Antibiotic Resistance: A Global Crisis
ABSTRACT
This article gives a very brief overview of the antibiotic resistance their causes, role of uses of antibiotics in veterinary medicine, measures taken to prevent resistance. Antimicrobials are probably one of the most successful forms of chemotherapy in the history of medicine, until the present-day situation, which is marred by the emergence of hard-to-treat multiple antibiotic-resistant infections. The ways of responding to the antibiotic resistance challenges such as designing more effective preventive measures and importantly, better understanding the ecology of antibiotics, role of food animals in sphered of antibiotic resistance and antibiotic resistance are discussed.
INTRODUCTION
The discovery of antibiotics revolutionized medicine, offering a powerful tool to combat bacterial infections that were once life-threatening. Antibiotics have saved countless lives, and their development was hailed as one of the most significant medical breakthroughs of the 20th century. However, the overuse and misuse of antibiotics, both in human medicine and agriculture, have given rise to a formidable global crisis: antibiotic resistance. This essay explores the multifaceted aspects of antibiotic resistance, delving into its origins, consequences, global impact, and strategies to mitigate this growing threat.
- Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria change in response to the use of these medicines.
· Bacteria, not humans or animals, become antibiotic-resistant. These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria.
· Indiscriminate use of antibiotics in food animals and their residues in meat are of great concern because it lead to development of resistance to that particular antibiotic in human as they unintentionally underdosed.
Antibiotic:
- An antibiotic is a type of antimicrobial substance active against bacteria and is the most important type of antibacterial agent for fighting bacterial infections.
- · Antibiotic medications are widely used in the treatment and prevention of infections.
Antibiotic resistance:
v Antimicrobial resistance (AMR or AR) is the ability of a microbe to resist the effects of medication that once could successfully treat the microbe.
v Resistant microbes are more difficult to treat, requiring alternative medications or higher doses of antimicrobials.
v These approaches may be more expensive, more toxic or both.
v Microbes resistant to multiple antimicrobials are called multidrug resistant (MDR).
v Those considered extensively drug resistant (XDR) or totally drug resistant (TDR) are sometimes called “superbugs”.
v All classes of microbes can develop resistance.
v Fungi develop antifungal resistance. Viruses develop antiv iral resistance. Protozoa develop antiprotozoal resistance, and bacteria develop antibiotic resistance.
v The World Health Organization concluded that inappropriate use of antibiotics in animal husbandry is an underlying contributor to the emergence and spread of antibiotic-resistant germs, and that the use of antibiotics as growth promoters in animal feeds should be restricted.
v The phenomenon of antimicrobial resistance caused by overuse of antibiotics was predicted by Alexander Fleming who said “The time may come when penicillin can be bought by anyone in the shops.
v The danger that the ignorant man may easily under-dose himself and by exposing his microbes to nonlethal quantities of the drug make them resistant.”
v Without the creation of new and stronger antibiotics an era where common infections and minor injuries can kill, and where complex procedures such as surgery and chemotherapy become too risky, is a very real possibility.
v Antimicrobial resistance threatens the world as we know it, and can lead to epidemics of enormous proportions if preventive actions are not taken.
RESISTANCE ARISES THROUGH ONE OF THREE MECHANISMS:
1. Natural resistance in certain types of bacteria
2. Genetic mutation
3. By one species acquiring resistance from another.
Antibiotic resistance tests
v Bacteria are streaked on dishes with white disks, each impregnated with a different antibiotic.
v Clear rings, such as those on the left, show that bacteria have not grown—indicating that these bacteria are not resistant.
v The bacteria on the right are fully susceptible to only three of the seven antibiotics tested.
HAZARDS OF ANTIBIOTIC RESISTANCE
v In this day and age current antimicrobial resistance leads to longer hospital stays, higher medical costs, and increased mortality.
In animals: –
§ It leads to increased cost of treatment towards higher antibiotics.
§ Loss of neonatalanimals due incurable infection.
§ Reduced yield and growth rate due to prolonged suffering.
§ Threat of such infection to veterinarian and animal attender.
- Loss of animal due unavailability of better antibiotics and indirectly economic loss of farmer.
Historical Perspective
To understand the contemporary problem of antibiotic resistance, it is crucial to delve into the historical development of antibiotics and their initial success in combating bacterial infections.
Pioneering Antibiotics
The discovery of antibiotics began with the chance observation by Alexander Fleming in 1928 when he noticed that a mold, Penicillium, killed Staphylococcus bacteria. This serendipitous observation led to the development of penicillin, the first widely-used antibiotic, and the initiation of the antibiotic era.
