Some make people, crops, or animals sick. Some of those germs are resistant to antibiotics. Antibiotics kill germs that cause infections. But antibiotic-resistant germs find ways to survive. Antibiotics also kill good bacteria that protect the body from infection. Antibiotic-resistant germs can multiply. Some resistant germs can also give their resistance directly to other germs. Once antibiotic resistance emerges, it can spread into new settings and between countries.
Top of Page. Germ Defense Strategies Antibiotics fight germs bacteria and fungi. Examples of Defense Strategies for Germs Germs can use defense strategies to resist the effects of antibiotics. Here are a few examples. Resistance Mechanisms Defense Strategies Resistance Mechanisms Defense Strategies Description Restrict access of the antibiotic Germs restrict access by changing the entryways or limiting the number of entryways.
Between and , E. Tuberculosis is another example of a disease caused by an organism that has gradually developed resistance over time.
Multidrug-resistant MDR tuberculosis i. Mycobacterium tuberculosis resistant to at least rifampicin plus isoniazid emerged in the s, whilst extensively drug resistant [XDR—resistant to isoniazid and rifampicin, any fluoroquinolone, and at least one of the three injectable second-line drugs amikacin, capreomycin or kanamycin ] subsequently emerged.
Antibiotic resistance is an international concern. Broadly, interventions can be categorized into two main approaches. Firstly, there are strategies aimed at protecting the existing antibiotics and preventing the emergence and spread of further resistance. Then, there are strategies aimed at reinvigorating drug development and bringing new antibiotics to market. Alternatives to current antibiotic therapy also need to be assessed, either through the development of new drug classes or through the use of vaccines or other therapeutic strategies.
Globally, the resistance problem has been recognized for many years. The WHO has held meetings, consultations and workshops since The WHO's first World Health Assembly on antibiotic resistance was held in where member states were urged to take action.
WHO also targets the veterinary and food sectors by publishing booklets on antibiotics for a food safety perspective, running national and sub-regional workshops and creating an advisory group on integrated surveillance. The World Health Assembly may be a forum through which international collaboration can be facilitated. Most countries have strategies that are based on governance, surveillance, infection prevention and control, regulation, international engagement, communication and research.
Effective antibiotic stewardship is required globally, together with better diagnostic tests to identify or rule out infection quickly. Several international groups and societies have been established to tackle antibiotic resistance. In , the British Society of Antibiotic Chemotherapy BSAC convened a working party to consider issues relating to the lack of antibiotic discovery and development.
It suggested increased funding to support antibiotic research and development and promoted the establishment of a BSAC Chair of Public Engagement in order to increase the public and political awareness of antibiotic resistance and promote dialogue. In India, the Chennai Declaration aimed to tackle the challenge of antibiotic resistance in a developing nation.
There were no restrictions in purchasing antibiotics and no standardized infection control practices. The first meeting laid out a roadmap for tackling antibiotic resistance. It managed to create awareness among policymakers and the highest authorities on the need of effective antibiotic policies in India. More than hospitals in 14 countries participate.
The first UK strategy against antimicrobial resistance was published over a decade ago and aimed to improve antibiotic prescribing practice and increase funding for drug discovery programmes and research. Some have argued that its impact was limited.
Its main objectives were to improve the knowledge and understanding of antibiotic resistance, to conserve and steward the effectiveness of current antibiotics and stimulate the development of new agents, diagnostics and novel therapies.
In the strategy and her annual report, published in February , the Chief Medical Officer in England recommended that antibiotic resistance be placed on the national risk register. Seven key priorities were outlined: Optimizing antibiotic prescribing has been targeted in both community and hospital settings.
Antibiotic stewardship programmes aim to ensure the effective treatment of patients with infection whilst minimizing collateral damage from antimicrobial use. Education, audit, guidelines and policies, IV to oral conversion and appropriate de-escalation are all potential elements.
