Why Should I Care About Antibiotic Resistance
Antibiotic resistance can affect any person, at any stage of life. People receiving health care or those with weakened immune systems are often at higher risk for getting an infection.
Antibiotic resistance jeopardizes advancements in modern health care that we have come to rely on, such as joint replacements, organ transplants, and cancer therapy. These procedures have a significant risk of infection, and patients wont be able to receive them if effective antibiotics are not available.
Aside from healthcare, antibiotic resistance also impacts veterinary and agriculture industries.
If The Situation Is So Grim What Are We Doing To Deal With It
According to the World Health Organization , the following measures can be taken by patients to handle this problem better.
As patients:
- We should use antibiotics only under proper medical supervision and prescription.
- We should avoid using antibiotics for cold and flu, which are viral infections and therefore not affected by antibiotics. If we use antibiotics for viral infections, we add to the overall risk of antibiotic resistance.
- We should refrain from sharing our leftover antibiotics with others or repeating a particular prescription without medical guidance.
Why Dont We Create New Antibiotics To Fight Resistance
The development of new antibiotic drugs to replace those antibiotics that have lost their efficacy is an obvious solution to the antibiotic resistance problem. However, the development of antibiotics has drastically slowed in recent decades. Antibiotic discovery is an expensive and technically difficult process and has become even more difficult now that many of the easier-to-develop drugs have already been discovered. According to the World Health Organization , there are also few drug companies investing in antibiotic development since they traditionally âhave a poor return on investment because they are taken for a short period of time and cure their target disease.â
This timeline shows the lack of new antibiotic class discoveries in the last several decades compared to the majority of the 20th century.
WHO Reference: Bulletin of the World Health Organization 2011 89:88â89. doi:10.2471/BLT.11.030211
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Promoting Delayed Prescribing Of Antibiotics
Delayed antibiotic prescribing means that the prescriber delivers an antibiotic prescription, but recommends the patient not to redeem it the same day. The prescription should only be redeemed if the patient feels worse within a few days. If symptoms reduce spontaneously, the prescription should be discarded. Delayed antibiotic prescribing is a widespread practice in the UK and its use is enforced by national guidelines , but it has been difficult to implement in other countries. However, recent evidence from Norway also indicates that delayed prescribing may lead to a reduction in antibiotic use, mainly for sinusitis and otitis media .
Why Should We Care About Antibiotic Resistance A Q& a With George Liu Md Phd
In recent history, its safe to say that one of the most revolutionary additions to the world of health care has been antibiotics. Designed to attack bacterial infections, antibiotics have made countless ailments that were once serious or even fatal simple and quick to overcome. However, with ease and efficacy has also come overuse, which, combined with bacterias natural ability to evolve, has led to an alarming problem: many types of bacteria are starting to outsmart antibiotics. What exactly does that mean for us as a society, and for the future of health care?
We asked George Liu, MD, PhD, chief of the Division of Infectious Diseases at Rady Childrens Hospital-San Diego and a lauded antibiotic-resistant bacteria researcher, to weigh in on this complex and quickly growing threat to public health.
What is antibiotic resistance and why is it such an important public health issue?
Antibiotics are one of mankinds most important discoveries. They allow us to survive serious bacterial infections. When bacteria become resistant to an antibiotic, it means that the antibiotic can no longer kill that bacteria. If the bacteria develops resistance to all antibiotics, it means that we could be back to where we were a century ago, being at the mercy of pathogens and not surviving even routine infections. The impact on public health would be devastating.
How does antibiotic resistance happen?
Are certain types of bacteria more susceptible to becoming resistant?
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Why Should I Care
Antibiotic resistant bacteria are spreading at an alarming rate and can affect anyone, anywhere on the planet. In this section, risks associated with antibiotic resistance and antibiotic use are discussed from the perspective of the individual and society.
Antibiotics can be life-saving medicines. However, they are often used when not needed or when not effective. Many regard antibiotics as the remedy for any infection, and that they can be used without negative consequences. Unfortunately, this is not true.
Why You Should Care About Antibiotic Resistance
Since the discovery of penicillin about 85 years ago, antibiotics have revolutionized healthcare and modern medicine, becoming the bedrock of many great medical advances of the century. From a small cut and root canal to infections and childbirth, antibiotics have marked their presence everywhere. They are the wonder drugs on which modern medicine and our health hinges. However, there is a scary side to antibiotics, too. Overuse or misuse has contributed to the phenomenon of antibiotic resistance.
What Is Antimicrobial Resistance ?While we found a way to outsmart the bugs, they didnt fall behind in the race either. Bacteria and other pathogens have evolved naturally and resistance to antibiotics is a consequence of such natural selection. Infection-causing bugs usually multiply or grow in millions and, during this, a few of them may develop a genetic mutation that makes these bugs superior to our pharmaceuticals. In the presence of antibiotics, while the non-resistant bugs will die, the ones with the genetic mutation survive. These further multiply in millions and transfer the drug-resistant gene to their offspring, adding to the pool of superbugs.
