We learn about bacteria, fungi, and viruses in school, about DNA and RNA. That was where I first heard about antibiotic resistance. At the time another student J, exclaims that they wouldn’t use even Tylenol because then he might become resistant to an infection and would not be able to take any medicine to treat it. That statement didn’t make sense, but what did we know? We were just kids.
Speaking about antibiotics now, put into perspective that statement, the truth, the half-truth, and the false. Penicillin was one of the first antibiotics and also the first mentioned in any pharmacology textbook – along with a section of how often bacteria are resistant to it. So what is antibiotic resistance? It is when bacteria change in such a way that a particular drug has decreased or absent effectiveness via modifying cell wall, a new enzyme, or gene transfer. Sir Alexander Fleming first introduced the world to penicillin and predicted the rise of antibiotic resistance by overprescription. Is it really all due only to drug happy medical professionals?
Surprisingly, no. It is partly nature, bacteria will always change and the resistant organisms not only propagate but share the responsible genes with other bacterium. Or due to use in agricultural and animal husbandry as a growth stimulant leading to consumers ingesting the resistant bacteria. It is due to noncompliance to the treatment regimen, so an infection is only partially cleared, not eradicated. It is in our antibacterial soaps, handwashes, and plastic utensils even.
Penicillin was discovered in 1928, and used during World War II as a miracle drug to treat all matter of infections. Now, less than a century later, there are very few sensitive organisms for which penicillin is the first line or even second line drug of choice. This timeline of resistance is even more alarming with vancomycin which was developed for resistant organisms in mind, resistance was noted within one to two decades of use. Currently for a patient arriving for treatment whether for tuberculosis, malaria, or a urinary tract infection, there is increasing incidence of resistant organisms. WHO’s Global Antimicrobial Surveillance System (GLASS) which was implemented in 2015, revealed that approximately 5,00,000 people in 22 countries were resistant with approximately 50% percent of people with pneumonia resistant to penicillins, over 60% people with E.coli UTI were resistant to ciprofloxacin.
To combat this growing problem, WHO is recommending antibiotic stewardship – treating infection only as appropriate with the appropriate drug and duration. Beyond this, research is focusing on the development and approval for new antibiotics, improved drug delivery for targeted action with nanoparticles, phages, and colloids, rapid resistance detection to facilitate better antibiotic selection, and implementing ayurvedic therapy as an adjunct are all being researched. As individuals, we can choose to not use antibiotic soap or eating antibiotic fed meat, decrease the use of antibiotics for a viral cold or sore throat.