These interventions to reduce excessive antibiotic prescribing in hospital inpatients can reduce antimicrobial resistance, hospital-acquired infections and can improve clinical outcomes.
Antibiotic cycling or rotating i. The goal of antibiotic cycling or rotation is a sustainable decline or stabilization in antimicrobial resistance through successive, prospective alterations in antibiotic selection pressures that prevent the selection of specific resistance mechanisms. Abel Zur Wiesch et al. In the UK, a number of tools are available to support antimicrobial stewardship in primary care.
In , the Health Protection Agency established a multiagency collaboration to improve antimicrobial prescribing in primary care. From this, epidemiological data collections and primary care-directed guidelines were produced e.
This programme was introduced in England in but was updated in as an evidence-based toolkit for hospitals and explains the importance of antimicrobial stewardship for treatment and prophylaxis. Biomarkers such as C reactive protein CRP or procalcitonin can potentially reduce unnecessary antibiotic use.
Automated susceptibility testing also has the potential to deliver results more quickly. The need for new antibiotics was illustrated in the TUN report.
In addition, increasing levels of bureaucracy and lack of clarity within regulatory frameworks and variation in the clinical trials process in different countries hinder the development of new agents. Several antimicrobials have failed to reach the market at this final hurdle.
Lack of international harmonization, continual changes to processes and ineffective pathways for dialogue between organizations, industry and regulators are all significant deterrents to the research and development of new antibiotics. However, it is clear that there is now political engagement with this issue and many initiatives are now ongoing around the world. A number of novel approaches to reinvigorate antibiotic development have been proposed.
Public—private partnerships could be set up to mitigate the up-front costs of drug discovery. Orphan drug legislation could help address the issue of needing large numbers of patients in clinical trials, thus shortening the length of a trial.
Other examples laid out in the English Chief Medical Officer's Annual Report to foster research and development of new drugs include research-related tax incentives, patent buyouts, health impact funds and funding of translational research. This provided a pay-out at the end of the development process with 5 years of guaranteed market exclusivity and priority review for antibiotics that target certain qualifying pathogens. It is due to produce a final report in , but the initial findings have been published and include a proposal to set up a global antimicrobial resistance innovation fund to boost the number of early research ideas, ensuring that existing drugs are used appropriately, improving the use of diagnostics wherever they can make a difference, attracting and retaining a high-calibre skills base and modernizing the surveillance of drug resistance globally.
The relentless rise in antibiotic resistance is a major public health concern, which will need to be acted upon now. We might not be able to stop antibiotic resistance or, in many cases, reverse the trend to ever-increasing resistance, but we certainly need to contain the speed to which this is happening. No single action or initiative by a single country would be able to achieve this. It requires participation and support from all levels; political, medical, veterinary, agricultural, environmental, academic, industry and the general public.
It is clear that there is political engagement with this issue and many different bodies are considering potential options to tackle it. However, it remains to be seen if activities can be sufficiently coordinated worldwide to effect a change in the situation. Conly J , Johnston B. Where are all the new antibiotics? The new antibiotic paradox. What are infectious diseases? What are Staphylococcal infections? What are Streptococcal infections? What is Salmonella? What is tuberculosis?
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Microbes also may get genes from each other, including genes that make the microbe drug resistant. Bacteria multiply by the billions. Bacteria that have drug-resistant DNA may transfer a copy of these genes to other bacteria. Non-resistant bacteria receive the new DNA and become resistant to drugs. In the presence of drugs, only drug-resistant bacteria survive. The drug-resistant bacteria multiply and thrive. Diagram showing how gene transfer facilitates the spread of drug resistance.
Bacteria that have drug resistant DNA may transfer a copy of these genes to other bacteria. Non-resistant bacteria recieve the new DNA and become resistant to drugs. The drug resistant bacteria multiply and thrive. The use of antimicrobials, even when used appropriately, creates a selective pressure for resistant organisms.
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