Credit: Wikipedia.

What is antibiotic resistance: everything you need to know

Antibiotics are medicines that combat infections caused by bacteria. However, due to misuse and overuse of antibiotics, many bacterial strains are developing antibiotic resistance.

antibiotic resistance art

Credit: Wikipedia.

Before Alexander Fleming discovered penicillin in 1928, there was no effective treatment for infections such as pneumonia, gonorrhea or rheumatic fever. Fleming’s discovery kicked off a golden age of antimicrobial research with many pharmaceutical companies developing new drugs that would save countless lives. Some doctors in the 1940s would famously prophesize that antibiotics would finally eradicate the infectious diseases that had plagued humankind throughout history. Almost a hundred years later since Fleming made his milestone discovery not only are bacterial infections still common, the misuse and overuse of antibiotics are threatening to undo all of this medical progress as bacterial strains become resistant. 

Antibiotic resistance: a modern problem that can be traced to ancient times.

Contrary to common belief, human exposure to antibiotics isn’t confined to the modern era. Traces of tetracycline, a broad-spectrum antibiotic, have been found in the skeleton remains from ancient Sudanese Nubia dating from 350-550 CE. Likewise, tetracycline has been found in remains dating from the late Roman period in the Dakhleh Oasis, Egypt. These people must have included tetracycline in their diet — and it was to their good fortune as the rate of infectious diseases documented in Sudanese Nubian populations was low. For thousands of years, Chinese herbalists have been using a variety of plants which contain antimicrobial active components for ancient traditional remedies.

Naturally, the selective pressure imposed by these ancient antimicrobial activities has led to the accumulation of antibiotic resistance genes. But that’s nothing like the scale and intensity of antibiotic resistance we’re seeing today.

What is antibiotic resistance

Antibiotic resistance occurs when an antibiotic is no longer effective at controlling or killing bacterial growth. Bacteria which are ‘resistant’ can multiply in the presence of various therapeutic levels of an antibiotic. Sometimes, increasing the dose of an antibiotic can help tackle a more severe infection but in some instances — and these are becoming more and more frequent — no dose seems to control the bacterial growth. Each year, 25,000 patients from the EU and 63,000 patients from the USA die because of hospital-acquired bacterial infections which are resistant to multidrug-action. The ECDC/EMA Joint Working Group estimated in 2009 that the cost due to multidrug-resistant bacterial infections amounts to EUR 1.5 million in the EU alone. According to a 2013 CDC report titled “Antibiotic Resistance Threats in the United States, antibiotic resistance is responsible for $20 billion in direct health-care costs in the United States.

Antimicrobial resistance threatens to undermine all the immense clinical and public health progress we’ve come to achieve so far. This is a very complex problem that requires concentrated and coordinated efforts of microbiologists, ecologists, health care specialists, educationalists, policy makers, legislative bodies, agricultural and pharmaceutical industry workers, and the public to deal with.

The main challenges in dealing with antibiotic resistance are, on one hand, genetically acquired immunity and, on the other hand, fewer and fewer novel drugs. Since the 1970s, the rate at which new antibiotic classes have been discovered has continued to drop. No novel drug classes have been developed in the last 20 years. Researchers nowadays agree that, at this current rate, humanity is destined to lose the arms race as sooner or later bacteria will acquire resistance to modified versions of currently available antibiotic classes.

How bacteria develop resistance to antibiotics

Schematic by MeMed.

Schematic by MeMed.

Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. In time, these leftover populations can become so strong that antibiotics no longer are effective.

There are several mechanisms bacteria employ to become resistant. Some gain the ability to neutralize the drug before it gets the chance to attack the bacteria. Other bacteria can rapidly pump the antibiotic out or can even change the attack site so the function of the bacteria isn’t affected.

