The Global Antimicrobial Resistance Crisis: History and Solutions
By Steven Wu, Camas High School, Camas, Washington, USA
The antimicrobial resistance (AMR) crisis stems from the overuse and misuse of antibiotic medications (Ventola, 2015). Antibiotics have been used to treat bacterial diseases, prevent infections during surgeries, and treat flesh wounds such as dog bites. Antimicrobial resistance accounts for more than 700,000 deaths per year worldwide and will cost 10 million lives by 2050 (Eisenstein, 2017). With the development of new antibiotics, bacteria have evolved to become immune to the treatments, creating a vicious cycle (Srinivasan, 2014).
The first antibiotic was penicillin, a type of mould, which was discovered by Alexander Fleming in 1928. Fleming’s work was the precursor to research by Howard Florey and Ernst Chain that demonstrated that penicillin could treat deadly bacterial infections. Penicillin entered widespread use during the Second World War, where it treated highly infectious wounds on the battlefield (Ventola, 2015). For their life-saving research, Fleming, Florey, and Chain received the Nobel Prize in Physiology or Medicine in 1945. But at the ceremony, Fleming predicted that antibiotic resistance would soon become a major medical issue (Ventola, 2015). Fleming’s prediction has turned out to be correct.
People in poor regions of the world that receive antibiotics often reduce the proper doses in an effort to conserve the medicine (Maron, 2014). Since antibiotics stunt growth and cause cell death, overprescribing and under-dosing antibiotics fosters AMR because the microbes mutate and develop resistance via natural selection (Ventola, 2015).
Throughout the past several decades, international health institutions have relied on creating new antibiotics to combat diseases. However, the rate of antibody discovery has slowed to a trickle; the last new class of antibiotics was discovered in 1987 (Maron, 2014). In recent years, there have been new technologies introduced and new methods created to combat AMR and improve antibiotic efficacy. Two of these methods are using whole-genome sequencing (WGS) (Koser et al., 2014), as well as treatment with an antisense oligonucleotide called PPMO (phosphonodiamidite morpholino oligomer) (Lundeberg, 2017).
The first of the two methods is still only in its preliminary stages of development. WGS is the process of determining the entire genome (DNA sequence) of an organism (Koser et al., 2014); it is mainly a diagnostic tool where phenotypic testing and genotypic testing are ineffective in clinical situations. WGS can cross-examine existing diagnostic tools to help avoid false negatives, detect bacterial outbreaks in hospitals, and provide insight into the presence of AMR in a hospital setting (Koser et al., 2014). By being able to surveille the emergence of AMR, it is able to quickly notify clinicians that the microbial resistance is present in their patients. The hope is WGS will serve as an infection control tool to curb the spread of AMR (Koser et al., 2014).
The second method is using PPMO peptides. PPMO is an oligonucleotide (a chain of 20 nucleotides or less) that effectively targets the RNA of the bacterial genome. PPMO re-sensitizes bacteria by targeting the portion of the RNA that causes resistance, most effectively by targeting portions operating drug efflux pumps, which spit antibiotics out of the cell, preventing them from doing their jobs (Lundeberg, 2017).
In addition, logistical improvements can greatly aid the eradication of antimicrobial resistance. Developing countries with lax manufacturing and distribution regulations should be encouraged to implement quality assurance systems and improve post-market surveillance with the mass training of qualified pharmacists for medication dispensation (Eisenberg, 2017). All nations should also ban the use of antibiotics for growth promotion in livestock (Gilbert, 2012). Global institutions and governments should create incentives for antibiotics and AMR treatments by pharmaceutical companies to stimulate the production of these life-saving drugs.
Investment in this research may be costly, but it will greatly benefit patients. Patients and doctors also have an important role, by appropriately administering and consuming antibiotics. Implementing measures such as these will help us win the war against bacterial resistance.
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