Antibiotic Resistance Crisis: What are the future problems with antibiotic resistance?

Antibiotic Resistance Crisis: Current Challenges and Future Directions.

Author: Emmanuel Michael

ABSTRACT

The upsurge of antibiotic resistance is a significant public health threat globally, demanding crucial innovative solutions and action. This review scrutinizes the present antibiotic resistance landscape, discovering its complex consequences and causes. We investigate into the driving mechanisms of resistance development, as well as antibiotics misuse and overuse, and the horizontal gene role transfer in resistance genes spreading among microbes. Moreover, the highlight challenges are linked with the antibiotic pipeline dwindling and the essentiality for new therapeutic methods.

Additionally, exploring the impact and antibiotic resistance epidemiology, our discussion stems from the antibiotic stewardship strategies and how important it is to carry out antimicrobial surveillance programs. We also scrutinize possible combating resistance avenues, like advancement of bacteriophage therapy and the regeneration of natural product-based drug finding.

Finally, our emphasis on the critical role of global interdisciplinary efforts and collaboration in highlighting the need to address antibiotic resistance crisis. By promoting novelty, encouraging responsible application of antibiotic, and capitalizing in research development, this approach can help in the mitigation of antibiotic resistance impact and safeguard the efficacy of these life-saving medications for upcoming generations.

INTRODUCTION

There is a rapid rise of bacteria resistance to antibiotics globally occurring, compromising antibiotics efficacy, which has been a transformative agent to medical sciences to save the life of mankind (Golkar et al., 2014). Several decades after foremost patients were administered and treated with antibiotics, bacteria related infections have become a threat again (Spellberg et al., 2014).

Although the resistance crisis has been scientifically proven to be attributed to the misuse and overuse of these medications, as well as deficiency of novel drug development by the pharmaceutical industries as a result of challenging regulations and economic incentives (CDC, 2015).

There is an urgent need to coordinate efforts by implementing new policies, revitalize research efforts, track steps towards the management of this crises (Gould et al., 2013).

The microbial infection management in antiquity specifically in Greece, Egypt and China is properly-documented (Sengupta et al., 2013). The antibiotics modern era started with penicillin discovery by Sir Alexander Fleming in 1928 (Sengupta et al., 2013; Piddock, 2012). Antibiotics has since then transformed modern medicine and save millions of lives globally (Gould et al., 2013; CDC, 2013). The prescription of antibiotics in 1940s (CDC, 2013). During the World War II, penicillin was used to successfully control bacterial infection among soldiers (Sengupta et al., 2013). However, penicillin resistance substantially became a clinical problem by 1950s and threatened several advances of the prior decades (Spellberg et al., 2014). The discovery of new beta-lactam antibiotics was developed, deployed, to restore confidence (Sengupta et al., 2013; Spellberg et al., 2014).

Nevertheless, the identification of methicillin-resistant Staphylococcus aureus (MRSA) was the first case during that same decade, in the United Kingdom in 1962 and United States in 1968 respectively (Sengupta et al., 2013; CDC, 2013).

Inappropriately, the eventuality of resistance is crystal clear in nearly all developed antibiotics (Read et al., 2014). In 1972, Vancomycin was introduced into clinical practice ensure the treatment of methicillin resistance in both coagulase-negative staphylococci and S. aureus (Read et al., 2014). There has been difficulty in inducing vancomycin resistance as was believed to occur unlikely in a clinical setting (Read et al., 2014). Nevertheless, the vancomycin resistance cases were stated in coagulase-negative staphylococci in 1979 and 1983 (Read et al., 2014). Althrough the late 1960s and early 1980s, the introduction of several new antibiotics by pharmaceutical industries has been to solve the resistance problem, but afterwards, the pipeline of antibiotic began to diminish with introduction of fewer new drugs (Lushniak, 2014).