Whenever bacteria survives an antibiotic onslaught, it can acquire resistant through mutation of the genetic material or by ‘borrowing’ pieces of DNA that code for the resistance to antibiotics from other bacteria, like those from livestock. Moreover, the DNA that codes the resistance is grouped in an easily transferable package which enables the germs to become resistant to many antimicrobial agents.

The types of bacterial resistance

  • Intrinsic resistance. Some bacteria are intriguingly resistant to antibiotics, such as those that don’t build a cell wall (penicillin prevents cell-wall building).
  • Acquired resistance. Bacteria can acquire resistance through new genetic change or by transferring DNA from a bacterium that is already resistant. This is the issue we’re having today.

According to the CDC, the following bacterial strains have developed the most resistance such that they’ve been listed as urgent hazards:

  • Clostridium difficile. Causes severe diarrhea, especially in older people and those who have serious illnesses.
  • Enterobacteriaceae. These normally live in the digestive tract but can invade other parts of the body, like the urinary tract, and cause infections.
  • Neisseria gonorrhoeae. Causes gonorrhea, a sexually transmitted infection. In 2016, the WHO said gonorrhea might soon become untreatable. 

 

Why antibiotic resistance is growing

When antibiotics are introduced in a bacterial population, most of the population dies but some resistant bacteria may survive. These resistant bacteria will continue to proliferate despite the presence of the antibiotic. In time, their population will increase until it becomes comprised mainly of resistant bacteria. Credit: ReActGroup.

When antibiotics are introduced in a bacterial population, most of the population dies but some resistant bacteria may survive. These resistant bacteria will continue to proliferate despite the presence of the antibiotic. In time, their population will increase until it becomes comprised mainly of resistant bacteria. Credit: ReActGroup.

There are a number of factors that contribute to this growing health hazard. Among them we can mention:

  • self-medication;
  • hygienic habits such as the use of anti-bacterial soap which research suggests is useless but significantly contributes to the growing problem of antimicrobial resistance;
  • counterfeit drugs, particularly rampant in the developing world;
  • antibiotics for livestock;
  • infections acquired in hospitals and nursing homes, particularly in the developed world;

There’s no surprise in the fact that antibiotic resistance infections correlate with the level of antibiotic consumption. The more antibiotics a population consumes, the faster bacteria will adapt and become resistant. One huge problem is the mindless use of antibiotics. For instance, many patients request their doctors to prescribe antibiotics when there is no need for them, such as in the case of viral infections. Research shows that up to 15 million people in the United States go to the doctor for a sore throat every year. About 70 percent of these patients receive strep throat antibiotics but only 20 percent actually have strep throat, according to the IDSA.

Another problem is compliance with strict drug regimes. To be effective, antibiotics needs to be taken at least over several days and the scheduling needs to be respected on the clock yet many patients fail to follow these instructions.

Things are worse in some countries than others. For instance, in some countries, antibiotics are available without a prescription so the potential for self-medication abuse is huge especially if the patient is not educated about antibiotics. In the absence of a proper diagnosis, suitable antibiotic choice, correct usage, compliance, and treatment efficiency monitoring, self-medicating antibiotics can only exacerbate the mounting resistance problem.

Another issue lies with antibiotics for domestic animals, particularly livestock. Farmers widely use antibiotics to stave off infections but also for promoting growth. Approximately 80 percent of the antibiotics sold in the United States are used in meat and poultry production, and in the vast majority of cases, the antibiotics are used on healthy animals. This practice can lead to the evolution of ‘superbugs’ which can migrate into the environment as people consume meat.

In 2003, an Expert Workshop co-sponsored by the World Health Organization, Food and Agricultural Organization (FDA), and World Animal Health Organization (OIE) concluded “that there is clear evidence of adverse human health consequences due to resistant organisms resulting from non-human usage of antimicrobials.  These consequences include infections that would not have otherwise occurred, increased frequency of treatment failures (in some cases death) and increased severity of infections”

Most recently in 2012, the FDA stated “Misuse and overuse of antimicrobial drugs creates selective evolutionary pressure that enables antimicrobial resistant bacteria to increase in numbers more rapidly than antimicrobial susceptible bacteria and thus increases the opportunity for individuals to become infected by resistant bacteria.”

