Understanding Antibiotic Resistance and How to Prevent It
Author: Emmanuella O'Ambrose, Bachelor of Pharmacy (BPharm)
Reviewed by Dr Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)
Introduction
Antibiotic resistance is an advancing risk in global health care. Defined as a lack of antibiotic effectiveness in treating illnesses that were previously handled very effortlessly. It is injurious to healthcare. Resistance to antibiotics occurs when specific germs grow and produce defensive mechanisms to outsmart antimicrobials. When resistant germs get into people, they prolong illnesses and cause deaths. To care effectively for people and also increase their life span, it is extremely essential to understand antibiotic resistance. This article will tell you what antibiotic resistance is and the best methods to prevent it.
What is antibiotic resistance?
The problem of antibiotic resistance is an urgent and significant threat. If an antibiotic suddenly becomes ineffective, it means that the microbe we want to eliminate is resistant. How, and why? Well, these bacteria can evolve, and when they do, it enables them to resist the effects of those previously effective antibiotics. Since they are not killed, they keep growing, and this causes worse infections and more deaths.
Antibiotic resistance is classified into two types.1 They are:
- Natural resistance
- Acquired resistance
A microbe has natural resistance if it’s never been exposed to the drug before, but it’s resistant already. If it has acquired resistance, then the drug could kill it before, but over time it evolved, thus rendering the drug ineffective. This evolution is as a result of genetic changes that make them unreceptive to antibiotics
How Do Bacteria Become Resistant to Antibiotics?
Every year in the United States there are over 2.8 million cases of antibiotic-resistant infections, resulting in about 35,000 deaths.2 It is important to know how these bacteria acquire antibiotic resistance so that you can control it. Bacteria become resistant through many methods. Some of these mechanisms include:
- Production of enzymes that degrade antibiotics
- Production of efflux pumps
- Genetic mutations
Degradation of antibiotics using enzymes
Antibiotic resistance occurs when the bacteria produce an enzyme that can break down an antibiotic and render it ineffective or less effective. These enzymes will destroy the antibiotics before they start functioning. A great example is the β-lactamase enzyme. This enzyme attacks a special group of antibiotics called beta-lactams.3 Examples of these antibiotics are cephalosporins and penicillin. Once the β-lactamase enzyme is around, it disrupts the structures of the beta-lactams, leaving them useless against the bacterium. The presence of the β-lactamase enzyme is a serious problem because it allows bacteria to survive treatments that should have otherwise been effective in eradicating those infections.5 These infections are harder to treat and would need stronger and, hence, costlier medications.
The production of efflux pumps
Some bacteria can become resistant to drugs by the efflux technique. In this process, some unique proteins called efflux pumps remove antibiotics and other chemicals that may be harmful from the cell. 6 These proteins are like little pumps in the cell, and they expel everything that can hurt the bacteria, and this includes antibiotic drugs. Generally, bacteria develop these proteins by undergoing genetic mutations.
Genetic mutations
Bacteria undergo numerous genetic mutations (changes in the genes), and bacteria are constantly evolving. This mutation occurs because of rapidly dividing cells. It is a lasting alteration. Picture this. An antibiotic is sent to attack bacteria, and it's only way in is xyz protein. Then the protein undergoes mutation. 7 The antibiotic cannot get in, and the bacteria is protected from the drug, and treatment is not effective.
These mechanisms, plus a host of others, make bacteria antibiotic-resistant. This is a global health issue, and we will explore it in depth to see how much antibiotic resistance has harmed millions around the globe.
Why is antibiotic resistance a global health problem?
Antibiotic resistance is a growing global health crisis that has impacted healthcare. Normally, treating common infections like pneumonia and urinary tract infections should not be expensive. Affordable and effective antibiotic drugs were used for treatment, but as bacteria become increasingly resistant to antibiotics, health providers have to climb further up the ladder to find antibiotics that will be effective in treating infections.8 These antibiotics are more expensive; some patients might not be able to afford them right on the spot. Death rates have greatly increased all around the world, stemming from the menace of antibiotic resistance.
