45work? Then what? And if one
00:08:47antibiotic didn't work, then
00:08:50some inflammatory, purulent
00:08:53problems arose, then the antibiotic is changed. And if the second didn't
00:08:57work, it's changed to the
00:08:59third.
00:09:02Unfortunately, now we cannot
00:09:05choose for very long, because
00:09:08we live in an era of multi-resistant
00:09:11bacteria. This means that bacteria have multiple
00:09:15resistance to various groups of antibacterial drugs.
00:09:18Therefore, such a trial and error, as I said, is certainly not so blind, just one
00:09:22is prescribed, another is thrown out. It is selected based on the results of certain
00:09:25bacteriological studies, but nevertheless, the number of antibiotics that we can use in our
00:09:29clinical practice is now
00:09:32very limited. And why? I understood
00:09:35that, well, there are a lot of microbes around us, right? And
00:09:39you said that they communicate with each other through.
00:10:12chemically creates this antibiotic, it spends
00:10:15significant effort on the initial stage of finding
00:10:19or creating this molecule. The next stage is the company
00:10:23must test this antibiotic for effectiveness, for its
00:10:27possible side effects, for toxicity, and so on and so
00:10:30forth. This takes quite a lot of
00:10:33time and money, because modern options for
00:10:36bringing a drug to market carry a lot
00:10:40of restrictions. This is very reasonable, because it's a way
00:10:43to protect the patient from some
00:10:46undesirable side effects, everything must be studied quite
00:10:49thoroughly. The moment when the company finally passed this
00:10:52thorny path, spent...
00:11:25as a matter of fact, they have many
00:11:27mechanisms to hinder antibiotics. And what does this mean?
00:11:31You say that development is underway, scientists, companies
00:11:34made an antibiotic that kills bacteria. Well,
00:11:37Pseudomonas aeruginosa, you probably encounter it in your practice, right? So
00:11:41the name is beautiful, the antibiotic kills it. So everything is already
00:11:44like a magic bullet, everything is ready. Why does the problem
00:11:48arise in the first place? What is the problem? Look,
00:11:51bacteria, they multiply very quickly.
00:11:56In the process of reproduction,
00:11:59random mutations occur,
00:12:02which create a field for potential
00:12:05resistance of one or two or several bacterial
00:12:08cells to a new antibiotic. That is, they
00:12:11bypass, they bypass this option, for example,
00:12:14the antibiotic cannot penetrate the cell,
00:12:17there is a special penicillin-binding protein, for example, in the cell, it
00:12:21must pull this antibiotic into the cell,
00:12:24a defective one turned out to be a very valuable thing for bacteria from the point of view of evolution, because
00:12:27the antibiotic stops working. It's strange to me about economics, but if people can die if you've
00:12:31tried four antibiotics and nothing works, then it's
00:12:35the end, right? Probably.
00:12:38It's obvious,
00:12:42it's obvious that there's a very big interest among end
00:12:45consumers, families, yes, all of us, society, that antibiotics
00:12:49work. What does economics have to do with this at all? And you
00:12:53know, as a doctor, I treat economics
00:12:55as a somewhat lower-grade
00:12:58substance, forgive my bluntness, because
00:13:02the patient's needs are more important than money. But
00:13:06we have to reckon with the fact that these antibiotics must appear on
00:13:09the market. And so the company that brings
00:13:12it to market must spend this money, and
00:13:15accordingly, when the antibiotic stops
00:13:19functioning after 2-3 years,
00:13:21it turns out that the money was thrown away, well, not to the wind, but in any case.
00:13:55were precisely related to this, that there was not
00:13:57enough antibiotics that could be
00:14:01replaced. The quantity, in the sense that they ran out, they ran out of enough
00:14:05effective antibiotics. That is, look,
00:14:08before, well, I don't know, 5-7 years ago -
00:14:12new antibacterial
00:14:15so quickly that outdated,
00:14:18ineffective ones could simply be set aside. I, as an intensivist, always had, well, what we called
00:14:22a shoulder.
