Antibiotic Resistance

Introduction

What is antibiotic resistance?

Antibiotics are a type of medication used to treat or prevent bacterial infections. They can achieve this by killing the bacterial cells or rather inhibiting them from reproducing, therefore stopping their spread.⁹

Antibiotic resistance, or more broadly speaking, antimicrobial resistance, is a growing issue where a microbe, such as bacteria, manages to build up defenses to antibiotics, rendering the treatment ineffective.¹

There are many ways for a bacteria to become resistant to specific antibiotics as shown below:

All of these act as defense mechanisms for the bacterial cells in order to prolong their survival. However, this means that when we want to treat bacterial infections in our body, previously effective treatments may no longer be a viable option due to these advancements in the bacteria’s defenses. This can have harmful effects as infections have the chance to grow while the body has to solely rely on its immune system, which cannot always overcome bacterial infections alone.

Causes

Why is this happening?

Usually, after catching a bacterial infection, you can be administered a course of antibiotics to help your body to combat the infection and recover to full health. If the treatment is successful, there is hope that all of the bacterial cells in your body are destroyed so that they cannot go on to reinfect you or another person. 

However, sometimes the bacterial cells can develop the ability to fend off the antibiotics, and survive the exposure to these drugs that are designed to kill them or inhibit their growth. This means that not only can the bacteria begin to reproduce and spread, but also have a mutation in their genetic code allowing them to be resistant to the treatment that would have previously been effective.

Even though antibiotic resistance can be a natural occurrence, with the genes relating to drug resistance dating back millions of years in some bacteria⁶, there are actions that we take that can increase the likelihood of a bacterium developing antibacterial resistance:

• One major cause is the overuse of antibiotics to treat common illnesses. Between 2000 and 2015, the use of Access antibiotics (first-line or second-line treatments) grew by 26.2% and the use of watch antibiotics (with higher resistance potentials) grew by 90.9%. There is evidence to suggest that this rapid increase in antibiotic use across the general population increases the rate at which bacteria develop antibiotic resistance, as they are being given more exposure more often, and begin to develop defenses against the treatment quicker.² 

• Poor sanitation and hygiene also play a large factor in the growing prevalence of antibiotic resistance. In Europe, around 75% of the burden of antibiotic resistance can be attributed to healthcare-related infections³. This can be due to a lack of established prevention and control measures for patients in healthcare settings. The resulting situation is that infections are much more likely to spread between patients, forcing the use of antibiotics that wouldn’t have been needed if there had been effective preventative measures in place.

• Insufficient access to healthcare facilities and treatments could also be a part of increasing levels of antibiotic resistance. Treatments such as vaccines are not always readily available to provide protection against potentially dangerous bacterial infections. This is especially true in low-income regions compared to wealthier countries, as there can be a lack of access to the latest vaccines and treatments, causing infection rates to increase and resistant bacteria to flourish.⁵

Effects

What does this mean for the future?

Antibiotic resistance has been on the rise in recent years and its effects are becoming more widespread and difficult to combat. 

Patients are going to be on the frontline of the battle as treatments will begin to become less effective, reducing efficacy rates and increasing the probability of an otherwise common bacterial infection resulting in fatalities.

The figure below shows estimates from 2014 on the number of people thought to die every year due to drug-resistant strains of common bacterial infections. It is likely that the current figure has risen beyond 700,000 deaths per year and could potentially rise to over 10 million deaths by 2050, possibly becoming a greater public health emergency than cancer.⁶

The rise of antibiotic resistance can also severely limit the treatment options available for healthcare professionals to administer. First-line antibiotics are the preferred initial treatment options for bacterial infections that are deemed the best available treatment regarding success rates, safety, and cost. 

However, it is becoming increasingly difficult to treat common bacterial infections with first-line antibiotics due to resistance. Antibiotics that doctors previously tried to avoid prescribing due to severe side effects, such as organ failure, are slowly becoming the only option as bacterial resistance grows against the most common antibiotics⁷. Furthermore, even these antibiotics won’t hold up against resistant bacteria as in 2018, already 37% of bacterial infections in Europe were caused by bacteria resistant to last-line antibiotics such as colistin and carbapenems which are in most cases the last treatment options available.³

Every day, relatively low-risk procedures such as organ transplants and cesarean sections have the potential to become dangerous for patients as our ability to effectively prevent and treat acute infections with antibiotics diminishes. This could consequently undermine the achievements of modern medicine and the life-saving medical advancements of the last century.^{6  7}            

The rate at which antibiotic resistance grows is threatening to overtake the rate at which we are able to develop new and effective antibiotics. The data below shows the current situation regarding the slowed development of antibiotics in recent years.