Solutions to antibiotic resistance

The sad reality today is that there’s not much we can do for patients who don’t respond to antibiotics, which is why mortality rates are so high.

“Antibiotic resistance is rising for many different pathogens that are threats to health,” said CDC Director Tom Frieden, M.D., in a statement. “If we don’t act now, our medicine cabinet will be empty and we won’t have the antibiotics we need to save lives.”

Some researchers have proposed alternatives to antibiotic treatment such as passive immunization or phage therapy but most efforts are directed towards the discovery of new and more efficient antibiotics. Like outlined earlier, however, most of our antibiotics have been isolated in the so-called ‘golden era’ of antibiotic discovery from a limited number of taxonomic groups, mainly from Actinomyces that live in the soil. Some research groups are exploring alternative ecological niches such as the marine environment. Other approaches involve borrowing antimicrobial peptides and compounds from animals and plants, as well as the natural lipopeptides of bacteria and fungi. There is also a potential to find new antibiotics by exploring the microbiota through the metagenomic approach. Finally, some groups are looking design new classes of antibiotics from scratch through complete synthesis.

Preventing antibiotic resistance

Finding new antibiotics, however, will likely not solve our growing antibiotic resistance problem. History has shown that after a new antibiotic therapy is introduced, sooner or later resistance will arise. This approach is destined to fail since bacteria will eventually respond to selective pressure by the emergence of resistance mechanisms.

What we can do, however, is to buy time until someone very clever figures a way to outsmart bacteria for good.

Scandinavian countries, for instance, banned the use of growth-promoting antibiotics in livestock since 2006 and other EU countries have been implementing similar measures. In 2012, the FDA ruled that certain extra-label uses of cephalosporin antimicrobial drugs should be banned from certain livestock.

It is estimated that in half of all cases, antibiotics are prescribed for conditions caused by viruses. Obviously, in such cases the antibiotics are useless and doctors and nurses ought to know better.

Governments have a critical role in combating antibiotic resistance. It’s imperative that robust action is taken both at a national and international level in order to regulate the appropriate use of quality medicines and education about the dangers of overuse. A lot of antibiotic resistance is building up in developing countries where there is little oversight. Governments need to work together to strengthen the health care quality in such places for the good of us all. Not least, the industry needs to move faster and more aggressively to research and develop new antibiotics.

What you can do

  • Don’t take antibiotics for a viral infection like a cold or the flu.
  • Do not save any antibiotics for the next time you get sick. Discard any leftover medication once you have completed your prescribed course of treatment
  • Always take antibiotics only after you’ve consulted with a health care professional. The FDA has a great campaign called “Get Smart: Know When Antibiotics Work”  that offers Web pages, brochures, fact sheets, and other information sources aimed at helping the public learn about preventing antibiotic-resistant infections.
  • Take an antibiotic exactly as the healthcare provider tells you. Do not skip doses.
  • Never pressure your provider to prescribe an antibiotic.
  • Never use antibacterial soap.

41 thoughts on “What is antibiotic resistance: everything you need to know

  1. G-Wiz

    "Naturally, the selective pressure imposed by these ancient antimicrobial activities has led to the accumulation of antibiotic resistance genes in human populations. But that’s nothing like the scale and intensity of antibiotic resistance we’re seeing today."