Incorrect diagnosis, unnecessary prescriptions and incorrect or improper use of prescribed antibiotics by patients all contribute to the rising resistance.
A few steps you can take and contribute to your fight against these superbugs are:
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Resistance Evolution In The Environment
Antibiotic resistance can arise both from mutations in the pre-existing genome of a bacterium and from the uptake of foreign DNA. Mutations readily occur and become fixed in the patient or animal treated with the antibiotic. Such a strong selection pressure on pathogens is rarer elsewhere. The process is also independent of the genetic reservoir in other species. Hence, external environments are generally less likely to provide a major contribution to mutation-based evolution of resistance for most pathogens. With regard to uptake of novel resistance factors, water, soil and other environments with highly variable ecological niches provide an unmatched gene pool with a diversity that greatly exceeds that of the human and domestic animal microbiota,. Indeed, the most striking feature of the environmental microbiome is its immense diversity, providing numerous genes that potentially could be acquired and used by pathogens to counteract the effect of antibiotics,,,,. All approved antibiotic classes so far, whether they be natural, semi-synthetic or synthetic compounds, have been met by resistance in at least some of the pathogens they target. This suggests that external environments already harbour resistance factors for all antibiotics that will ever be developed, unless we start thinking radically differently about how antibiotics are designed.
Fig. 1: The role of the environment in the emergence of new resistance genes in pathogens.
What Are Inflammatory Biomarkers
Of particular interest to doctors treating bacterial infections are inflammatory biomarkers. But what are biomarkers, and what are they used for?
Inflammatory biomarkers are signs that evidence inflammation somewhere in the body. This tends to be revealed through blood tests, which measure the amount of protein being released into the bloodstream.
By studying the type and concentration of these proteins, doctors can form a diagnosis to determine what kind of infection is causing the overt symptoms.
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What Does The Future Hold For Antibiotics
If antibiotic resistance is such a huge problem, does this mean that we need to do away with antibiotics entirely and find a different solution?
A problem comes from the profitability of developing new antibiotics. While research into novel treatments for things like heart disease and cancer might be commercially viable, the same cant be said for antimicrobial treatments. Only a low volume of such treatments make the journey from basic research all the way through to clinical approval.
While we cant rule out the discovery of miraculous new treatments by microbiologists, a better strategy might be a more sensible use of the drugs we already have. This will require co-operation between medical institutions across different states, as well as social and economic interventions alongside medical ones.
A potential way to manage this is for providers to charge a fixed price for the use of their drugs, even if those drugs arent actually used a little like a Netflix subscription. This would sever the link between the volume of drugs distributed and the profitability of the drug companies, thereby incentivising further innovations. More accurate measurement of the prevalence of the problem might also be possible using point prevalence surveys, and new fields like bioinformatics.
The History And Evolution Of Antibiotic Resistance
Penicillin was the first antibiotic discovered by Sir Alexander Fleming in 1928. Since its discovery, penicillin was heavily used to treat soldiers suffering from bacterial infections during the Second World War. However, by the 1950s, penicillin resistance became a grave problem. This led to the development of beta-lactam antibiotics, but unfortunately, the first case of methicillin-resistant Staphylococcus aureus was identified during the 1960s. Vancomycin, another antibiotic, was introduced in the 1970s to tackle MRSA, but that also showed resistance by the 1980s. Hence, many decades after the miraculous discovery of antibiotics, in our current day and age, we seem to have returned to a pre-antibiotic era due to the exponential rise of antibiotic resistance.
We understand very clearly now that antibiotic resistance is a real threat and a global cause of concern. Now, lets look at the possible causes and mechanisms by which this resistance develops.
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How Are The Authorities Fighting Antibiotic Resistance
Antibiotic resistance is a major problem. Public authorities are takingmeasures against antibiotic resistance wherever necessary to protect peopleshealth. The One Health approach recognises that the health of humans is relatedto the health of animals and the environment:
- Researchers are studying how superbugs on food can be transmitted to people.Understanding how this works will enable the government to introduce effectivemeasures.
- Antibiotics in the environment Resistant bacteria are also found in soil, air and water. The government hasasked researchers to find out how to stop the superbugs spreading in theenvironment.
Spread Of Germs & Resistance Mechanisms
To survive, germs develop defense strategies against antibiotics called resistance mechanisms. DNA tells the germ how to make specific proteins, which determine the germs resistance mechanisms. Bacteria and fungi can carry genes for many types of resistance.
When already hard-to-treat germs have the right combination of resistance mechanisms, it can make all antibiotics ineffective, resulting in untreatable infections. Alarmingly, antibiotic-resistant germs can share their resistance mechanisms with other germs that have not been exposed to antibiotics.
