Antibiotic Resistance & Human Medicine

This post provides background information on the issue of antibiotic resistance. It is written as a general overview for people that are hearing about the topic in the media but don’t understand the key concerns.

Alexander Flemming discovered penicillin in 1928. By 1945, when he received his Noble Prize for this discovery, Flemming warned that resistance would emerge with use of antibiotics. This early warning proved true and today society is feeling the consequences of antimicrobial resistance.

In the 20th century antimicrobial resistance was counteracted by discovering of new antimicrobials (follow this link for a timeline of discoveries). As time went on new discoveries became rarer, instead being replaced by modifications to existing molecules to extend their usefulness. But over time the pipeline to develop new antimicrobials slowed to a trickle and has now virtually dried up. While there are many reasons for this, the effect is that we can no longer rely on the invention of new antibiotics to combat resistance. The result? A growing health crisis of unprecedented magnitude.

What is the big deal about antibiotic resistance? Both physicians and veterinarians often prescribe antimicrobials empirically. This means they use their clinical experience to make a presumed diagnosis and prescribe the “first-line” antimicrobial. This is the drugs that best balances efficacy, side-effects, cost, and convenience. Doctors prescribe empirically because illness is urgent enough that they cannot wait for laboratory results to begin treatment.

When the bacterial causing disease is resistant to the first-line treatment the patient suffers. Resistance in its mildest form leads to longer illness and higher medication expenses. More severity consequences include toxic side effects, complicated illness, and in the worst case scenario there are no effective treatment options and the patient dies.

The World Health Organization has emphasizes that antimicrobial resistance is a serious threat that can affect anyone, of any age, in any country. “Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades con once again kill.” People who are at particularly high risk are those receiving cancer chemotherapy, undergoing complex surgery, on renal dialysis, or with a suppressed immune system such as patients with rheumatoid arthritis or organ transplants. This list encompasses modern medicines most important advancements. In addition, rising rates of community acquired infections mean that healthy individuals are increasingly at risk.

How often does are people actually affected by antimicrobial resistance? The United States Center for Disease Control estimated that resistant bacteria cause 2 million illnesses and 23,000 deaths annually in the United States alone. If those numbers are not startling enough, the UK has estimated 10 million people will die each year around the globe by 2050.

Antimicrobial resistance is a biological reality. We can’t turn the clock back to when resistance was a theoretical concern. What we can do is minimize antimicrobial use to slow the development and spread of resistance. Antibiotic stewardship is the responsibility of everyone who prescribes, dispenses, administers or takes antibiotics.

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