Updated: Jan 13
Antimicrobial resistance (AMR) problems were predicted back in 1945 by Nobel Prize
Winner, Alexander Fleming who discovered Penicillin – the first antibiotic. He warned
everyone about the danger of underdosing of antibiotics, which can lead to ineffective
treatment by the same antibiotic because of bacteria acquiring the resistance. Generally,
resistance always occurred in nature to some degree, however, an alarming issue nowadays is that it is increasing and accelerating due to many different causes worldwide which will be discussed later.
When we talk about AMR, we are not just talking about bacteria becoming resistant to
antibiotics. AMR also concerns antiprotozoal, antiviral, and antifungal treatments for
infections in humans. This phenomenon occurs when the microorganisms like bacteria,
viruses, and fungi change so that medications used to treat them become ineffective. There
are 2 main mechanisms of acquiring a resistance: by a genetic mutation (Fig1.) or by transfer of drug resistance gene from another microorganism already resistant to the drug (Fig2). If a microbe acquires further resistance to many different drugs (multi-drug resistance) it can be called a ‘superbug’.
Therefore, why can the underdosing of antibiotics be dangerous? The problem is that not all of the bacteria may be killed by the antibiotic in such conditions. The bacteria that survive will be able to acquire resistance to that antibiotic. These bacteria will also multiply as they will have preferable conditions to grow and take over, causing a disease that can no longer be treated with this kind of antibiotics.
It raises concerns, as for example organ transplantation, cancer chemotherapy, and surgeries require antibiotics for treating reoccurring infections that can be caused by the treatment. The problem also involves new-borns treated at neonatal intensive care at hospitals. Antimicrobial resistance can therefore cause achievements of modern medicine becoming high-risk procedures and it already contributes to higher mortality among patients. WHO has announced this year that AMR is one of the top 10 global public health threats facing humanity. According to the UN Interagency Coordination Group (IACG) on Antimicrobial Resistance, if no action is taken against antimicrobial resistance, by 2050 drug-resistant diseases could cause 10 million deaths each year, and by only 2030, it could increase extreme poverty up to 24 million people worldwide.
Acceleration of antimicrobial resistance has various causes worldwide. One of them is overprescribing of antibiotics – prescribing when not needed, so for example when the infection is not bacterial. In many countries, you don’t even require a prescription to buy antibiotics. The patients usually take the wrong dose for a too short period of time therefore encouraging bacterial antibiotic resistance to expand. This problem is being addressed by focusing on increasing patients' awareness about antimicrobial resistance, enhancing surveillance of antibiotic’s distribution nationwide, and on research to deliver cheap diagnostics that would distinguish between types of infections and if the infectious microbe is resistant. Better surveillance is also needed at the level of hygiene and sanitation to prevent the spread of infections in the first place.
Usage of antibiotics in agriculture – livestock farming and crops – also contributes to antimicrobial spread. The first thing is that these are food-producing animals and crops, and some research suggests that antibiotic resistant bacteria can spread to humans in this way. Agriculture also contributes to the spreading of resistant bacteria in the environment as organic fertilizers and contaminated irrigation water are used and therefore left in the soil.
Greater innovation, co-ordinated around the world is needed to combat the alarming problem of antimicrobial resistance. Research should focus on the diagnostics but also increase the rate of discovery of new classes of antibiotics (class of antibiotics involve a group that shares basic chemical structure and mechanism of action). This is important because if a bacterium becomes resistant to an antibiotic it often extends its resistance to all antibiotics within the same class.
If we don’t make people around the world aware of antimicrobial resistance and don’t change our priorities, there may be no antibiotics left to treat infections in the future!