Antibiotic Resistance: Causes and Solutions

This assignment delves into the critical issue of antibiotic resistance. It examines the factors contributing to this growing public health threat, including the overuse and misuse of antibiotics in healthcare settings and agriculture. The discussion encompasses the scientific mechanisms behind resistance development and the alarming consequences for global health. Furthermore, it explores various strategies aimed at mitigating antibiotic resistance, such as promoting antimicrobial stewardship programs, developing new antibiotics, and raising public awareness about responsible antibiotic use.

Running head: ANTIBIOTICS
Antibiotics
Name of the Student
Name of the University
Author Note

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Controlling the growth of the microorganism is critical for the treatment and
prevention of infectious disease caused by bacteria. One of the important agents that are used
to control microbial growth is antibiotics. The term antibiotic is derived from two Greek
words, anti meaning against and bios meaning life. Antibiotics are the by-products that are
synthesised within the microorganisms and are used to inhibit bacterial growth (bacterio-
static) or to kill the micro-organisms (bactericidal) (Owen, Punt and Stranford 2013). The
first ever antibiotic is Penicillin, from Penicillium notatum, discovered by Sir Alexander
Fleming, a Scottish scientist in the year 1928. Fleming though contributed towards a path
breaking discovery, but also stated an alarming prediction and that too, 80 years ahead of his
time. After he was credited with a Nobel prize for his novel discovery in the year 1945,
Fleming said that“The thoughtless person playing with penicillin treatment is morally
responsible for the death of the man who succumbs to infection with the penicillin-resistant
organism” (Calderone, 2015).
Figure 1: Properties of Antimicrobial Drugs
(Source: Owen, Punt and Stranford 2013)

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Figure 2: Microbial Source of Antibiotics
(Source: Owen, Punt and Stranford 2013)
Threat Arising from Antimicrobial Resistance and over use of Antibiotics
Antimicrobial resistance is one of the greatest threats worldwide that is affecting
human health. Methicillin-resistant Staphylococcus aureus (MRSA) has more annual
mortality rate than HIV/AIDS, Parkinson’s disease and other homicidal activities. It is
estimated that 20% of the previously treated cases of tuberculosis strain are now resistant to
rifamcipin and isoniazid (Llor and Bjerrum 2014). For the last 10 years, the anti-tuberculosis
agents are effective against tuberculosis but at present, that effect is insufficient. Today, more
than half of the multi-drug resistant (MDR) tuberculosis is effectively treated along the
application of other existing drugs (World Health Organization 2014). Extensively MDR
tuberculosis strains have been detected in 84 different countries (World Health Organization
2013). Apart from tuberculosis, extended-spectrum beta-lactam producing Enteroacteriaceae
and Carbapenem-resistant Enterobacteriaceae has been recently isolated (Society of
Healthcare Epidemiology of America 2012). There is a huge dearth of development of new
chemotherapeutic agents against the existing MDR bacteria with a special mention to those

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producing carbapenemases (Boucher et al. 2013). Moreover, none of the antibiotics, which
are currently available, are effective against treating the disease. Antibiotic resistance is also
a predominant problem under the clinical settings of the hospitals. According of the National
collaborating Centre for Infectious Diseases (2010), MDR bacteria is also detected among the
patients of the primary care. As per the report of the WHO, this scenario is not common in
the poor or the third world countries; the situation is equally relevant throughout the world.
However, the rate of antibiotic resistance among the bacteria varies between the countries.
For example the of resistant Escherichia coli varies at a rate of 18% between Greece (18.2%)
and Swede (1.0%) and for Klebsiella pneumoniae, the rate of variance is 0.7% in Sweden and
64.1% in Greece (European Centre for Disease Prevention and Control 2011). Asia accounts
for the highest rate of antibiotic resistance with the Klebsiella pneumoniae showing resistance
against the third generation cephalosporins, aminoglycosides and fluroquinolones. Most of
these antibiotics are considered critical by WHO for the treatment of the bacterial infection.
The problem of antibiotic resistance not only hampers the community, but also affects
at individual level. According to the recent reports patients who are treated with antibiotics
for respiratory tract infection or urinary tract infection, reported the persistence of the
individual resistance for up to 12 months after the treatment and thus generating need for the
second-line of antibiotic treatment. Countries which have higher rate of antibiotic
consumption have higher rate of antibiotic resistance. Infection caused by the antibiotic
resistant bacteria generates severe illness along with increased risks of medical
complications, increase rate of hospitalization and mortality rates (Livermore 2012).
Antibiotic resistance leads to increase health-care costs, amounting to about €9 billion
annually in Europe (Oxford and Kozlov 2013).

