Since the inception of the first penicillin drug in 1928 by Alexander Fleming, antibiotics have systematically changed and revolutionized the field of medicine. These antibiotics drugs or antimicrobial substances are widely used throughout medical treatment to prevent infections by inhibiting the growth and survival of bacteria. However, as the use of antibiotics continues to become mainstream, reaching even consumer shelves in what are now known as “over-the-counter medicine”, so does the risk of bacteria gaining resistance to these antibiotics.
Pioneered by Sir Alexander Fleming in 1928, the penicillin “Wonder-Drug” transformed modern medicine and saved millions of lives. These antibiotics were first prescribed during the World War 2 era to control infections on wounded soldiers. However, only years later penicillin resistance became a massive problem in many clinics and health organizations. In response to the new penicillin-resistant bacteria epidemic; a new line of beta-lactam antibiotics were created, restoring confidence in antibiotics across the country. Antibiotics have not only played a pivotal role in saving patients’ lives, but have also aided in key medical and surgical breakthroughs. They’ve successfully prevented or treated infections in patients undergoing procedures such as chemotherapy, who have chronic diseases such as end-stage renal disease, or rheumatoid arthritis, or who have undergone complex procedures including organ transplants or cardiac surgery.
The Quiet Crisis
The world was warned of the imminent antibiotic resistance crisis as early as 1945. Sir Fleming expressed his concerns about an age of antibiotic abuse, “[the] public will demand [the drug and] … then will begin an era … of abuses.” (Ventola 2015) Despite the pleas of Fleming, as well as many other scientists, antibiotics still continue to be overused worldwide. The CDC has already classified hundreds of bacteria that continue to pose concerning threats towards our healthcare systems and their patients.
Additionally, resistance genes from bacteria can easily be spread from one species to another through a method known as Horizontal Gene Transfer (HGT). As the primary mechanism for spreading resistance, HGT is defined as the, “movement of genetic information between organisms”. Due to HGT and the hereditary passing of genetic information to offspring (Vertical Gene Transfer) eliminating bacteria with resistance genes has become a seemingly impossible problem for healthcare professionals to deal with. In third-world countries such as India, the antibiotic resistance crisis has become so bad that many simple wounds lead to deadly infections.
The crisis is further perpetuated through problems such as inappropriate prescribing, extensive agricultural use, and the availability of few new antibiotics. Antibiotics that are given incorrectly continue to corroborate the spread of microbial resistance. In a recent study, Ventola expresses, “Studies have shown that treatment indication, choice of agent, or duration of antibiotic therapy is incorrect in 30% to 50% of cases.”. Antibiotics administered inappropriately have limited medical benefits and expose patients to antibiotic-related risks, such as drug-induced liver injury. Such antibiotic administrations can lead to genetic alterations within the bacteria such as changes in gene expression and HGT. These alterations promote increased bacterial virulence and resistance.
Furthermore, Antibiotics are largely utilized in animals to stimulate growth and prevent infection, accounting for over 80% of antibiotics sold in the United States. Antimicrobial treatment of livestock is supposed to improve the animals’ overall health, resulting in increased yields and a higher-quality output. Bacteria found inside of these livestock gain resistance to the antibiotics being ingested by the cattle, which is then transferred to the humans who eat the meat of the newly butured cattle. Antibiotic use in agriculture has an impact on the microbiome in the environment. Drugs administered to livestock are expelled in urine and stool in up to 90% of cases, and afterwards broadly disseminated by fertilization, freshwater, and runoffs. This approach also exposes bacteria in the surrounding area to development-inhibiting substances, affecting the ecology of the environment by raising the ratio of resistance against vulnerable bacteria.
Although the antibiotics resistance crisis seems to be unsolvable, many of the world’s citizens can play their part through less consumption of antibiotics and only using them when need be. Additionally, a new micro-organism, known as “Bacteriophages” seems to be a promising alternative that could help alleviate the stress on the antibiotic resistance crisis.
- Bohan, J. G. B., Cazabon, P. C., Hand, J. H., Entwisle, J. E., Wilt, J. K. W., & Milani, R. V. M. (2019, February 13). Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports. PubMed. Retrieved February 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440589/
- Romero-Calle, D. R., Benevides, R. G. B., Góes-Neto, A. G., & Billington, C. B. (2019, September 4). Bacteriophages as Alternatives to Antibiotics in Clinical Care. PubMed. Retrieved February 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784059/
- Ventola, C. L. V. (2015, April). The Antibiotic Resistance Crisis. PubMed. Retrieved February 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/#:~:text=The%20antibiotic%20resistance%20crisis%20has,incentives%20and%20challenging%20regulatory%20requirements.
- World Health Organization. (2020, July 31). Antibiotic resistance. World Health Organization. Retrieved February 25, 2022, from https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance