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Source: Public Health Matters. https://bit.ly/3wVTuxy.
In order to fully understand the concept of antimicrobial resistance, it is important to first understand the term ‘antimicrobials’ and their use in the medical sector. Antimicrobials are drugs or substances that are capable of destroying or preventing the growth of microorganisms that could be potential pathogens. They encompass various drug categories such as antibiotics, antifungals, antivirals and antiparasitics, which are drugs that kill or halt the growth of pathogenic bacteria, fungi, viruses and parasites respectively. Antimicrobial resistance is the term used to describe a scenario where pathogenic microorganisms develop the ability to counter the effects of these drugs and continue thriving.
Different classes of microorganisms have different ways of developing resistance to drugs, such as antiparasitic resistance observed in human parasites like the Malaria parasite (Plasmodium falciparum), antifungal resistance in parasitic fungi like Candida albicans, and antibiotic resistance observed in various bacteria. Among all the forms of drug resistance, the most prevalent and most disturbing is the problem of antibiotic resistance, which will be the main focus in this article.
Antibiotics are drugs that destroy or inhibit the growth of bacteria, and are widely used to cure numerous infectious diseases like tuberculosis, meningitis, typhoid fever, etc. They are actually chemicals produced naturally by various bacteria and fungi in the environment when competition for nutrients is very high, and are used as weapons to destroy other microorganisms in order to get enough nutrients for themselves. Though most antibiotics are natural, some are produced artificially by man or by chemical modification of the natural antibiotics.
Just as we humans make use of antibiotics to fight bacteria, these bacteria are also learning ways to fight back. Naturally, when bacteria are exposed to antibiotics for long periods, they begin to adapt by developing various cellular mechanisms to resist the effects of the drugs. There are many factors that facilitate the occurrence of antibiotic resistance, such as when we overuse antibiotics for minor infections or take them wrongly for non-bacterial infections like common cold and flu, which are generally caused by viruses. Another cause of antibiotic resistance is self-medication, or not completing one’s dosage of prescribed drugs. Also, the use of antibiotics in agriculture for improving livestock growth is a major factor, as drug resistant microbes can quickly develop in these animals and get transmitted to humans through the faeco-oral route or by consumption of these livestock as food.
Source: Center for Infectious Disease Research and Policy. https://bit.ly/3wVVlTk.
Antibiotic/Antimicrobial resistance is actually rated by the World Health Organization (WHO) as one of the top ten global public health threats facing humanity. According to global statistics, an estimated 700,000 people die yearly from antibiotic-resistant infections and at the rate which antibiotic resistance is rising, WHO estimates that by 2050, about 10 million people could die yearly, which is equivalent to a death rate of one person every three seconds. The emergence of antibiotic resistance means that simple bacterial infections could become fatal and the current medical treatments we take for granted might soon be ineffective. A plethora of infectious diseases caused by bacteria will become untreatable, and implementation of surgical procedures will be hazardous due to the risk of infection by drug-resistant bacteria.
In addition, a more worrisome trend is the emergence of bacteria nicknamed ‘superbugs’, which exhibit resistance to many types of antibiotics (multidrug resistance). An example is the bacteria that causes gonorrhoea, called Neisseria gonorrhoeae, which has developed resistance to almost every type of antibiotic used for treating gonorrhoea. This poses a major problem, as the possibility of gonorrhoea becoming untreatable is quite glaring, and infected individuals run the risk of extensive damage to their reproductive system, which can cause infertility and could possibly become fatal if the infection spreads to other parts of the body.
Another alarming fact to note is the persistent drop in the research and development of new antibiotics since the 1980s due to a number of barriers in scientific discovery, pharmaceutical production and international drug policy. Another contributing factor to delayed drug development is the logic that as more antibiotics are produced and used, more cases of antibiotic resistance keep emerging worldwide.
The major impediment to curbing antibiotic resistance is the fact that many people are not aware about the threat it poses to public health on a global scale. Therefore, the first step to controlling antibiotic resistance is raising massive public awareness about how dangerous it is, and what can be done by individuals, non-governmental organisations, civil societies, healthcare providers and the government especially to effectively curb this menace. Healthcare providers play a major role in the awareness drive by educating patients and the general public on the various steps to ensuring appropriate use of antibiotics, such as the avoidance of self-medication, strict adherence to drug prescription from a certified medical professional, and reducing the excessive use of antibiotics for minor infections. Antibiotics should never be taken for cold or flu symptoms, as these are mainly caused by viruses.
The government and national policymakers also have a major role to play in a number of areas so as to ensure effective antibiotic resistance control. There is a need for country leaders and health-allied organizations to channel more funds into the research and development of new drugs that will be effective against already resistant bacteria, and also develop novel rapid diagnostic methods that can quickly determine the specific cause of an infection and how best it can be treated. This will help reduce the use of and subsequent resistance to antibiotics. Also, regulatory policies need to be implemented by national policymakers to reduce the use of antibiotics in agriculture for animal growth enhancement. It is also important for healthcare sectors worldwide to start developing alternative treatments aside antibiotics that will be effective in destroying bacteria and treating infections without the risk of drug resistance emerging. Examples of such alternatives include the use of Phage therapy, Lysin treatment, Bacteriocins and the exploitation of Predatory Bacteria in killing infectious pathogens. Vaccines also play an important role, as they offer protection against infectious diseases, thus, reducing the need for antibiotics and preventing the emergence of antibiotic resistance.
World Health Organization (2020). Antimicrobial resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.
Centers for Disease Control and Prevention (2020). Antibiotic/Antimicrobial Resistance (AR/AMR). https://www.cdc.gov/drugresistance/about.html.
Friedman ND, Temkin E, Carmeli Y. The negative impact of antibiotic resistance. Clinical Microbiology and Infectious Diseases. 2015;22:416–422.
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