“The human species is in the midst of a war with the microbial world –a resilient foe that will never be completely defeated.” - Anthony Stephen Fauci, Director of the National Institute Of Allergy and Infectious Diseases.

WHO states that antimicrobial resistance (AMR) occurs when microorganisms such as bacteria, viruses, fungi, and parasites change in ways that render the medications used to cure the infections they cause, ineffective. Antibiotics are medicines used to treat infections caused by bacteria. Our body comprises more bacterial cells than all the collective human cells. These bacteria cells live in our bodies, thrive, and compete with each other for food and resources. Thereby some cells sustain infection and become infective, causing disease in our body. Resistance occurs when bacteria become overpowered and thus resistant to the drug which where once offered to treat them, leading to far-reaching consequences in the human body. They do this by killing the bacteria themselves or reproducing. However, bacteria are rapidly becoming resistant to all the bacteria we currently use. Bacteria are all around us. They have been in existence for over 3.5 billion years, and it only takes about 30 minutes to multiply. The resistant bacteria survive, and the bacteria which are susceptible die when offered antibiotics leading to microbial resistance by the resistant bacteria. These resistant bacteria now have room to thrive and multiply, and they can transfer part of their DNA to other bacteria, and that is how antibiotic resistance spreads.

What is AMR

Antibiotic resistance is a property of the microorganisms to conquer and beat the medicines that treat the infections caused by them. Accumulating evidence suggests that the response of bacteria to antibiotics is significantly affected by other existing interacting microbes. Through antimicrobial stewardship, we need to effectively tackle the spread of AMR and develop a novel antimicrobial compound for which we need to understand how bacteria adapt and evolve to survive antibiotic treatments. The potential hazard of using these drugs is touching all walks of life, with all stages of human beings targeted. Some more crucial medical advancements like dialysis, heart transplants, replacement surgeries, etc require the usage of these drugs to fight the complications of the overall procedure. But enormous lives would be at stake until the repercussions of these drug treatments are accordingly dealt with.

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History

The story starts in the 1920s with the discovery of penicillin by Alexander Flemming. It was the first commercialized antibiotic that was not available to the general public until the 1940s. Ever since, there has been discovery and acknowledgment of resistance, alongside the discovery of new antibiotics. Penicillin was considered a miraculous drug, sold over the counter (OTC) and overused. Germs usually look for ways to survive and resist new drugs. Over a year of the discovery of penicillin, a person started developing resistance, and by the 1950s, this resistance was widespread. Every year millions of people are dying of this resistance, which is threatening everyone around us. If we continue on the current trajectory, 10 million people per year will die by 2050, which is one person dying every 3 seconds. Ever since we have been living in the golden epoch of the antibiotic era.

Mechanism

Antibiotics are like no other drugs. They work by breaking up the cell wall or interfering with replication. But the bacteria are smart organisms, so when the antibiotics come in, they develop enzymes that can break up the antibiotic and molecules that bind to the antibiotic, making them ineffective. Sir Alexander Flemming figured out in a lab that if we use too low of a dose of penicillin or if we give intermittent doses of penicillin, the bacteria acquire resistance. He said: "An ignorant man may underdose himself ……make them resistant, rendering penicillin ineffective in the future." Bacteria are part of our everyday life. There are tens of trillions of microorganisms in our bodies. There are more bacterial cells than human cells in our body, which are essential to keep us healthy and helps us with digestion and regular metabolism. The major problem occurs when they overgrow and invade parts of our body. Antibiotics do not work on viruses like rhinovirus causing the common cold, influenza virus causing flu. They neither work on fungi like trichophyton that causes an athlete's foot. ANTIBIOTICS work on bacteria such as E.coli causing urinary tract infection, Group-A streptococcus causing strep throat, or pneumococcus causing pneumonia. Bacterial organisms are living organisms that can easily replicate in the environment.

Post antibiotic era

Antibiotic resistance is on the verge of causing a substantial threat to the living organisms and humanity as a whole, thereby posing an ultimatum to the hugely necessitated drug of the genre. Day by day, diseases like Tuberculosis, Salmonellosis, etc. is becoming difficult to treat because of the implications of antimicrobial resistance which is why there needs to be a more scrutinized way of dealing with the entire scenario. The rise of AMR makes it possible for the horrors of the pre-antibiotic era to return.

A prominent example of overuse is over-prescription. General practitioners still rely on the patient’s symptoms and slow diagnostic tools such as blood or culture tests to distinguish between viral and bacterial infections. Better diagnostics such as the point-of-care C-reactive protein (CRP) testing had trialed in the UK. The test only requires a finger prick, but it has not proven effective in reducing unneeded prescriptions. But reducing antibiotic use in humans is not enough to tackle resistance. The FDA reports that 70% of the antibiotics critical in treating human infections, are used in agriculture and aquaculture. Although they are needed to treat animal or plant infections, instead most of these antibiotics, including last-line antibiotics, are not only used to promote organism growth but prevent potential infections.

Action plan

The response to AMR has been spearheaded by WHO through the One Health Global Action Plan, by collaborating with the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE). The action items we can start implementing today are:

1) Improve awareness and understanding of AMR: Knowledge itself is power. Proper communication, education, and training are required. Further, we need to strengthen the understanding and evidence-based through surveillance and research.

2) Using antibiotics sparingly: We need to optimize the use of antimicrobial medicines in human and animal health. Antibiotics do not work on viruses, but they work only against bacteria. They should not be used regularly for coughing, sneezing, or cold without knowing what caused it. We need to reduce the incidence of infection through proper sanitation, hygiene, and infection prevention measures.

3) We need to stop buying meat raised with antibiotics: Antibiotics are often injected into the animals as they work as growth promoters in animals. We may not directly take those antibiotics, but we may take bacteria within those animals, as those animals carrying antibiotic-resistant bacteria can easily transmit them into the environment through the soil, air, and water.

Conclusion

Over the millennia, microorganisms have evolved evasion strategies to overcome innumerable chemical and environmental challenges, including antimicrobial drugs. The origin of antibiotic resistance in the environment is relevant to human health because of the increasing importance of zoonotic diseases besides the necessity for predicting emerging resistant pathogens. Although it is apparent that not all resistance genes are likely to geographically disseminate the threat presented by those that are serious and warrants an interdisciplinary research focus. Thereby we need to create a pathway for improved proactive identification ad mitigation of emerging antibiotic resistance threats.

Reference:

1. Fact-sheet details W.H.O (2020)
2. About Antibiotic Resistance, (2020) Centers for disease control and prevention.
3. An update on the fight against antimicrobial resistance –W.H.O (2020)
4. Michael J. Bottery, Jonathan W. Pitchford, Ville-Petri Friman, (2020) Ecology and evolution of antimicrobial resistance in bacterial communities. The ISME Journal.
5. Terence S. Crofts, Andrew J. Gasparrini, Gautam Dantas, (2017) Next-generation approaches to understand and combat the antibiotic resistome. Nature Reviews Microbiology.
6. Image created by the Author