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Antimicrobial Resistance

Microbes cause disease, and include bacteria, viruses, fungi, and parasites.  In the last century great strides in medicine were made in combating diseases caused by microbes.  Antimicrobials have increased human life expectancy and decreased the ability of microbes to cause disease.  Disease conditions that used to be fatal are now easily treated with antimicrobials.

Unfortunately a new trend has reared its ugly head:  the microbes are fighting back.  Because they can easily mutate, reproduce, and pass on new anti-microbial genes to the next generation, microbial resistance has become a problem.  Many of the causes are due to our use and overuse of antimicrobials.

According to the World Health Organization (WHO), “The bacterial infections which contribute most to human diseases are also those in which emerging and microbial resistance is most evident:  diarrhoeal diseases, respiratory tract infections, meningitis, sexually transmitted infections, and hospital-acquired infections.”

The FDA’s Center for Veterinary Medicine provides this nine-minute video explaining the mechanisms of antibiotic resistance.

Causes

When microbes are fought with microbial agents, they must either adapt a method of resistance (“selective pressure”) or die. Those that are able to survive have genes for resistance, and pass these genes on to microbes near them (“conjugation”) or by reproduction.

Although developing a resistance to antimicrobials is a natural phenomenon, humans are often guilty of amplifying or accelerating the process.  For example, “when antimicrobials are used incorrectly—for too short a time, at too low a dose, at inadequate potency; or for the wrong disease—the likelihood that bacteria and other microbes will adapt and replicate rather than be killed is greatly enhanced” (WHO).

The WHO lists these trends that increased infections and allowed a misuse of antimicrobials:

  1. Urbanization causing overcrowding and poor sanitation, which has increased diseases like typhoid, tuberculosis, respiratory infections, and pneumonia;
  2. Pollution, environmental degradation, and changing weather patterns, causing malaria and other diseases spread by insects;
  3. Demographic changes, including a growing elderly population, increasing hospital-acquired infections;
  4. The AIDS epidemic, which has increased the number of immunocompromised patients and many infections (which were previously rare)
  5. The resurgence of old foes (malaria and tuberculosis), due to misplaced confidence that they were conquered, but are now responsible for millions of infections a year
  6. The growth of global trade and travel, increasing the speed and facility of infectious disease and resistant microorganism spread;
  7. The routine use of antimicrobials as growth promoters or preventive agents in food-producing animals

Self-Medication

An increasingly worrying cause of antimicrobial resistance is the self-medication of the developed world population.  When given the choice between first- and second-line drugs, some patients choose the more expensive second-line drugs, thinking that they will be better at fighting disease.  However, what they are really doing is allowing the microbes the chance to become resistant to the second-line drugs, thereby rendering first-line drugs useless for everyone else.  Therefore, diseases that used to be cured by a cheap, efficient drug are now resistant to it and to the next level of defense.

When people choose to self-medicate themselves, microbes get a chance to see and adapt to the antimicrobial weapons in our arsenal.  For example, self-medicated antimicrobials are often unnecessary, inadequately dosed, or may not have an adequate amount of drug.  Often times, people stop taking antimicrobials once they feel better, which can occur before the microbe has been completely eliminated, thereby increasing antimicrobial resistance.

Anti-bacterial Soap

Of all the ways a person can combat antimicrobial resistance, not using anti-bacterial soap is one of the easiest to do.  When we use soap that contains anti-bacterial properties, we are showing the bacteria weapons in our arsenal and giving them a chance to mutate and adapt.  With every time use of anti-bacterial soap, more and more bacteria are exposed to our arsenal, and more and more are given the chance to adapt and pass their method of survival on to other bacteria.

The fact is that regular, non-antibacterial soap, kills bacteria on its own.  Soap is a cleaning agent, like bleach, that kills bacteria on the spot.  Bacteria cannot adapt to bleach, or to soap, because it will always kill.  The CDC says, “Antibacterial-containing products have not been proven to prevent the spread of infection better than products that do not contain antibacterial chemicals.”

Unlike soap, antibiotics work by disrupting some process of the bacteria’s cell life, such as protein synthesis, which will lead to their death.  While this is great for illnesses caused by bacteria, it can only be done a certain number of times before the bacteria mutate, or figure out a way to resist the antibiotics that are interfering with their protein synthesis.  So every time you use anti-bacterial soap, you are giving more bacteria the chance to mutate and survive.  Traditional soap works just as well (perhaps even better) than anti-bacterial soap.

The APUA has this to say about antibacterial soap:  “To ensure that [antibiotics] continue to be effective when they are needed, products containing these antibacterials should only be used when they are essential to fight against infection… Generally, the best way to remove ‘bad’ bacteria is through good hand-washing practice using a non-bactericidal soap and water.  Proper hand-washing will remove 99.9% of bacteria, and normally, few other control measures are needed.”

Physicians Practices

Oftentimes, when a person feels sick from a common cold, they will go to the doctor and demand an antibiotic.  Physicians who are either too busy or too lazy will provide a prescription to placate the patient, without explaining that antibiotics to not treat colds.  Viruses cause colds; antibiotics kill bacteria.  Antibiotics do not treat viral infections; it is like trying to cure dementia with a band-aid.  According to the WHO, “Physicians can be pressured by patient expectations to prescribe antimicrobials even in the absence of appropriate indications.”

Patient Compliance

Another cause of microbial resistance is patience non-compliance with prescribed antimicrobials.  “Patients forget to take medication, interrupt their treatment when they begin to feel better, or may be unable to afford a full course, thereby creating an ideal environment for microbes to adapt rather than be killed” (WHO).

Consequences

When microbes become resistant to treatment, infections become more difficult to fight.  When a person has an illness caused by a microbe that is resistant to a drug, not only does his length of illness increase but also he will infect others with the antimicrobial resistant microbe.  In turn, the microbe will become more numerous and even more difficult to treat.

When the drugs that used to be used as a first-line of defense fail, the second- and third-line drugs must be used.  These drugs are more expensive and more toxic.  The WHO says, “In many countries, the high cost of such replacement drugs is prohibitive, with the result that some diseases can no longer be treated in areas where resistance to first-line drugs is widespread.”

“Even if the pharmaceutical industry were to step up efforts to develop new replacement drugs immediately, current trends suggest that some diseases will have no effective therapies within the next ten years” (WHO).

Need for Change

In 2001, the WHO launched the Global Strategy for Containment of Antimicrobial Resistance to recognize the problem of antimicrobial resistance.  The strategy recommends interventions to slow the resistance, including legislation regarding the sale of antimicrobial products.

The Centers for Disease Control and Prevention (CDC) provides a Get Smart antibiotics awareness program, “What everyone should know and do: Snort. Sniffle. Sneeze.  No Antibiotics Please!”  The website provides information on colds and flus, as well as general information on antibiotic resistance.

The CDC explains, “Almost every type of bacteria has become stronger and less responsive to antibiotic treatment when it is really needed.  These antibiotic-resistant bacteria can quickly spread to family members, schoolmates, and co-workers- threatening the community with a new strain of infectious disease that is more difficult to cure and more expensive to treat.  For this reason, antibiotic resistance is among CDC’s top concerns.”

The Alliance for the Prudent Use of Antibiotics (APUA) promotes proper antibiotic use and preventing antibiotic resistance on a global scale.  The APUA works with the WHO, Pan American Health Organization, and the CDC, among other organizations.  They also publish a quarterly newspaper about antibiotic use and resistance, and have done so since 1982.  The APUA received an unrestricted educational grant from bioMerieux and the CDC to study the economics of antibiotic overuse and antibiotic-resistant infections.