Many experts now believe that we are in a ‘post-antibiotic era’ due to the lack of recent major breakthroughs in antibiotic development.⁴ Despite this, there are some new antibiotics in development, although they are still not expected to act as effective treatments for the most dangerous strains of antibiotic-resistant bacteria.⁷

These effects on the treatments that patients receive also carry economic impacts with them. There are over 2 million yearly bacterial infections in the US alone that are resistant to at least first-line antibiotic treatments, leading to excess costs of around 20 billion USD every year. This is due to extended hospital stays alongside the higher cost of producing stronger last-line antibiotics on a large scale.⁴

Impacts also range beyond patients and into the agricultural sector. Farmers across the world have generously used antibiotics in farming for years however this overuse and misuse can cause problems. Despite being banned in Europe since 2006 by the European Union, farmers in the US and other countries are still allowed to give a low dose of antibiotics to healthy livestock in order to promote growth and prevent illnesses.⁸ Even though this may seem to provide useful benefits, this excessive practice increases the risk of antibiotic-resistant bacteria growing in the farm environment. This poses a threat to animals and humans as infections will become harder to treat and therefore more dangerous over time.⁸

Solutions

What can we do to fight antibiotic resistance?

In order to crack down on the emergence of bacterial resistance, there are many measures that need to be adopted on an international level to provide a global response to a global problem. 

A major part of tackling antibiotic resistance is preventing the infections from taking hold in the first place. There are many ways to help reduce the likelihood of catching a bacterial infection:

• Healthcare facilities need to ensure that they have effective infection prevention and control practices. Combining this with improved sanitation and hygiene will make sure that it is harder for bacteria to spread from person to person, reducing the need for widespread antibiotic use. An example is introducing proper water and sanitation infrastructure which has the potential to significantly reduce the related diarrhea cases that need antibiotic treatment by 60%⁶. This will aid in reducing the development of antibiotic resistance not only for patients in healthcare settings but also for ordinary people in the wider community as well.³

• Healthcare professionals need to avoid prescribing antibiotics to patients when they are not needed. 40 million people are given antibiotics for respiratory issues each year in the U.S; however, only 13 million of those people actually needed antibiotics while the remaining 27 million were given them unnecessarily⁶, leading to the bacteria gaining exposure to the antibiotic when the patient could have beaten the infection without the treatment. 

• In agriculture, national governments must begin to restrict the overuse of antibiotics for promoting growth or preventing disease in otherwise healthy animals. Vaccinations should be used to prevent diseases in animals as an alternative to antibiotics and improved hygiene and animal welfare should be implemented on farms to reduce the spread of disease and keep animals healthy for longer, reducing the likelihood of needing antibiotics.⁷

• Finally, in order to reduce the use of antibiotics, there should be global initiatives to identify alternatives. More low-income areas should have easy access to vaccinations, which can be utilized to prevent infection in the future. For instance, widespread use of the pneumococcal conjugate vaccination could result in a 47% decrease in the number of pneumonia cases treated with antibiotics, and avoid 11.4 million days of antibiotic use annually by children under 5⁶. Governments and organizations should also promote the development and research of new antibiotics with novel ways of attacking bacterial cells³, making it harder for bacterial resistance to arise. Between 2003 and 2013, less than 5% of pharmaceutical research and development investment was allocated to antimicrobial development, showcasing how there are currently not enough resources being given to such an alarming problem.⁶

If these actions are adopted amongst other initiatives, we could make real steps towards tackling antibiotic resistance and making sure that we preserve the essential modern medical advancements whilst also allowing us to bring a new age of medicine without having the burden of antibiotic resistance on our shoulders.

References

¹CDC (2021) “About antimicrobial resistance” cdc.gov https://cdc.gov/drugresistance/about.html

²Moore, Sarah. “Origins of Antibiotic Resistance”. News-Medical. 23 July 2022. https://www.news-medical.net/life-sciences/Origins-of-Antibiotic-Resistance.aspx

³“Antibiotic resistance – an increasing threat to human health” antibiotic.ecdc.europa.eu, 15 Nov. 2018, https://antibiotic.ecdc.europa.eu/en/publications-data/antibiotic-resistance-increasing-threat-human-health

⁴CDC (2019) “2019 Antibiotic Resistance (AR) Threats Report” cdc.gov, Dec. 2019, https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf

⁵Thompson, Tosin. “The staggering death toll of drug-resistant bacteria”. Nature.com, 31 Jan. 2022, https://www.nature.com/articles/d41586-022-00228-x

⁶O’Neill, Jim. “Tackling drug-resistant infections globally: final report and recommendations”. https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf

⁷World Health Organization. “Antibiotic resistance”. who.int, 31 Jul. 2020, https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance#:~:text=Bacteria%2C%20not%20 humans%20or%20 animals,hospital%20 stays%2C%20and%20increased%20 mortality.

⁸Antibiotic Research UK (2021) “Antibiotic resistance in farming and agriculture” antibioticresearch.org.uk, https://www.antibioticresearch.org.uk/about-antibiotic-resistance/antibiotic-resistance-farming/9. NHS (2019) “Antibiotics”. nhs.uk, 23 May 2019, https://www.nhs.uk/conditions/antibiotics/

⁹NHS (2019) “Antibiotics”. nhs.uk, 23 May 2019, https://www.nhs.uk/conditions/antibiotics/