Understanding Antibiotics (Part 3)

Antibiotic resistance is a critical concept in the treatment of infectious diseases. As we have already discussed in the first part of this series, antibiotics are unlike other medicines. Antibiotics do not have a direct effect on our bodies but on microbes. Subsequently, in the second part, we saw that these living microbes have learned how to resist antibiotics.

What is antibiotic resistance?

Antibiotic resistance is the capacity of a microorganism to withstand the effects of an antibiotic. Antibiotic resistance happens when germs like bacteria develop the capacity to defeat the drugs meant to kill them. By developing resistance, these germs continue to multiply and cause disease, and even death.

Antibiotic resistance does not mean humans or animals becoming resistant to antibiotics; bacteria develop resistance to the antibiotics meant to kill them.

How do bacteria develop antibiotic resistance?

Over many decades, bacteria have evolved many strategies to achieve resistance. Here are two important methods:

1. Bacteria stop the antibiotic from reaching its target in their cells
2. Bacteria modify the target of the antibiotic action

For each of these methods, they have different mechanisms. For example, to stop the antibiotic from reaching the target, bacteria may pump the antibiotic out from the bacterial cell, destroy the antibiotic using its enzymes, or make it more difficult for the antibiotic to enter their cell. These are complicated processes that happen over many generations of bacteria.

What is the problem with antibiotic resistance?

These resistant bacteria may infect humans and animals, and these are harder to treat than those caused by non-resistant bacteria.

Antibiotic resistance is rising to dangerously high levels in all parts of the world. As a result, an increasing number of infections – such as pneumonia, blood infections, urinary tract infections, tuberculosis, and intestinal infections like typhoid – are becoming harder to treat as antibiotics become less effective.

Antibiotic resistance makes infections harder to treat, and has made it one of the most urgent threats to public health.

US Centre for Disease Control and Prevention

Why is antibiotic resistance increasing?

Antibiotic resistance occurs naturally, but the misuse of antibiotics in humans and animals is accelerating this process.

In countries where antibiotics can be bought without a prescription, resistance is higher. Similarly, resistance is higher in countries where antibiotics are over-prescribed by health workers and veterinarians and over-used by the public. The prescription of antibiotics by ill-trained health workers and quacks adds to the problem.

Antibiotics are life-saving. But we need swift action to curb antibiotic resistance. Otherwise, we will soon be in the post-antibiotic era. It means, even simple injuries and common infections can kill.

Prevention of antibiotic resistance

The misuse and overuse of antibiotics have worsened antibiotic resistance. Inadequate infection prevention and control make antibiotic use higher and promote resistance. So, steps should be taken at all levels of society to reduce the effect and reduce the spread of resistance.

What should I do to reduce the problem of antibiotic resistance?

As an individual, you can make a difference. We should try. If we don’t, our future generations will not forgive us for what we are doing.

The problem of antibiotic resistance is similar to global warming and climate change. In climate change, global warming as well as antibiotic resistance, our individual acts of defiance may appear insignificant now, but their cumulative effect on our environment is tremendous.

– on twitter

1. Use antibiotics only when prescribed by a registered medical professional
2. Never demand antibiotic
3. Follow the doctor’s advice about the dose and duration of antibiotics
4. Never share antibiotics
5. Never use leftover antibiotics
6. Prevent infections by maintaining good hygiene, avoid close contact with infected people and taking vaccinations as recommended. Vaccinations are now routine practice in adults too. Please talk to your doctor about it.

What should be done in agriculture and poultry?

Use of antibiotics in agriculture (for animals) and in poultry (for chicken) also promotes antibiotic resistance that can affect humans. This is a reality now.

1. Give antibiotics to animals only under veterinary advice and supervision
2. Do not use antibiotics to prevent infections in animals
3. Do not use antibiotics as growth promoters
4. Vaccinate animals to reduce antibiotic use
5. Improve hygiene in farms and poultry to reduce the antibiotic requirement.

What should health professionals do?

The role of health workers is also critical in reducing antibiotic resistance.

1. Prescribe antibiotics only when there are needed
2. Prevent infections in patients by ensuring clean hands, clean instruments and clean hospital environment
3. Wash hands frequently when at work
4. Educate patients about the proper use of antibiotics

What should our government do?

Governments make policies and implement them. They should recognize antibiotic resistance as a significant public health problem.

1. Action plan to manage antibiotic resistance
2. Strengthen implementation of infection control and prevention measures
3. Regulate and promote the use of good quality medicines
4. Clampdown illegal dispensing of antibiotics by quacks and those without a license to prescribe (including chemists and pharmacies)
5. Public education about the impact of antibiotic resistance.

What is the impact of antibiotic resistance?

When infections cannot be treated by the usual simple antibiotics, more expensive antibiotics must be used. A longer duration of sickness and treatment, often with a hospital admission may be needed. This increases health care costs on families.

Antibiotic resistance is threatening the achievements of modern medicine over the last century. Organ transplantations and surgeries such as cesarean sections become much more dangerous without effective antibiotics for the prevention and treatment of infections.

World Antibiotic Awareness Week

Since 2015, the World Health Organisation holds the World Antibiotic Awareness Week in November of every year. This aims to increase awareness of global antibiotic resistance and to encourage best practices among the general public and healthcare professionals.

In 2019, the World Antibiotic Awareness Week is on 18-24 November.

Take a pledge to reduce antibiotic use.

This concludes the series of articles on Understanding Antibiotics. Thank you for reading them!

Shashikiran Umakanth

Dr Shashikiran Umakanth (MBBS, MD, FRCP Edin.) is Professor & Head of Internal Medicine at MMMC, Manipal Academy of Higher Education, and has clinical responsibilities at the Department of Medicine, Dr TMA Pai Hospital, Udupi, Karnataka, India.