BENEFITS OF ANTIBIOTICS

Antibiotics have played an essential role apart from saving patients’ lives, in achieving most important medicine and surgery advances (Read et al., 2014). They have efficaciously prevented or treated infections that are likely to occur among patients on chemotherapy treatments; with chronic diseases like end-stage renal disease, diabetes, or rheumatoid arthritis; or subjected to complex surgeries like joint replacements, organ transplants, or cardiac surgical treatment (Nature, 2013; Read et al., 2014; Michael et al., 2014)

CAUSES OF THE ANTIBIOTIC RESISTANCE CRISIS

Overuse

In the early 1945, Sir Alexander Fleming upstretched the apprehension concerning antibiotic overuse when he cautioned that the “public will request [the drug and] … then will begin a period … of abuses” (Lushniak, 2014). Antibiotics overuse obviously drives resistance evolution (Read et al., 2014). Epidemiological researches have directly demonstrated the relationship between consumption of antibiotic, emergence and resistant bacteria strains dissemination (Nature, 2013). Notwithstanding cautions concerning overuse, worldwide antibiotics are overprescribed (Nature, 2013).

Inappropriate Prescribing

Antibiotics incorrectly prescribed also contribute to the resistant bacteria promotion (Read et al., 2014). Studies have revealed that treatment indication, agent choice, or antibiotic therapy period is improper in 30% to 50% of cases (Read et al., 2014; Van Boeckel et al., 2014). Additionally, prescription of antibiotics in intensive care units (ICUs) have been found to be inappropriate, unnecessary, or suboptimal (Van Boeckel et al., 2014).

Extensive Agricultural Use

Antibiotics are widely applied as supplements for growth in livestock globally in both the developed and developing world (Piddock, 2012; Nature, 2013; Read et al., 2014). The use of antibiotics in livestock are ingested by humans as consumers (CDC, 2013). This exposure of microorganisms practice has contributed to the growth-inhibiting agents in the society today, causing environmental ecology alteration by cumulative proportion of susceptible versus resistant microorganisms (CDC, 2013).

AVAILABILITY OF FEW NEW ANTIBIOTICS

New antibiotics development by the pharmaceutical industry has remained a strategy to effectively combat bacteria resistant in antiquity, had fundamentally hindered as a result of regulatory and economic hindrances (Piddock, 2012).  The development of antibiotic is no longer well-thought-out to be an investment economic-wise by pharmaceutical industry (Piddock, 2012). Extra factor that causes the lack of economic appeal regarding antibiotics development is as a result of antibiotics at relatively low cost (Piddock, 2012; Nature, 2013; Read et al., 2014)

REGULATORY BARRIERS

The optimism of companies about following up the new discovery of antibiotics, obtaining regulatory approval is often an impediment (Piddock, 2012; Read et al., 2014). Amid 1983 and 2007, a substantial decrease occurred in the several new antibiotic approvals (Read et al., 2014). Standards for the changes in clinical trial design designed by the U.S. Food and Drug Administration (FDA) throughout the past two decades have resulted to antibiotic clinical trials predominantly challenging (Nature, 2013).

ANTIBIOTIC-RESISTANT BACTERIAL INFECTIONS

Already in the U.S., antibiotic-resistant infections are widespread globally (CDC, 2013). Gram-positive pathogens, a universal pandemic of resistant Enterococcus and S. aureus species are currently posing the major threat (Read et al., 2014). Gram-negative pathogens are predominantly worrisome due to their close resistant to available antibiotic drug choices (CDC, 2013; Read et al., 2014).

THE ECONOMIC AND CLINICAL ANTIBIOTIC RESISTANCE BURDEN

The antibiotic-resistant associated infections are economic and health problem in the United States health care system, as well as patients and their families (CDC, 2013). They commonly occur in hospitals settings, due to the vulnerable patients gathering, application of extensive invasive measures, and high rates of antibiotic utilization in this setting (CDC, 2013).

CONCLUSION

The emergence of resistant bacteria threatens the unusual health benefits achieved with antibiotics (Piddock, 2012). This is a global crisis, reflecting the universal overuse of these drugs and the absence of development of novel antibiotic agents by pharmaceutical companies in addressing this challenge (Piddock, 2012). The infections associated with antibiotic-resistant places a substantial economic and health burden on the United States health care system and populace (CDC, 2013). Corresponding efforts to implement innovative policies, reintroduce result-oriented research efforts, and follow phases to the crisis management are of great importance (Bartlett et al., 2013; Read et al., 2014).

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