This table gives a few examples of defense strategies used to resist the effects of antibiotics.
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What Is Antibiotic Resistance What Causes It
Resistance to an antibiotic occurs when a microorganism is able to grow or survive in the presence of a concentration of antibiotic that is usually sufficient to inhibit or kill organisms of the same species. The terms susceptible and resistant relating to antibiotics are usually used in clinical practice to infer the likely success or failure of treatment. Resistance is more likely when the concentration required to inhibit or kill microorganisms exceeds that achievable in a patient.
Microorganisms can be either intrinsically resistant to an antibiotic or develop resistance following exposure to that antibiotic . Resistance can develop as a result of mutation or direct transfer of genes encoding a resistance mechanism. Transfer of resistance genes can occur by a variety of mechanisms including conjugation , transformation or transduction . Genetic material, including antibiotic resistance genes, can spread very effectively between bacteria, even those of unrelated species.
The efficiency and rate at which a resistant phenotype spreads within a previously susceptible species are unpredictable. For example, the staphylococcal -lactamase gene is very successful in Staphylococcus aureus, with similar genes in Haemophilus influenzae and many Enterobacteriaceae, but they have never spread widely in enterococci. Fortunately, vancomycin resistance genes found in enterococci remain rare in S. aureus.
And What About Toothache
BH: When patients attend a dentist with throbbing toothache disturbing sleep, what they often need is surgical intervention whether it be removing dental decay, root canal treatment or extracting a tooth, rather than antibiotics alone. If antibiotics are prescribed without surgically removing the source of infection, there is a risk of the dental condition worsening, restricting mouth opening and causing difficulty swallowing and breathing. Antibiotics, when used appropriately, can be a good way of treating the infection and preventing the situation worsening. However, it is not always appropriate. A Cochrane review investigating the prophylactic use of antibiotics following a tooth extraction found that the use of antibiotics in this situation may cause more harm than benefit for both the individual patient and population at large.
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Highway To Antibiotic Resistance
The evolution of AR comprises the emergence, the transmission, and the persistence of ARBs . Concerning human health, selection of ARBs/ARGs is particularly relevant at the individual health level, whereas transmission is a main element to be taken into consideration at the One Health and Global Health levels . Indeed, unless AR is transmitted, it will be just an individual problem that would not affect the community at large.
A final issue concerning AR is its stability in the absence of selection. It has been proposed that the acquisition of AR reduces bacterial competitiveness in the absence of antibiotics certainly, a wishful proposition such as, if true, the reduction in the use of drugs or eventually antibiotic-cycling strategies should decrease AR . Nevertheless, eliminating the use of an antibiotic does not produce a full decline of AR . In fact, different studies have shown that AR not always reduces fitness but also can even increase bacterial competitiveness . In addition, compensatory mutations or physiological changes that restore fitness can be selected in resistant bacteria . It is a fact, however, that although ARBs are found nearly everywhere, including wild animals, natural ecosystems, or people from isolated populations without contact with antibiotics, among others , AR prevalence is consistently lower when antibiotics are absent, which suggests that pollution may impact AR, a feature that is discussed below.
How Do Bacteria Become Resistant To Antibiotics
Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm. Bacteria can do this through several mechanisms. Some bacteria develop the ability to neutralize the antibiotic before it can do harm, others can rapidly pump the antibiotic out, and still others can change the antibiotic attack site so it cannot affect the function of the bacteria.
Antibiotics kill or inhibit the growth of susceptible bacteria. Sometimes one of the bacteria survives because it has the ability to neutralize or escape the effect of the antibiotic that one bacterium can then multiply and replace all the bacteria that were killed off. Exposure to antibiotics therefore provides selective pressure, which makes the surviving bacteria more likely to be resistant. In addition, bacteria that were at one time susceptible to an antibiotic can acquire resistance through mutation of their genetic material or by acquiring pieces of DNA that code for the resistance properties from other bacteria. The DNA that codes for resistance can be grouped in a single easily transferable package. This means that bacteria can become resistant to many antimicrobial agents because of the transfer of one piece of DNA.
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How Can I Prevent Antibiotic
By visiting this website, you are taking the first step to reducing your risk of getting antibiotic-resistant infections. It is important to understand that, although they are very useful drugs, antibiotics designed for bacterial infections are not useful for viral infections such as a cold, cough, or the flu. Some useful tips to remember are:
Promoting The Use Of Valid Point
If you visit a primary-care consultation in a Scandinavian country and compare it with a similar consultation in a Southern European country, you soon realize that the most important difference is the number of diagnostic tools available in Scandinavia. GPs in Northern countries usually use rapid antigen detection testing for the diagnosis of streptococcal pharyngitis, C-reactive protein devices for ruling out serious respiratory tract infections, equipment capable of determining the number and type of leukocytes and agar plates for urine culture and susceptibility testing of bacteria .
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