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Figure 3: Risks associated with the overuse of antibiotics
(Source: Llor and Bjerrum 2014)
Apart from spreading disease resistance, the over-use of antibiotics is also associated
with several complications as enlisted in figure 3. In United States, consumption of
antibiotics causes drug-related emergency. Over-use of antibiotics also causes neurologic,
gastrointestinal and psychiatric complications (Lode 2010). Although the majority of the
adverse effects arising out of the AMR are mild but certain side-effects are fatal.
Hepatotoxicity arising out of clavulanate and amoxicillin may generate sever life-threatening
complications. Over-prescribe of antibiotics increase re-attendance of patient because it
medicalizes the conditions that are self-limiting. While more attendance in hospitals signifies
more administration of antibiotics.
Implications for health Professionals
At present, the human race is living in the dawn of the postantibiotic era. All the
disease-causing bacteria have become resistant to antibiotics, which are commonly used to
treat them. Without antibiotics, conducting minor injury to major transplants can become
almost impossible and the cost burden of health-care is likely to spiral with longer hospital

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admission. Moreover, the mortality rates related to infection can excess to that of early 20th
century.
Antibiotics are used across the world. It is mixed in animal feed and used as a non-
prescription mode and at times, the sales of the antibiotics are incentivised, with half of
revenues in some hospitals coming from antibiotic sales. Now, this over reliance over the
antibiotics and the emergence of the multi-drug resistance bacteria is a global problem. Lack
of surveillance system and policy methods have augmented the problem of over use of the
antibiotics. An urgent need for antibiotic stewardship is important at this stage (Howard et al.
2013).
According to Légaré et al. 2012, prescribing nature of the doctors is influenced by
several threats like demands coming from the patients for speedy recovery, threat coming
from the competition or alternative healthcare system and lucrative nature of financial
incentives. So a balance needs to be maintained between the restricting the availability of
antibiotics while ensuring timely diagnosis of the chronic infection. Maintaining a balance
between the use of the antibiotic is difficult in countries, which have a robust health-care
systems and exponentially problematic in the countries, which have limited facilities in health
care (Howard et al. 2013). However, the emergence of the antibiotic resistant
Enterobacteriaceae, the principal reason behind the new born sepsis in the developing
countries indicated that antibiotic resistance is a serious threat in these countries (Van Duin et
al. 2013). Concretion actions and that too globally are required to handle this problem while
ensuring equal access of the alternative effective treatments. Microbial diagnostic tests can
assist in preventing the unwanted use of the antibiotic while narrowing down the spectrum of
coverage that is required to treat microbial infection. However, microbial diagnostic tests are
slow and delay the overall treatment, increasing the mortality rate and thus broad spectrum
antibiotic therapy is prescribed (Sibley, Peirano and Church 2012). Generation of fast

