Globally, antimicrobial resistance (AMR) is becoming an increasingly serious public health concern. In particular, the development of antibiotic resistance – due to the frequent and commonplace use of antibiotics in modern society – has become a highlighted medical issue in recent times. Antibiotic resistance is now considered to be one of the biggest threats to global health, food security and development, and is rising to dangerously high levels all over the world.
What are antibiotics?
Antibiotics are medicines used to prevent and treat bacterial infections and have completely revolutionised medicine. In 1928, Scottish scientist Sir Alexander Fleming invented the first antibiotic when an apparently accidental contamination led to the discovery of what is now known as penicillin.
Worldwide, antibiotics have been used to prevent and treat common bacterial infections that used to be incurable and were often deadly. For example, STI's and tuberculosis amongst other diseases are far more easy to treat nowadays than they were 100 years ago. In addition, before antibiotics were invented any wound – no matter how minor – could become infected and lead to death. Likewise, common surgical procedures and childbirth were extremely high risk.
Having effective antibiotics against bacterial infections are essential in modern medicine, and not having drugs to prevent and treat common bacterial infections will seriously impact global public health efforts.
Antibiotic resistance
Concerns over antibiotic resistance have been reported as far back as 1945, including by Sir Alexander Fleming himself who warned about the dangers of antibiotic resistance in an article for the New York Times, cautioning that:
"... the microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out....In such cases the thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism. I hope this evil can be averted.”
It's been less than 100 years since Sir Alexander Fleming invented the first antibiotic, and just over 70 years since he warned of the dangers of antibiotic resistance, yet today antibiotic resistance is a serious global public health concern.
What's causing antibiotic resistance?
Although antibiotic resistance occurs naturally overtime, it is being accelerated due to overuse and misuse of antibiotics, combined with a lack of new drug developments. Antibiotics have no affect on viral infections such as the common cold or the flu, yet are all too often demanded and/or prescribed as a first line of attack. Even when prescribed correctly, many patients misuse their antibiotics – in particular stopping their treatment course early because they feel better. A lot of research has been performed to determine the shortest treatment course required to completely kill all bacteria, and by stopping treatment early you run the risk that the antibiotics won't have killed all of the bacteria in the infection. These bacteria can then mutate, become resistant to that antibiotic, and spread throughout the population.
In addition, antibiotics are heavily used in the agriculture industry as growth promoters and to prevent and treat infections in animals, as well as being mixed into stock food and sprayed on crops. It is very easy for antibiotics to enter the food-chain and be passed on to humans. Most recently, a US preliminary study has shown the presence of antibiotic-resistant bacteria in many ready-to-eat food products such as dairy and fresh produce.
Present day
Already, a growing list of infections – such as pneumonia, tuberculosis, gonorrhoea and blood poisoning – are becoming harder and harder to treat as antibiotics are becoming less effective. Worryingly, some bacteria have become resistant to multiple antibiotics, and the list of treatment options is getting smaller.
Last year, a US woman in her 70's died following an infection with Klebsiella pneumoniae – a carbapenem-resistant Enterobacteriaceae (CRE) that is resistant to the carbapenem (or 'the last resort') class of antibiotics. It is thought that she contracted the infection after being hospitalised in India following a broken leg injury. Upon her return to the US she was again hospitalised and treated with 26 different antibiotics – everything the hospital had available – yet sadly went into septic shock and died. The K. pneumoniae infection was resistant to every one of those 26 antibiotics, and as a result the doctors were unable to save her life.
Worryingly, reports like this one are likely to become more and more common as we continue to battle against the rise in antibiotic resistance. It is essential that everyone works towards preventing, or at the very least delaying, a post-antibiotic era, as without urgent action common infections and minor injuries will once again be deadly.
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