    Hmmmmm…??? antibiotic resistant genes in ….. << human populations >> ….. or << BACTERIAL POPULATIONS !!! >>

  2. lazinov

    You know perfectly well that colloidal silver is the perfect antibiotic. It is totally safe and effective against all known pathogens. The pharmaceutical industry is terrified of it and with the support of the FDA and the EU successfully suppress it and outlaw it. Depriving people of cures for more than 650 different illnesses, because it can be produced so cheaply and simply – obviously there is no possibility for the industry to take advantage.
    The fact that health care is so expensive means that many millions have no possibility of help, they could help themselves very simply with colloidal silver and the cost of the health care industry could benefit from that advantage.
    I don't understand why your publication avoids any mention of CS???
    CS is also effective against ebola and during the crisis last year a substantial consignment was shipped to the stricken African countries but rejected by the officials. The danger being that had CS been used its effectiveness would have been obvious to all and the information could have no longer been suppressed.
    Geoffrey

  3. Alex Micu

    I think what Tibi was saying is that "Selective pressure ….. antibody resistance genes in [strains who were actively infecting] human populations."
    Edited for greater scientific glory, thanks.

  4. Alex Micu

    Internal use of colloidal silver can cause all sorts of problems in your brain, kidneys, or liver. Even if I did agree with you that CS was the mother of all disinfectants (I don't,) I couldn't in good faith publish anything about that on a science website until a scientific paper backed my claim.
    That being said, CS is used as a disinfectant but for in vitro applications. The WMO was happy to expand on its uses ( http://apps.who.int/iris/bitstream/10665/68905/1/a85637.pdf ) so I don't think there's any conspiracy here.
    Also on a personal note 'cause this made me grin: "because it can be produced so cheaply and simply – obviously there is no possibility for the industry to take advantage". Have you ever seen somebody buy bottled water before?

  5. lazinov

    Helo Alex,
    So thats the problem with my brain! No doubt Nasa and the US military will discontinue using it once they learn the 'facts'!
    You failed to comment concerning Ebola.
    When taken correctly there are no side effects from the ingestion of CS.
    Of course the market is awash with low cost items, however, my point related to relative cost compared to pharmaceutically produced antibiotics.
    It has been successfully proven for many thousands of years. What else can you use on newborn babies with eye infections?
    As a scientific publication might I suggest an investigation of the many authoritative papers published on the positive advantages of CS. Please don't mention argyria, the result of incorrect use, obviously many medications can have far more serious results.
    Despite my comments I do appreciate your publication and compliment you thereon.

    Ciao
    Geofffrey

  6. G-Wiz

    I realize what a careful reading of the text meant. It's either a language problem or a typo. In that the incorrect form of (resistant – resistance) was employed, seems likely a problem of native foreign language adapting English.
    Yet, there's no arguing "resistant genes in human populations" do not account for "Antibiotic Resistance" in Bacteria.
    With such an illuminating example in hand of the role (natural) "selective pressure" plays in modern age disease transmission & morbidity, it frankly sad to have misconstrued the very role genetic mutations play in acquiring anti-bacterial resistance.

  7. lazinov

    Hello Alex,

    Do please read the following. Something has to be done to correct the misleading information concerning superbugs:

    Colloidal Silver’s Astonishing Effectiveness Against Drug-Resistant Superbugs

    First, in early March 2017, the World Health Organization (WHO) issued a warning <https://fx229.infusionsoft.com/app/linkClick/6160/a69bcbcf7dcf3c10/3601030/c4618727ff2fd43e&gt; about
    three specific superbugs that “pose the greatest threat to human health.”
    In their warning, they listed the following three pathogens:

    Carbapenem-resistant Acinetobacter baumannii

    Carbapenem-resistant Pseudomonas aeruginosa

    Carbapenem-resistant Enterobacteriaceae (CRE)

    According to LiveScience.com, “All of the top three pathogens on the list are resistant to a group of antibiotics called carbapenems. These antibiotics are sometimes referred to as "last resort" medications, because if they don't work, very few options are left.”

    The WHO went on to say that up to 51% of people infected with these drug-resistant pathogens end up dying of their infections.

