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14 November, 2018 11:24:14 AM / LAST MODIFIED: 14 November, 2018 11:32:52 AM
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Antibiotic resistance: A major and growing global health threat

Changes in bacteria, known as resistance mechanisms, come in different forms and can be shared between different bacteria, spreading the problem
Mohammed Abul Kalam, PhD
Antibiotic resistance: A major and growing global health threat

This year World Antibiotic Awareness Week (12-18 November, 2018) is being observed by the WHO as a part of their world-wide campaigns. This year’s theme is “Change Can’t Wait. Our Time with Antibiotics is Running Out”. Each November, World Antibiotic Awareness Week (WAAW) aims to increase global awareness of antibiotic resistance (AMR) and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of antibiotic resistance. Since their discovery, antibiotics have served as the cornerstone of modern medicine. However, the persistent overuse and misuse of antibiotics in human and animal health have encouraged the emergence and spread of AMR, which occurs when microbes, such as bacteria, become resistant to the drugs used to treat them (WHO).

Nearly one million people die every year from bacterial infections that cannot be treated with common antibiotics. This is frightening because right now we don’t have any alternatives to these antibiotics. Antibiotic resistance occurs when bacteria change in a way that prevents the antibiotic from working. Changes in bacteria, known as resistance mechanisms, come in different forms and can be shared between different bacteria, spreading the problem.Antibiotic resistance risks returning us to an age where even simple cuts and scrapes can become deadly. For a glimpse of what could be commonplace in our future, here are five of the scariest antibiotic resistant bacteria from the last five years.Antibiotic resistance has the potential to affect everyone. Most people would have heard about antibiotic resistance and studies show many are aware the cause of the current crisis is due to their overuse. But few know how and where the resistance occurs.

What is antibiotic resistance?Antibiotic resistance happens when bacteria change in a way that prevents the antibiotic from working. Changes in bacteria, known as resistance mechanisms, come in different forms and can be shared between different bacteria, spreading the problem. Bacteria and fungi naturally use antibiotics as weapons to kill each other to compete for space and food; they have been doing this for over a billion years. This means they are used to coming into contact with antibiotics in the environment and developing and sharing antibiotic resistance mechanisms.

Most antibiotics we use today are modelled on the ones naturally created by bacteria and fungi. In the past, if the bacteria didn’t encounter the antibiotic they developed resistance for, they could lose the resistance mechanism. But now, because we are overusing antibiotics, the bacteria are encountering them all the time and therefore keeping their resistance mechanisms. Hence the crisis.

Bacteria frequently now encounter antibiotics in the environment (such as the soil) as well as in our bodies and those of animals. Antibiotic resistant bacteria mostly survive these encounters and then multiply in the same manner.This results in an increased chance of people being infected with antibiotic resistant disease-causing bacteria, which can lead to increased complications, prolonged hospital stays and an increased risk of death.

How resistance develops and spreads: Some bacteria are naturally resistant to certain antibiotics. For instance, the antibiotic vancomycin cannot kill Escherichia coli (E. coli), while metronidazole can’t kill the whooping cough-causing Bordetella pertussis. This is why different antibiotics are prescribed for different infections.

But now, bacteria that could previously be killed by certain antibiotics are becoming resistant to them. This change can occur in two ways:  (1) Genetic mutation, and (2) Horizontal gene transfer.

Genetic mutation is when bacterial DNA, that stores the bacteria’s information and codes for its traits, randomly changes or mutates. If this change, that could be resistance to antibiotics, helps the mutated bacteria survive and reproduce then it will thrive and outgrow the unchanged bacteria. Random mutation would happen with or without antibiotic overuse. However, the resistant changes only stay in the bacterial population if the antibiotic is constantly present in the bacteria’s environment. Our overuse of antibiotics is resulting in the propagation and maintenance of these changes.

Most antibiotics we have today have been modelled on those naturally designed by fungi and bacteria. Horizontal gene transfer is when one bacterium acquires antibiotic resistance mechanisms – carried by a particular gene – from other bacteria.This can occur between the same kinds of bacteria, such as between E. coli that cause urinary tract infections and E. coli that cause food poisoning; or between different kinds of bacteria, such as between E. coli and antibiotic-resistant Staphylococcus aureus (MRSA). Horizontal gene transfer can also occur between the natural and disease-causing bacteria in our gut. So our gut can act as a source of antibiotic resistance genes.

This is why it is important to only take antibiotics when they are needed. As bacteria can transfer multiple resistance mechanisms at once and can become resistant to many types of antibiotics very quickly – known as multi-drug resistance.  Many people also tend to think they need something when they are sick and doctors may feel pressure to meet their patients’ expectations of treatment. Expectations are often inaccurate – people overestimate the benefits and underestimate the harms of treatment. Research shows that antibiotics offer little or no benefits for some common infections such as colds, coughs and sore throats..

What can be done?There is no simple answer. But there is no doubt a societal approach is needed. Governments, health professionals, veterinarians, members of the public and various industries are all working towards solutions. The World Health Organization suggests that surveillance of antimicrobial resistance, regulating antibiotic use in humans and animals, infection prevention and control, and research innovations are all needed to tackle the crisis.

The challenge is ongoing. But a key message to take away from our recent research is that although antibiotic resistance might feel distant, it is everyone’s problem. It is individuals who decide to use antibiotics, and it is individuals who have the power to minimise use and halt antibiotic resistance.

What will happen as the drugs stop working?Without antimicrobials we risk a return to death from infections previously thought defeated. We will likely also be unable to safely perform routine medical procedures such as hip replacements and Caesarean sections, or administer chemotherapy to cancer patients, as each often rely on accompanying antibiotics to prevent or treat infections.

What’s the solution?Antimicrobial resistance is a complex problem involving different sectors. It is driven by, and affects, the human, animal and environmental health sectors. Within human, animal and environmental health, groups of prescribers, users and regulators have influence over antimicrobial use and resistance. We often think of prescribers as GPs, but within this group are all doctors, dentists, pharmacists, vets and nurse practitioners working in the community, in hospitals and in residential aged care facilities.

Similarly, patients are not the only users of antimicrobials. Farmers and pet owners also fall into this category. Local and national governments typically play the role of regulating antimicrobials, but as antimicrobial resistance is a global problem, the actions of international governments and agencies are also significant. Action to combat antimicrobial resistance requires prescribers, users and regulators of antimicrobials in human, animal and environmental health work together. This is because no single action in any single group is sufficient. This also makes it a very challenging solution to deliver.

The writer is Former Head, Department of Medical Sociology,

Institute of Epidemiology, Disease Control & Research (IEDCR)

Dhaka, Bangladesh

E-mail: med_sociology_iedcr@yahoo.com

IK

 

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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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