00:14:55there is always a chance, unfortunately, it's a biological
00:14:58law, that some bacterial cell
00:15:02will develop resistance, it wants to
00:15:05live, and will produce offspring that will be resistant to this antibiotic.
00:15:09The other question is that if the patient is not very
00:15:12sick, then they start to recover, they have enough strength
00:15:15to cope with the infection, well,
00:15:18relatively speaking, on their own, and there is no
00:15:21need to change the antibiotic. But in cases of severe patients, complex...
00:15:25Well, those same COVID patients, they
00:15:27were on artificial lung ventilation due to severe viral
00:15:30lung damage, they had an intubation tube, through which
00:15:34bacteria entered from the external environment. And we couldn't
00:15:38wean them off artificial lung ventilation because they didn't
00:15:42have enough of their own reserves. Therefore, in the process of treatment,
00:15:46he recovered, but at the same time, the lung damage was still
00:15:49high enough that I could wean him from
00:15:53artificial lung ventilation. Accordingly, he
00:15:56developed a new wave of bacterial infection, and these
00:15:59waves, in the end, overwhelmed him, and the person
00:16:03died.
00:16:06We're watching. Baden Baden Podcast, I'm your host, Konstantin
00:16:10Severinov. We are talking about antibiotics
00:16:13resistant to antibiotics, bacteria, with Sergey
00:16:16Vasilyevich Tsarenko, chief resuscitator of the Ministry of Health
00:16:20of the Russian Federation. What you are describing, it feels
00:16:24like game over will come soon, the game will end, right? If there are no new ones, then
00:16:28gradually all bacteria in the scenario you describe should
00:16:31become resistant, inasmuch as we use antibiotics, you
00:16:35use antibiotics, doctors, yes. And so
00:16:39antibiotic-resistant microbes emerge. Absolutely
00:16:43true. And then it should end soon,
00:16:46right? And that's a very sad thing. If you recall films
00:16:50from
00:16:52somewhere around the 1930s of the last century, when someone with
00:16:56lobar pneumonia lies there,
00:16:58breathing heavily, and the doctor treats him with some camphor so he doesn't
00:17:02die. The same story, we are actually heading towards it.
00:17:06haven't arrived yet.
00:17:38That is, they are simply forced, they are financed, they just don't
00:17:41want to. So these are such evil industrialists who, well, they
00:17:44could, but they simply leave the market
00:17:48from this. But this means that they have these antibiotics, they
00:17:51simply this means that they consider it economically unfeasible
00:17:55to develop them, develop them - it means to find new ones, to
00:17:59find new ones, yes, to which there is no resistance, to which
00:18:02there is no resistance yet. Well, this is such a vicious cycle, but
00:18:05you'll find what you described, that... you'll find it, but in 2-3 years
00:18:09you'll have to introduce a new one again, right? Absolutely right,
00:18:13in this vicious cycle you just need to live for some time, because
00:18:16you have to treat sick people with something, so new
00:18:59point of view, well, we can't move away.
00:19:03Microbes are everywhere, you said. Well, actually, the solution
00:19:05begs for...
