The term antimicrobial resistance (AMR) refers to the ever increasing phenomenon whereby a particular microorganism develops resistance to a drug which it had previously been susceptible. This can occur in fungi and also viruses but here the focus will be on the development of bacterial resistance. This process of genetic alteration is a natural process and can occur via a variety of mechanisms. So what’s the problem?
The problem lies in our dependence on antibiotics. Antibiotics are drugs containing chemicals which kill harmful bacteria known as pathogens. Sometimes these harmful bacteria can penetrate the body and evade the immune system long enough to cause illness. When this occurs, it is currently possible to take antibiotics which kill the bacteria and therefore prevent the illness from persisting. But when a bacterial strain develops resistance to an antibiotic, the effect of the antibiotic is negated. Taking the antibiotic does not kill the resistant bacteria and therefore the bacteria can continue to cause illness. In these instances it is often necessary to take an increased dosage of the antibiotic or, alternatively, to take a second antibiotic. Failure to do so can lead to prolonged illness. However, exposure of the bacteria to more antibiotics has the potential for further AMR development. Therefore, the potential risk imposed by AMR is this; pathogenic bacteria may develop for which there are no effective antibiotics. Additional effects of AMR include; increased healthcare costs, increased risk of infection spreading, decreased effectiveness of treatments, increased treatment length and increased risk of mortality. These effects can have serious consequences on public health care.
Antibiotics are widely used to treat all kinds of bacterial infections and are also used as a preventative measure in procedures such as organ transplantation and cancer chemotherapy where a patient is susceptible to bacterial infection. They are also used in agriculture, being given to livestock to prevent the spread of disease and to accelerate the rate of body growth in cattle and pigs. Antibiotics are overused and often, prescribed wrongly (such as for a viral infection). This poor management, when combined with other malpractice, such as poor infection control, accelerates AMR development which in turn accelerates the problems highlighted above. So what can be done to slow this growing phenomenon?
The UK five year antimicrobial resistance strategy 2013-2018 (published September 2013) suggests AMR should be tackled in the following ways;
- Improvement of knowledge and understanding of AMR
- Conservation and stewardship of the effectiveness of existing treatments
- Stimulation of the development of new antibiotics, diagnostics and novel therapies
The effectiveness of this and other similar strategies remains to be seen. But one last thought remains; the title and general thread of this article are based on AMR being a growing problem to society. To us humans, AMR is indeed a problem. Let me put it this way; antibiotics reduce suffering and greatly reduce mortality, especially in infants. And AMR has the potential to reverse this effect. The high success rates of procedures we have been accustomed to may alter and quality and longevity of life may, in turn, decline. But perhaps an alternative idea needs to be considered here. Everything is not black and white after all, and a venture into the ‘grey’ leads me to this question; is AMR nature’s way of dealing with overpopulation? An interesting idea, if nothing else.