The Golden Age of Antibiotics
The years following the discovery of penicillin marked the golden age of antibiotics. Scientists and pharmaceutical companies made significant advancements, creating antibiotics like streptomycin, tetracycline, and chloramphenicol. These drugs proved remarkably effective in treating bacterial infections and reducing mortality rates.
Widespread Use
The availability of antibiotics led to their extensive use in medicine, transforming the treatment of infections and surgery. Additionally, antibiotics found their way into agriculture, where they were used to promote animal growth and prevent disease in crowded and unsanitary conditions.
- The Emergence of Antibiotic Resistance
- Mechanisms of Resistance
Antibiotic resistance develops as a result of bacteria adapting to the selective pressure of antibiotics. These adaptations can include mutations in bacterial DNA, acquisition of resistance genes through horizontal gene transfer, and the formation of biofilms that protect bacteria from antibiotics.
The Role of Horizontal Gene Transfer
Horizontal gene transfer is a critical mechanism for the rapid spread of antibiotic resistance. Bacteria can exchange resistance genes among themselves, allowing resistance to develop and propagate more quickly.
III. The Global Impact of Antibiotic Resistance
Public Health
Antibiotic resistance poses a significant threat to public health. Resistant bacteria can cause infections that are challenging to treat, leading to longer hospital stays, higher medical costs, and increased mortality rates. Common infections, such as urinary tract infections, pneumonia, and skin infections, have become more difficult to manage due to antibiotic resistance.
Economic Impact
The economic consequences of antibiotic resistance are substantial. Increased healthcare costs, prolonged hospitalizations, and lost productivity result in economic burdens on individuals, healthcare systems, and governments.
Agriculture and Food Security
The use of antibiotics in agriculture has contributed to the rise of antibiotic-resistant bacteria, which can be transmitted to humans through the food supply chain. This poses a direct threat to food safety and food security, as well as the livelihoods of farmers and the sustainability of agriculture.
Environmental Consequences
Antibiotics and antibiotic-resistant bacteria can enter the environment through various routes, including the discharge of pharmaceutical manufacturing waste, agricultural runoff, and the improper disposal of unused medications. This contamination can impact ecosystems and aquatic life, potentially exacerbating the problem of antibiotic resistance.
- Factors Contributing to Antibiotic Resistance
- Overuse and Misuse
One of the primary drivers of antibiotic resistance is the overuse and misuse of antibiotics in human medicine. Patients sometimes demand antibiotics for viral infections, which antibiotics cannot treat, and physicians may prescribe them unnecessarily.
Agricultural Use
The agricultural sector’s use of antibiotics in livestock farming, particularly for growth promotion and disease prevention, contributes significantly to the development of antibiotic resistance. The practice of administering antibiotics to healthy animals in crowded conditions is of particular concern.
Poor Infection Control
Inadequate infection control measures in healthcare settings can facilitate the spread of resistant bacteria. This includes the improper use of antibiotics in hospitals and the lack of adherence to strict hygiene protocols.
Global Travel and Trade
The global movement of people and goods allows antibiotic-resistant bacteria to spread across borders. Resistant bacteria can be carried by travelers, making containment and control more challenging.
The Role of Antibiotic Stewardship
Antibiotic stewardship is a comprehensive strategy aimed at preserving the effectiveness of antibiotics while ensuring their appropriate use in healthcare settings. It involves several key components:
Rational Antibiotic Prescribing
Promoting the judicious use of antibiotics in healthcare, including accurate diagnosis, appropriate prescription, and consideration of the patient’s specific clinical needs.
Public Awareness
Educating the public about the responsible use of antibiotics and the consequences of antibiotic resistance.
Surveillance and Research
Monitoring antibiotic resistance patterns and conducting research to develop new antibiotics and alternative treatments.
Regulation and Policy
Implementing regulations and policies that restrict the use of antibiotics in agriculture, healthcare, and veterinary medicine. These policies can include restrictions on over-the-counter antibiotic sales and the phasing out of antibiotics for growth promotion in agriculture.
Global Initiatives and Collaborations
Efforts to combat antibiotic resistance extend beyond national borders, with various international organizations and initiatives dedicated to addressing this global crisis:
World Health Organization (WHO)
The WHO has developed a Global Action Plan on Antimicrobial Resistance, which outlines strategies to combat antibiotic resistance and promote responsible antibiotic use.
The Tripartite Collaboration
The collaboration between the WHO, the Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (OIE) aims to address antibiotic resistance in human health, agriculture, and the environment.
National Action Plans
Many countries have developed national action plans to combat antibiotic resistance, outlining their strategies for surveillance, prevention, and control.
VII. The Future of Antibiotics
The development of new antibiotics is a crucial component in the fight against antibiotic resistance. Researchers are exploring novel approaches, including:
Alternative Therapies
Exploring alternative treatments, such as bacteriophages, probiotics, and phage therapy, to target bacterial infections without relying on traditional antibiotics.