00:19:37alive, but at the same time not
00:19:41to secrete virulence factors that kill
00:19:44the macroorganism, i.e., humans. That is, a theoretically achievable
00:19:48story, it's not science fiction,
00:19:50when the hypothetical Pseudomonas aeruginosa coexists
00:19:54with the patient, they exist perfectly, he
00:19:58lives with it, walks safely, she is with him,
00:20:02well, we have this skin bacteria on the surface, right? In the lungs, as far as I understand, it's
00:20:06usually there, so it basically coexists. So, somehow we need to understand why at some point it gets out of
00:20:07control,
00:20:14and we start to suppress it with antibiotics. At this moment, it, like
00:20:18that untamed planet, develops even more powerful means of
00:20:21attack, as a result everyone dies, both the patient
00:20:24and it. Well, that is, these are my personal relations with my
00:20:28personal microbes, when I am treated they become
00:20:31resistant, or I also transmit them to everyone else. And you transmit them to
00:20:35everyone else, because why? Firstly, well, you, I don't know,
00:20:39cough, you touch things with your hands, then
00:20:42someone else can pick it up. So antibiotic resistance is contagious,
00:20:45it turns out. Yes, bacteria, in fact,
00:20:49have learned to
00:20:51interact with each other in such a way that in some cases they simply
00:20:55transmit their ability to be resistant to antibiotics
00:20:58to each other. There is such a structure in
00:21:01a bacterial cell called a plasmid, well, like a small
00:21:04carriage, in this carriage live
00:21:07resistance genes, this carriage, New Year's
00:21:10gifts, yes, this New Year's gift, for example,
00:21:14from Pseudomonas aeruginosa can be transferred to Klebsiella or
00:21:17some other microbe, a completely different one.
00:21:50How do you know what to choose from the four antibiotics that you have in
00:21:53your arsenal? There are several points. The first
00:21:57point, of course, ideally, I must obtain the bacterium
00:22:01that is actually causing the infection
00:22:04from the specific patient. So I get
00:22:08the bacterium, I examine it in a certain
00:22:11way in the bacteriological laboratory,
00:22:15and test it for sensitivity to antibiotics. I have
00:22:18tested and understood that these...
00:22:32it gets worse, and there's a rule that the later you prescribe an
00:22:34effective antibiotic, the worse the results. Well, it's also obvious
00:22:37that if the bacteria wasn't caught the first time, but only the fourth time, that's
00:22:41much worse chances. Therefore, unfortunately,
00:22:44in this zone of uncertainty
00:22:47we have to work, and well, then it turns on... well, I would
00:22:51say, excuse me, common sense. Common sense says that
00:22:54a patient admitted, for example, from home with
00:22:57bacterial pneumonia, that most likely there's
00:22:59pneumococcus, with a high probability this pneumococcus
00:23:03is sensitive to certain antibiotics, and I
00:23:06prescribe these antibiotics, because I don't have
00:23:09time to wait. He didn't come to me in intensive care for nothing, he's already so bad that
00:23:13he needs to be treated in the intensive care
00:23:16unit, expecting that...
00:23:50again, this patient was admitted, right? Before
00:23:53prescribing antibiotics, I obtained some biological medium from him,
00:23:57either he coughed sputum into a Petri dish,
00:24:01or the patient was so severe that I had to insert an intubation tube, and I used a special
00:24:04bronchoscope to retrieve that sputum. Before
00:24:08I started treating with antibiotics, I would still
00:24:11take a culture of the medium. But you
00:24:15talk about common sense, you talk about common sense. I
00:24:18had COVID twice, but not severely, thank God. But a doctor came to
00:24:22my home, prescribed antibiotics, he didn't take anything from me. The doctor
00:24:25who prescribed you antibiotics for COVID wasn't treating you or even
00:24:29COVID. I call it treating, the doctor was treating
00:24:32fear in the pit of his stomach, his own fear.
