Antibiotic resistance is not a disease, but rather is a phenomenon that poses a significant challenge to the treatment of bacterial infections and to global health in general.

The term refers to the development of resistance in bacteria (and sometimes fungi) towards antibiotics that would ideally be used in the treatment against them.

Based on their mode of function, antibiotics are usually classified as:

• bacteriostatic, where they prevent the growth and multiplication of the pathogen.
• bactericidal, where they kill the pathogen.

They work by destroying bacterial cell walls, blocking protein production or hindering reproduction, thereby weakening or destroying the microorganism.

Resistance arises due to an evolutionary process that occurs when bacteria that are exposed to a particular antibiotic undergo either or both of the following processes:

• mutation – Most bacteria reproduce every few hours, meaning that there is a substantial probability of mutation occurring as numbers increase relatively rapidly. Some of these mutations may induce resistance, making these bacteria more robust than the rest. The weaker bacteria die out and the resistant bacteria now thrive in a case of survival of the fittest.
• gene transfer – A mutated or inherently resistant gene may be passed on between bacteria – sometimes even species of different kinds (in a phenomenon referred to as ‘horizontal gene transfer’), thereby giving rise to the presence and survival of more antibiotic resistant bacteria, which subsequently multiply.

The unnecessary exposure of bacteria to antibiotics increases the probability of incidence of resistance, creating a steep challenge for healthcare personnel in their fight against the progress and spread of bacterial infections.

Some species of bacteria have developed resistance to multiple drugs over time and have gained themselves the title ‘superbugs’. These include:

• Methicillin-resistant Staphylococcus aureus (MRSA), which is transferred by skin and fomites, mostly affecting hospitalised patients
• Vancomycin-resistant enterococcus (VRE), which is a group of bacteria that can cause blood, wound and urinary tract infections, mostly affecting hospitalised patients
• Carbapenem-resistant Enterobacteriaceae (CRE), a group of bacteria which mostly affects hospitalised patients on ventilators or catheters
• Clostridium difficile, which can cause severe bowel infections, mostly affecting hospitalised patients or those who have been administered antibiotics for another ailment
• Resistant strains of Mycobacterium tuberculosis that cause multi-drug resistant tuberculosis (MDR-TB)

Causes

There are several reasons that have contributed towards the increase in antibiotic resistance. These are mainly:

• Overuse of antibiotics – Antibiotics are sometimes prescribed when not needed – e.g. for the common cold, which is a viral infection and against which antibiotics are ineffective. This could be due to reasons such as incorrect diagnosis, pressure from the patient to prescribe medication of their preference, or pressure from pharmaceutical giants (the pharmaceutical ‘mafia’) to promote and prescribe their products for an incentive

• Prescription of incorrect antibiotics – Misdiagnosis could lead to the wrong antibiotic being prescribed. Ideally, a culture test should be carried out (unless straightforward and obvious) prior to antibiotic administration. This would show which antibiotic(s) is most effective against the infection. However, sometimes an incorrect antibiotic or a cocktail of antibiotics may be prescribed in cases where a proper diagnosis has not been made.

• Misuse of antibiotics – It is imperative that antibiotics are taken in their correct dose and for the prescribed period of time. If taken in too less a dose or for too short a period of time, bactericidal antibiotics may instead have a bacteriostatic effect, or the infection may not be controlled and eliminated. In such scenarios as well as in unnecessary extended use, it is possible that the pathogenic bacteria may develop resistance.

• Easy access to antibiotics – Although more and more countries are introducing regulations which prevent the sale of over-the-counter (OTC) antibiotics, there are still many parts of the world in which antibiotics are available for purchase without a prescription. This and an increasing number of online pharmacies encourage the habit of inappropriate self-prescription of antibiotics (often for viral colds and sore throats).  

• Lack of new development of antibiotics – Funding for the research and development of antibiotics is usually very low, despite them often being life-saving agents. This is mostly because antibiotics are a short-term mode of treatment (as opposed to medication for diabetes, cardiac disease, etc.), which brings in lesser revenue than long-term medications. Also, it is almost inevitable that bacteria would develop resistance to newer antibiotics as well over time. Hence, putting time and money into antibiotic research is not seen as a profitable exercise among commercially driven pharmaceutical giants.

• Excessive use of antibiotics in farming and agriculture – With increasing global demands for consumable produce, farmers and manufacturers resort to the use of synthetic chemicals in order to maximise production. These include pesticides, weedicides, synthetic fertilisers, steroidal hormones and antibiotics. When produce is generated on a large scale, there is a greater risk of spread of disease. The application of antibiotics helps to ease loss due to disease, especially among poultry and farm animals. However, the adverse effect of this is that we end up unnecessarily consuming antibiotics in our food, resulting in a collective increase in the probability of antibiotic resistance – in both farm animals and humans.

Prevention

Given the evolutionary nature of most bacteria and microorganisms, it might be inevitable to completely prevent the occurrence of antibiotic resistance. However, there are practices which – if we adopt as a community – could help to reduce the rate at which bacteria become resistant to newly developed antibiotics, and would in turn make existing and new antibiotics more effective and life-saving.

Needless to say, stopping or preventing the causes discussed above would help to minimise the incidence of antibiotic resistance in the future. Putting it simply:

• refrain from consuming antibiotics unless they are absolutely necessary
• refrain from purchasing OTC antibiotics that have not been prescribed or recommended by a medical professional
• make sure you are not prescribed with antibiotics in an ad hoc manner – never hold back any questions you have with regard to your prescription (it is your right to know)
• if you have been prescribed with antibiotics, make sure that you follow the correct dosage and time period as recommended
• do NOT share with or recommend to others antibiotics that have been prescribed to you, and vice versa
• support and encourage research on antibiotics (and other medication), if and when possible
• try to stick to organic options in food whenever possible
• discourage the use of antibiotics (and other chemicals and hormones) in farming and agriculture, if and when possible
• encourage strict regulation of the prescription and use of antibiotics by your government and health authorities
• maintain a lifestyle that would help you to stay healthy and reduce the incidence of illness, and therefore minimise the need for medications such as antibiotics

Cover illustration from Dribbble.