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A resistance worth fighting

Updated: Mar 31



Antibacterial resistance is increasing. One study reported that there were 2 million people who became ill due to antimicrobial resistance and 23,000 who died from these infections in 2019. With resistance on the rise, doctors are now turning to last resort antibiotics, that are less available, more expensive, and not fully understood, in order to combat infections by resistant microbes. Several factors influence this rise in resistance, presumably many of which the average person is at fault for. Everything from eating meat, to simply everyday sanitation can may you guilty of contributing to this epidemic. In this post I will review some of the commonly voiced factors that have lead to the onset of the resistance, and provide some ways to help and instill hope to circumvent a potentially microbe-filled future.

1. Prescribing antibiotics for non-bacterial related illness

This is a notion more people are becoming familiar with. Studies have shown that 30% of antibiotic courses are too long and extensive. Testing to identify the cause of illness make take hours to days, patients are often expecting to be given a prescription during their visit. About 10% all doctors visits end with an antibiotic prescription. This, along with other influences on the medical community (such as a study revealing overseas hospitals incentivize prescribing antibiotics as they will receive money from pharmaceutical companies), has results in exaggerated use of antibiotics. In 2014 alone, 250 million courses of antibiotics were prescribed by doctors in the US.

2. Greater accessibility of antibiotics

As with all pharmaceuticals, there is a production period where the drug may be too expensive to produce or distribute and become used by the general public. Over time this expense is reduced and so we have greater availability to a particular drugs. This point regarding antibiotics, can be spilt into two. The first is accessibility in your local neighborhood, where people are self diagnosing and using antibiotics or antibacterial remedies themselves, without proper knowledge to fully understand if they have a bacterial infection, a virus, or simply are bloated. The second half of this argued point is accessibility of antibiotics in poorer countries. Countries that previously were unable to overly prescribe these drugs (due to cost and distribution issues), are now able to take advantage of its medical promise, this unfortunately may be in vain as microbes have advanced in their resistance and the antibiotics finally available in poorer countries, no longer have the same effect as they once did.

3. Overuse of antibiotics in the meat industry

As with humans, animals can also get bacterial infections requiring medication. What differs in the livestock industry is that farmers will give antibiotics as a preventative measure. Bacterial outbreak would be disasterous for that seasons yields, and it is an issue easily avoided by feeding their animals antibiotics beforehand. Feeding livestock with antibiotics has also shown to increase animal mass for more meat and therefor more profit. Several papers have cited this and some have even connected the obesity epidemic observed in humans, to this phenomenon of growing livestock fatter through the use of antibiotics. This would lead to a disbalance in the gut microbiome, resulting in increased weight. With humans using more and more antibiotics, its no wonder we are also increasing in weight as farmers already do with their animals, nevertheless the point stands: contributing to the meat industry is a contribution to the overuse of antibiotics and furthered antibacterial resistance. About 80% of the antibiotics used in the USA are for the sole purpose of livestock. 4. Antibiotics in wastewater

To understand this reason you must first understand how bacteria become resistant to antibiotics. The cause is not that the same bacteria simply acquires an affinity for resistance, but rather the antibiotic kills off a large percentage of the microbes, with surviving microbes being already slightly different from the rest due to a mutation. Bacteria also have an ability to pass on genes by horizontal gene transfer, thus helping neighboring bacteria to potentially become resistant to any following rounds of the antibiotics. Suppose even in the event one were to become ill with a bacterial infection, and take their prescribed antibiotics as required, this shouldn’t have an effect on the increasing antibacterial resistance right? Wrong. Studies have found that antibiotics that have been discharged into wastewater spread increase the likelihood of horizontal gene transfer and therefore resistance. So that bacteria that hasn’t even be given the opportunity to infect someone, has now come into contact with an antibiotic or mutated bacteria and the resistant form survives and thrives. The solution? Education and taking antibiotics only when confirmed its necessary. It is still a drug after all and should be treated with the same care and careful calculations as any other. Further research is also needed for the production of new, viable antibiotics. The earliest medicines have come from plants, researchers are now looking back to the natural world to find novel antibiotics to protect us from resistant microbes.



REFERENCES Bartlett, J. G., Gilbert, D. N., & Spellberg, B. (2013). Seven ways to preserve the miracle of antibiotics. Clinical Infectious Diseases, 56(10), 1445-1450. Corredor, M., & Muñoz-Gómez, A. (2021). Pharmaceutical Antibiotics at a Significant Level in Nature: From Hospitals, Livestock, and Plants to Soil, Water, and Sea. Emerging Contaminants, 163. Hofer, U. (2019). The cost of antimicrobial resistance. Nature Reviews Microbiology, 17(1), 3-3. Dadgostar, P. (2019). Antimicrobial resistance: implications and costs. Infection and drug resistance, 12, 3903. Fletcher-Lartey S, Yee M, Gaarslev C, Khan R. (2016) Why do general practitioners prescribe antibiotics for upper respiratory tract infections to meet patient expectations: a mixed methods study. BMJ Gadisa, E., Weldearegay, G., Desta, K., Tsegaye, G., Hailu, S., Jote, K., & Takele, A. (2019). Combined antibacterial effect of essential oils from three most commonly used Ethiopian traditional medicinal plants on multidrug resistant bacteria. BMC complementary and alternative medicine, 19(1), 1-9. Hofer, U. (2019). The cost of antimicrobial resistance. Nature Reviews Microbiology, 17(1), 3-3. Kumar, A., & Pal, D. (2018). Antibiotic resistance and wastewater: correlation, impact and critical human health challenges. Journal of environmental chemical engineering, 6(1), 52-58. Lee, R. A., Centor, R. M., Humphrey, L. L., Jokela, J. A., Andrews, R., Qaseem, A., & Scientific Medical Policy Committee of the American College of Physicians*. (2021). Appropriate use of short-course antibiotics in common infections: best practice advice from the American College of physicians. Annals of internal medicine, 174(6), 822-827.



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