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diagnostic test can help prevent this delay, promoting the treatment via targeted antibiotic
from the very beginning (Caliendo et al. 2013). Proper education of the prescribers, about
the importance of citing this test results while administrating antibiotics would help to
prevent the overuse of broad-spectrum agents. It will in-turn prevent the development of
antibiotic resistant bacteria (Kotwani et al. 2012). More research is required in the field of use
of antibiotics in psisculture, agriculture and veterinary sectors. Reduction in the use of
antibiotic in animal husbandry must be obtained via observing proper safety in food supply or
the use of antibiotics in food. Further research is also required in the domain of non-human
use of antibiotics and generation of antibiotic resistance in human being. Only two new
classes of antibiotics have reached the pharmaceutical market since, 1970s (Howard et al.
2013). According to Llor and Bjerrum (2014), an instant need exist for the development of
new generation antibiotics. However, there are certain economic challenges around the
profitability of the newly discovered antibiotics. Innovative funding are required to influence
research in the field while effective removal of incentive based salary structure of
pharmaceutical companies, which they use to maximise their sales turn over (Llor and
Bjerrum 2014). The innovative funding structure must include new models of collaboration
encompassing research funders, including academia and non-profit organisations. Moreover,
funding must also be raise against the development of the antibiotic alternative like vaccines
and other antivirulence agents like antibiotic adjuvant and inhibitors of quorum sensing
mediated by small diffusible molecule (Allen et al. 2013).
Implications for Patients
In dodging the threat against the antibiotic resistance, the observance of the hygiene
cannot be overlooked. The effect of reimplementation of effective hand hygiene protocol in
health-care clinics are found in reducing the incidence of emergence of methicillin-resistant

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Staphylococcus aureus (MRSA) and Clostridium difficle (Calfee et al. 2014). Moreover, the
implementation of proper sanitization methods in the rural areas can help in reduction of the
burden of infection caused but bacteria which are spread via faeces like Salmonella
typhimurium (Narváez-Bravo et al. 2013). It will reduce the burden of both infection and
spread of antibiotic resistance micro-organism. Proper education of the public about the
increase in the incidence of the multi drug resistant bacteria (MDR) will act as a mode of
awareness. In, UK, a cross-government antimicrobial strategy has been initiated. The main
factors of this strategy include, overall improvement in prevention of infection, specialised
control practise in animal and human health, proper standardisation of the antibiotic
prescribing practise, overall improvement of professional education, effective training, public
engagement and development of new age drugs or antibiotics (Kessel and Sharland 2013).
The government of UK is also working in collaboration with the other governmental bodies
under the banner of WHO to improve the antimicrobial stewardship globally along with
proper surveillance (Ashiru-Oredope et al. 2016).
Associated Implications
Other steps that must be undertaken include, use of less antibiotics, proper
enforcement of government laws that prohibits over-the-counter sales of antibiotics for the
sake of incentives, proper campaigns and audits of the antimicrobial stewardship programs,
derivation of more evidence from the pragmatic studies that are being carried with the
primary care patients, promotion of the use of the valid-of-care tests among the patients,
promotion of delayed use of antibiotics and proper communication among the patients (Llor
and Bjerrum 2014).

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Figure: Communication tips with patients to reduce overuse of antibiotics
(Source: Llor and Bjerrum 2014)
The communication tips will also help in the generation of awareness among the
patients. Majority of the patients who are residing in the third world countries treat antibiotics
like any other drugs. They start consuming it after been asked to do so by the doctors but as
soon as the disease symptoms fade, they stop the intake of the medicine altogether, without
even completing the dose. This incomplete dosage increase the emergence of the MDR
bacteria which are fatal and thus promoting second time recurrent infection. But when they
try of reuse the left over antibiotics for the treatment of the recurrent infection, they get no
results and the outcome is increase in the mortality rates. So, effective communication
regarding the use of antibiotics is a must need. Here not only the doctors, but the
governmental bodies must come forward to generate the awareness via organizing
campaigns. In the campaigns can be audio visual like in the form of television advertisements
or audio ode, circulated in radio or live stage show. Here the patients will be made to
understand that how antibiotics are different from other analgesic and how the completion of
the dose is a must in order to prevent recurrent infection (Farag et al., 2014).

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Thus from the above discussion it can be concluded that there lies no basis behind
explaining the use of antibiotics behind treating respiratory tract infection among the primary
care patient. Doctors need to serve the patient for the betterment of health while abiding by
the ethical principles of justice and autonomy. However, ethical conflicts breach in under the
domain of non-maleficence and justice during the overuse of the antibiotics. By reducing the
use to antibiotics in treating mild infection can reduce the incidence of generation of
antibiotic resistance among the bacteria. The use of the strategies as, discussed above will
help the doctors to reduce the over-use of the antibiotics.

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