    The WHO then listed six more drug-resistant pathogens in what they termed their “high priority” category, which are:

    Enterococcus faecium, vancomycin-resistant

    Staphylococcus aureus, methicillin-resistant, vancomycin-intermediate and resistant

    Helicobacter plyori, clarithromycin-resistant

    Campylobacter spp., fluoroquinolone-resistant

    Salmonellae, fluoroquinolone-resistant

    Neisseria gonorrhoeae, cephalosporin-resistant, fluoroquinolone-resistant

    And finally, the WHO then listed three medium-priority drug-resistant pathogens, which are:

    Streptococcus pneumoniae, penicillin-non-susceptible

    Haemophilus influenzae, ampicillin-resistant

    Shigella spp., fluoroquinolone-resistant

    A few days after the WHO released their warning, Harvard University Medical School released a video purporting to show antibiotic-resistant bacteria in a petri dish mutating to become immune to up to 1,000 times the normal dosage of antibiotic drugs.

    The news article <https://fx229.infusionsoft.com/app/linkClick/6162/cacd7fd472b73baf/3601030/c4618727ff2fd43e&gt; accompanying
    the video went on to call the scenario painted in the video as an “antibiotic apocalypse” and a “doomsday phenomenon that could kill 10 million people a year.” And it pointed out that more people are now dying each year from drug-resistant superbug infections than from breast cancer.
    And the only mention in the WHO warning and the article accompanying the Harvard Medical School video of any kind of a solution is that eventually the public is going to have to accept the fact that antibiotic drugs with severe side effects will eventually have to be employed in the battle against the superbugs.

    No Mention of Colloidal Silver

    What’s not mentioned, of course, is the fact that safe, natural antimicrobial silver has already been demonstrated in numerous clinical studies to kill many of these same drug-resistant “superbugs” mentioned above by WHO and Harvard Medical University.

    In fact, here are three recent clinical studies demonstrating silver’s effectiveness against a wide variety of drug-resistant pathogens; read them carefully because it will blow your mind to see how effective colloidal silver really is against the drug-resistant superbugs:

    Clinical Study #1: Colloidal Silver Kills up to 99.7% of Six Multidrug-resistant Superbugs! In this fascinating clinical study published in the World Journal of Microbiology and Biotechnology in 2010, it was found that antimicrobial silver killed up to 99.7% of drug-resistant bacteria, including some of the most virulent multidrug-resistant strains. The study authors stated: “In our study, antimicrobial silver nanoparticles exerted a bactericidal effect against six drug-resistant bacterial strains… the same nanosilver concentration inhibited 99.7% of erythromycin-resistant Streptococcus pyogenes, 95.7% of ampicillin-resistant E. coli and 92.8% of multidrug-resistant P. aeruginosa.” The researchers further concluded that silver exhibited bactericidal effect rather than merely bacteriostatic effect. That’s important news, because it means the use of antimicrobial silver is so effective against drug-resistant strains, it outright kills them rather than merely inhibiting their growth!

    Clinical Study #2: Colloidal Silver Kills Antibiotic-Resistant Staph, E. Coli, Pseudomonas and Salmonella! In this clinical study, titled “Colloidal Silver as a New Antimicrobial Agent,” published in the respected International Journal of Microbiological Research in 2010, the researchers demonstrated that colloidal silver effectively decimated antibiotic-resistant strains of Staphylococcus
    aureus, Escherichia coli, Pseudomonas aeruginosa and Salmonella typhi. The researchers concluded, “Resistant clinical isolates of Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Salmonella typhi were used as the test organisms. This study demonstrated powerful antimicrobial activity of colloidal silver against all multidrug-resistant clinical pathogens tested.”