00:24:36No, he was very scared for you. Well, but I'm not
00:24:40making it up, doctors did prescribe antibiotics, didn't they? Yes, it was
00:24:43the idea, which at first also seemed to them
00:24:47to be common sense. Common sense
00:24:50suggested that a viral infection
00:24:53cannot help but weaken the human body, and if it
00:24:57weakens the human body, then bacteria living
00:25:00in us or present in
00:25:03the environment will attack these affected lungs. In this
00:25:07context, there will be terrible bacterial pneumonia, from which
00:25:10the patient will die. Therefore, to prevent this from
00:25:13happening, he needs to be given an antibiotic. For example,
00:25:16the widespread use of azithromycin
00:25:20during the pandemic led to a shortage of it in pharmacies
00:25:24at one point, it was hard to find, even in pharmacies. Well, fortunately,
00:25:28in our country it was in shorter supply than, for example, in some China. This is
00:25:31good, this turned out to be good, thank God, because now this
00:25:35mycoplasma pneumonia, which, for example, many are now writing about in China,
00:25:38is also a bacterium, only it is a rather peculiar one, it's mycoplasma. In
00:25:42China it is multiply resistant to azithromycin. Here, fortunately,
00:25:45azithromycin doesn't work on this
00:25:49mycoplasma yet. Therefore, we didn't very much shower
00:25:51patients with a mountain of azithromycin, and it
00:25:55is still in the arsenal, at least.
00:25:57And what then should a consumer do? I am a consumer in
00:26:01this case, that is... a doctor comes, a person with a diploma,
00:26:04prescribes antibiotics to me. I mean, do I need to
00:26:07ask him why? Do I need to argue? Do I need to, after all, he
00:26:11might send me to the grave this way?
00:26:15No, well, he won't send you to the grave, well, if something else happens
00:26:18later, this is a strategically incorrect decision. Tactically,
00:26:22it won't kill you, it won't send you to the grave, but strategically,
00:26:26the decision is wrong. Strategically it's wrong to take
00:26:28antibiotics, to take antibiotics for a viral infection, yes...
00:27:02to sell, because I'm an intensivist, I don't work in a
00:27:05polyclinic, I don't have prescription forms, I know
00:27:09when I personally need an antibiotic, and when I don't.
00:27:12But I'm glad that we still, and even I couldn't buy it without
00:27:16a prescription at the pharmacy. So you are in favor of more regulation
00:27:20of this whole area, more bureaucracy? Absolutely it needs to be
00:27:24regulated, to be strictly regulated. And what
00:27:28about, you know, there's labeling on
00:27:31food, on meat, yes, that it's grown without antibiotics. I understand that
00:27:35much of the agricultural produce we consume
00:27:38is grown with, I don't know, maybe cows get sick or for some other reason, there are antibiotics there
00:27:42too. This is a very sad story, actually,
00:27:45the over-the-counter sale of antibiotics in pharmacies is such a
00:27:49tiny contribution that it makes to bacterial
00:27:52resistance, to antibiotics. The main thing, of course, is agriculture.
00:27:56They get sick because
00:27:59of viruses, chickens get sick, or whoever gets sick. It's not even about diseases,
00:28:03actually, antibiotics, it's our American partners who once found
00:28:07this beautiful idea: if you inject
00:28:10a cow with an antibiotic, it gains weight faster. That is,
00:28:14meat, again, economics, meat will be cheaper then, probably meat
00:28:17becomes cheaper, there's more of it because you inject antibiotics,
00:28:21and they also get prescriptions, where do they get
00:28:24these antibiotics? The whole sadness is that antibiotics used in the agricultural
00:28:28industry are
00:28:30those needed in...
00:28:33in medicine. For example, there is an antibiotic called colistin. For now, it is the
00:28:36main reserve against the infamous Pseudomonas aeruginosa,
00:28:40E. coli. When you tried number one, number two and number three, you switch to
00:28:43colistin, absolutely true. So,
00:28:47chickens in China, for example, are treated with colistin. Agriculture
00:28:50solves the problem of feeding the people and
00:28:52at the same time, gifting the people resistance
00:28:56to colistin. Therefore, when people get severe bacterial
00:29:00infections, colistin will not help them. The more you use
00:29:03an antibiotic, the more resistance there is to it. And an antibiotic
00:29:06is like an atomic bomb for bacteria, it kills everyone,
00:29:09or is it not an atomic bomb?