Some essential metrics on the prevalence of antibiotic resistance worldwide are listed below:
- According to the World Health Organization, in 2019, antibiotic-resistant infections were responsible for roughly 1.27 million deaths globally and contributed to 4.95 million deaths in total due to complications from these infections.9
- Every year in the United States, there are over 2.8 million cases of antibiotic-resistant infections, resulting in about 35,000 deaths.2
- More than 1 million people died from antibiotic-resistant infections each year between 1990 and 2021. This number is projected to rise significantly in the coming decades, with estimates suggesting that by 2050, nearly 2 million deaths annually could be attributed to drug-resistant infections.10
Common Causes of Antibiotic Resistance
Many decades after the first victory of using antibiotics to treat bacterial infections, it has again become a threat. Antibiotic resistance is caused by misuse or overuse of antibiotic medications. We can say that antibiotic overuse is the beginning of antibiotic resistance. Studies have shown that there is a direct link between antibiotic consumption and the growing resistance to antibiotics.11
In various countries, antibiotics are available for sale in local pharmacy stores without prescriptions, so it is difficult to regulate their consumption. You might wonder why people use antibiotic medications so much. Well, before its discovery, people used other types of drugs that were not as fast at eliminating illnesses. Upon its emergence, it provided a faster and more effective way to treat infections. This led to its constant use.
Drug misuse or overuse results from:
- Needless prescribing
- Self-medication
- Abuse, i.e. improper dosing
- Indiscriminate use of antibiotics in animals.
How to Prevent Antibiotic Resistance
There are quite several ways to avoid drug resistance and live healthily. Some of them are:
- Only use these antibiotics when you really need them. Do not purchase antibiotics over-the-counter to treat viral infections like the flu or common cold. Antibiotics are not effective against viruses, and using antibiotics in these situations will cause resistance.12
- Health providers are to only prescribe antibiotics when the patient can absolutely not do without them.
- Complete your prescribed dosages. Even when you feel better already, complete the full dose. Stopping halfway can allow some germs to live, and they will develop resistance against that antibiotic and then come back for you. Do not forget to use your medications at the proper time, or some of the bacteria will survive and become resistant.
- Do not share your antibiotics. Do not play doctor to your friends; keep your medicines to yourself. Do not give out your extra medicines or use leftovers. Different infections require different antibiotics, and you may not know which. It is much better to get a personal prescription.
- Practice proper hygiene. Frequently washing your hands with soap and water will help to reduce the spread of infections13 It will also keep you safe. When your hands are clean, it is less likely that germs will get into your body.
- Get vaccinated. Instead of getting infected, you can get vaccinated. Vaccination will prevent you from getting infections like pneumonia that will require antibiotic treatment.
- Consult your healthcare provider. Your doctor knows what is best for your personal health. They will decide if you need that antibiotic drug or not. If you do, they will also let you know about the potential side effects and tell you about proper usage.
- Overuse of antibiotics in the treatment of animals like poultry and fish leads to development and subsequent increase in antibiotic resistance. This can happen through direct contact with humans, contaminated environments, or the food chain. Farmers, animal caretakers and veterinarians should be educated on the dangers of antibiotic overuse in animals, and it should be taken only when necessary.
The Role of Healthcare Providers in Reducing Antibiotic Resistance
- Assess the patient’s condition thoroughly.
- Refer the patient for essential laboratory testing.
- Prescribe responsibly to ensure patient safety.
- Educating the patient on their treatment plan and the importance of adhering to it.
- Monitor and review treatment plans
- Ensure proper paperwork and documentation
Conclusion
Antibiotic resistance is a major global problem, and it is changing the landscape of healthcare. The rate at which it is causing deaths globally is truly a menace. By understanding how bacteria become resistant to antibiotic drugs, we can know how best to tackle and also prevent illnesses. This article helps to curb antibiotic resistance, and as you wash your hands, teach others, and visit your healthcare providers before taking antibiotics, you would be equally helping to eradicate it too. The role of healthcare providers in curbing resistance is also very important, and by prescribing responsibly and educating patients, lives can be preserved.
References
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8. Poudel AN, Zhu S, Cooper N, Little P, Tarrant C, Hickman M, et al. The economic burden of antibiotic resistance: A systematic review and meta-analysis. PLoS One [Internet]. 2023 May 8 [cited 2024 Oct 10];18(5):e0285170. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166566/
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