Combination Therapy
Using combinations of antibiotics to enhance effectiveness and reduce the likelihood of resistance development.
Drug Repurposing
Repurposing existing drugs for antibacterial properties, potentially bypassing some of the challenges associated with developing entirely new antibiotics.
Guidelines for successful antimicrobial therapy
- For definitive therapy recommend a narrow spectrum antimicrobial drug.
2. Keep the broad-spectrum drug reserved for situations where they are specifically indicated or where causative agents / sensitivity is not known.
3. Prefer bactericidal over a bacteriostatic drug.
4. Use a less toxic antimicrobial than a potentially /more toxic agent.
5. Prefer an antimicrobial that requires less frequent administration than that which is given after short intervals.
6. For less severe infections prefer an oral antimicrobial drug(except in ruminants), but for severe infections(e.g. septicaemia, meningitis)use a parental antimicrobial drug.
7. Always use antimicrobial agent in proper dose(neither higher or lower) and for proper duration of time.
8. When a combination regimen is used,all individual agents should be used in full dosage.However,do not combine antimicrobials without valid cause.
9. Select an antimicrobial only when the medical indications are clear;do not use antimicrobial therapy indiscriminately.
10. Avoid overuse f newer agents when already available agents are effective.
11. Prefer less expensive and easily available antimicrobial agent.
12. Always select an antimicrobial manufactured by a reliable pharmaceutical firm.
13. Do not use antimicrobials to treat trivial, self-limiting or untreatable infections.
Commonly used antibiotics:
Name of antibiotics
1. Enrofloxacin
2. Ceftriaxone
3. Penicillin
4. Oxytetracycline
5. Amoxicillin
6. Ceftiofur.
Preventive measures of antibiotic resistance
l Discover new drugs faster than emergence of resistance
l Promote discovery, development and dissemination of new antimicrobial agents
l Prevent emergence of resistance by reducing selection pressure by appropriate control measures
l Rationalize the use of available antimicrobial agents
l Promote discovery, development and dissemination of new antimicrobial agents
Steps taken by WHO: –
1. World Antibiotic Awareness Week ,Held every November since 2015 with the theme “Antibiotics: Handle with care”, the global, multi-year campaign has increasing volume of activities during the week of the campaign.
2. The Global Antimicrobial Resistance Surveillance System (GLASS) The WHO-supported system supports a standardized approach to the collection, analysis and sharing of data related to antimicrobial resistance at a global level to inform decision-making, drive local, national and regional action.
3. Global Antibiotic Research and Development Partnership (GARDP) A joint initiative of WHO and Drugs for Neglected Diseases initiative (DNDi), GARDP encourages research and development through public-private partnerships. By 2023, the partnership aims to develop and deliver up to four new treatments, through improvement of existing antibiotics and acceleration of the entry of new antibiotic drugs.
4. Interagency Coordination Group on Antimicrobial Resistance (IACG) The United Nations Secretary-General has established IACG to improve coordination between international organizations and to ensure effective global action against this threat to health security. The IACG is co-chaired by the UN Deputy Secretary-General and the Director General of WHO and comprises high level representatives of relevant UN agencies, other international organizations, and individual experts across different sectors.
CONCLUSION
Antibiotic resistance is a complex and pressing global crisis with profound implications for public health, economics, agriculture, and the environment. It is a challenge that requires international cooperation, strong policy measures, responsible antibiotic use, and innovative research to combat effectively.
Addressing antibiotic resistance demands a multifaceted approach involving healthcare providers, policymakers, researchers, and the public. The preservation of antibiotics as effective tools in modern medicine is essential, and the responsible use of these life-saving drugs is a shared responsibility. By working together to combat antibiotic resistance, we can hope to prevent the dire consequences of a post-antibiotic era and secure the future of healthcare and human well-being.
The world urgently needs to change the way it prescribes and uses antibiotics. Even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat. Behaviour changes must also include actions to reduce the spread of infections through vaccination, hand washing, practising safer sex, and good food hygiene. · Comprehensive efforts are needed to minimize the pace of resistance by studying emergent microorganisms, resistance mechanisms, and antimicrobial agents.
· Multidisciplinary approaches are required across health care settings as well as environment and agriculture sectors.
· Progressive alternate approaches including probiotics, antibodies, and vaccines have shown promising results in trials that suggest the role of these alternatives as preventive or adjunct therapies in future.
Compiled & Shared by- This paper is a compilation of groupwork provided by the
Team, LITD (Livestock Institute of Training & Development)
Image-Courtesy-Google
Reference-On Request.