00:29:12But we also have beneficial microbes, right? So
00:29:16it's not just about beneficial microbes. So, look, the thing
00:29:20is that we hardly ever use such
00:29:24high-precision weapons against antibiotics now. These are the so-called
00:29:27against microbes, against microbes, yes, I misspoke. These are the so-called
00:29:31bacteriophages, that's a separate topic. song, what is it, they
00:29:34sell them in pharmacies, I know, those they sell are not very effective, for
00:29:38this there are certain reasons, so we have to
00:29:41select combinations of antibiotics for now, considering that
00:29:45they might enhance each other's effect, and
00:29:48then, we returned to where we, from where we started,
00:29:51that new antibiotics are needed and while they are
00:29:55being invented, the development of strategies is needed when we will
00:29:59not kill bacteria that live
00:30:06in us, that is, we will somehow learn to interact, there will only be antibiotics that kill bad microbes, but not affect good ones,
00:30:10there will be antibiotics that limit the pathogenicity of bacteria, that is, their
00:30:14disease-causing ability, that is, ideally it should remain with us for life
00:30:18a purulent bacillus, but simply not kill us, in
00:30:21general, this is not science fiction, you see, a doctor,
00:30:25he is not a scientist, a doctor, he is a consumer, I can only
00:30:28say that I would need this, but I don't know how
00:30:32to do it, I lack biological knowledge, I lack chemical knowledge, and you communicate with
00:30:35scientists, with Russian scientists, that is, I understand that
00:30:38there is a demand, you need this very much, and most importantly, patients need it, yes,
00:30:42you see, we communicate, now there are several developments, for example, in the same
00:30:45Gamaleya Institute, there
00:30:48are attempts to bring to the market an antibiotic called
00:30:51ftorquinolones, it has certain prospects, but it
00:30:55is also not a magic bullet, strictly
00:30:57speaking, that will solve everything, so here a
00:31:01certain spectrum is still needed. the development of new antibiotics should be
00:31:04simply supported only by state grants,
00:31:07money and, well, what
00:31:11is called,
00:32:37Where do antibiotic-resistant microbes come from, why
00:32:40antibiotics don't work, we'll talk about this and much more
00:32:44today in...
00:32:53in how many cases antibiotics work, what percentage
00:32:57of bacteria are resistant? 5% or if 90%, then
00:33:00this is probably a really hopeless clinical situation, I would say
00:33:04so, I would estimate them at around
00:33:0710%, these are people whom you cannot help, they
00:33:11will be as if there are no antibiotics, then, well, it's a toss-up.
00:33:15Absolutely right, yes, so, I will try to find
00:33:18a combination of antibiotics for this patient, based simply on
00:33:22common sense, and some will be lucky, and some won't, you are
00:33:25now saying 5-10 years today, and 5
00:33:29years ago, for example, how many according to your practice, 5 years ago it
00:33:31was 2-3%.
00:33:35Well, in our case with pneumonia on mechanical ventilation, the mortality was
00:33:3830-40% before the pandemic, the mortality was due
00:33:42to the fact that you could not, you could not pick it up.
00:33:46And one of the reasons was, one of the reasons was, well, there was also the severe
00:33:50severity of the pneumonia itself and so on, but in general
00:33:5430-40%, and at that time the math
00:33:57and common sense don't add up, you say
00:34:01that patients who cannot be helped now are 5
00:34:03-10% due to antibiotic resistance,
00:34:07on the other hand, you say that the mortality rate of pneumonia is 30-40, this is
00:34:10a big gap, and this mortality is due to the fact that antibiotics don't work, did I
00:34:14understand correctly? Look, here we are talking about different
00:34:18nosological groups, different groups of patients, for example,
00:34:21patients with viral pneumonia, these were extremely
00:34:25severe patients, lying for a long time, this is
00:34:28one, there are simply not so many such patients, now in general
00:34:31the proportion of such patients has decreased,
00:34:35thank God, so I say that an approximate assessment of
00:34:38such a patient, whom every
00:34:41tenth cannot help, but this can all return back, bacteria can become resistant again.
00:35:15efforts and now we have what we have, right, but initially
00:35:19this was not the case, so, probably, they should have been able to return to normal, well, I
00:35:22see only one option, we stop using antibiotics completely, we just
00:35:26make a moratorium, for how long should it be done so that everything returns to
00:35:29normal, ah, well, let's just understand that during the moratorium patients will
00:35:33die, will such an option suit us, well, if antibiotics don't work, they will still
00:35:37die, ah, well, good, here is your specific
00:35:40relative lying in my intensive care unit, I tell you,
00:35:43Konstantin, you know, there is resistant flora here.
00:35:45I will come to you with a knife to your throat begging, well, find
00:35:48something,
00:35:52ideally, since we are friends, we will find a combination, maybe, or maybe
00:35:55not, yes, on the other hand, I have an analysis
00:35:59of sensitivity, all the letters of antibiotics are r, that is, resistant, from
00:36:03a formal point of view, there is nothing to prescribe, so if
00:36:06we theoretically did not prescribe
00:36:08to these patients, they would have died along with their
00:36:12bacteria, then... I think it's a matter of a few
00:36:16years, well, this is such an extrapolation of data, there is such
00:36:19a method of withdrawing an antibiotic from practice
00:36:22in your hospital and seeing when it will work
00:36:26again. usually
00:36:36this process takes about a year,
00:36:40I heard that in 4-5 years the frequency
00:36:44of resistant microbes has doubled, maybe
00:36:47multidrug resistant, so then in 5 years it
00:36:51will become even more and in general, however,
00:36:54I don't quite understand what a state program in itself will do. Well, how, can't
00:36:58a new group of antibiotics be found that will
00:37:12COVID we talked a lot about it, including me,
00:37:16now this topic has somehow faded
00:37:20into the background, there are other concerns, but nevertheless,
00:37:23unfortunately, the fact remains a fact, and my colleagues in
00:37:27this regard are not perfect, I must
00:37:30clearly say that, antibiotics are prescribed just in case, this
00:37:33applies to colleagues of any nationality, American, Chinese,
00:37:37Russian, this is generally - just in case, what about us?
00:37:41Well, in China they use colistin in agriculture,
00:37:44for example, and you ate Chinese chicken and your microbes
00:37:47received microdoses of colistin, well, and at the same time
00:37:51I understand that a microbe that has become resistant to
00:37:54colistin, even if it didn't come here from chicken. Since
00:37:58there are no borders for microbes, yes, it still spreads eventually across the entire
00:38:02planet, that is, what happens in America or Chile is important for us, because
00:38:06these microbes will end up with us, on the contrary, absolutely right, sooner or later
00:38:09it will happen, this is practically an apocalypse, this is
00:38:13practically, you talk about it so calmly, but I've already overcome
00:38:16this topic, I don't know, you've become resistant, well,
00:38:20you can't always live in a state of
00:39:33antibacterial soap, it will clean all your skin
00:39:37from bacteria, including beneficial ones, and there are antibiotics, because
00:39:40there is, because there is an antiseptic, well, this is like an antibiotic,
00:39:44such a drug that kills bacteria
00:39:47on the surface, washed with antiseptic,
00:39:50treated hands, no bacteria, in fact, this is completely unnecessary, because when
00:39:54you just washed with regular soap, the number of bacteria...
00:39:58decreased to 30-40% of the
00:40:00initial hundred that were on your dirty hands, this is enough not
00:40:04to get some intestinal infection, for example, and
00:40:07if you treated 100%, killed with antibacterial
00:40:11soap, then sooner or later pathogenic
00:40:14bacteria, disease-causing, will settle on your skin, so you don't need
00:40:18to remove too much, you need to wash your hands before
00:40:22eating and after the street, but not with antibacterial
00:40:26soap, I ask...
00:40:58with bacteria. Thank you very much.