    Clinical Study #3: Colloidal Silver Kills 49 Different Strains of Antibiotic-Resistant Superbugs! In this clinical study titled “The Antimicrobial Efficacy of Silver on Antibiotic-Resistant Bacteria Isolated From Burn Wounds,” conducted by researchers at the Department of Pathology at West Virginia University, and published in the International Wound Journal in October 2012, a total of 49 different antibiotic-resistant bacteria were isolated from burn wounds and tested against silver. These deadly, drug-resistant pathogens included Vancomycin-resistant Enterococcus faecium, Methicillin-resistant Staphylococcus aureus, multidrug-resistant Pseudomonas
    aeruginosa, multidrug-resistant Vibrio sp, drug-resistant *Klebsiella pneumonia*, drug-resistant Escherichia coli, multidrug-resistant Acinetobac terbaumannii and 42 others. After exposing these drug-resistant pathogens to antimicrobial silver the researchers concluded, “…all forty-nine antibiotic-resistant bacteria showed susceptibility to the antimicrobial activity of silver…”

    As you can see, there’s hardly a superbug in existence that hasn’t been demonstrated by clinical research to be sensitive to antimicrobial silver. And that includes the deadly MRSA pathogen that kills some 94,000 people per year in the U.S. alone!

    What’s more, here’s an article about a clinical study demonstrating that when small amounts of silver are added to existing antibiotic drugs that are no longer effective against drug-resistant microbes, the silver boosts the effectiveness of those drugs by up to 1,000 times and restores their effectiveness against the resistant microbes:

    Study: Silver Boosts Effectiveness of Antibiotics By Up to 1,000x! <https://fx229.infusionsoft.com/app/linkClick/6164/fe360ba17a22fdcf/3601030/c4618727ff2fd43e&gt;

    And here’s another article about a study demonstrating that when silver is added to antibiotic drugs that no longer work against the drug-resistant pathogens, the drugs suddenly and miraculously start working again; what’s more, when added to the antibiotic drug ampicillin, the silver restored the drug’s effectiveness against drug-resistant E. coli:

    Silver Makes 26 Antibiotic Drugs Work Better Against Pathogens <https://fx229.infusionsoft.com/app/linkClick/6166/864c9d0cf860125f/3601030/c4618727ff2fd43e&gt;

    So why all of the scary WHO bulletins and Harvard Medical School videos portraying an imminent global apocalypse caused by drug-resistant pathogens?
    It’s simple.

    The medical authorities have yet to figure out a way to patent colloidal silver and monopolize its sales. After all, silver is a completely natural substance.
    And the medical Gestapo are aware that if they openly admit silver is the answer to the drug-resistant “superbugs,” people will simply go to their local health food stores and buy some, or get a colloidal silver generator <https://fx229.infusionsoft.com/app/linkClick/6168/536d52187d616917/3601030/c4618727ff2fd43e&gt; and
    start making their own colloidal silver, rather than paying through the nose for expensive antibiotic drugs.

    Nevertheless, silver really is the solution to the drug-resistant pathogen crisis. As Dr. Joseph Weissman, M.D. board certified immunologist and Assistant Clinical Professor at the University of California Medical School has stated:

    "Today, many antibiotics are losing the battle with germs. Fortunately, the best germ killer, which was discovered over 2,000 years ago, is finally getting the proper attention from medical science – natural silver. I sincerely recommend that everyone have electrically generated colloidal silver in their home as an antiseptic, antibacterial and antifungal agent."

    As Harvard-educated Dr. Jonathan Wright, M.D. has stated:

    “Colloidal silver just might be the next germ-fighting wonder drug. And not just for the serious threats making headlines: It's also effective against bacterial infections like strep throat, viruses like the flu, and fungal infections like Candida.

    No matter how much a germ mutates, it can't change enough to escape the damaging effects of colloidal silver. And in the process, the silver doesn't harm human tissue or kill off the good bacteria in the intestine the way antibiotics and other medications do."

    As Dr. Ron Leavitt, Ph.D., of the Department of Microbiology at Brigham Young University has stated:

    "The data suggests that with the low toxicity associated with colloidal silver, in general, and the broad spectrum of antimicrobial activity of this colloidal silver preparation, this preparation may be effectively used as an alternative to antibiotics."

    And as author Zane Baranowski, CN, has stated:

    "Silver is one of the most universal antibiotic substances. When administered in the colloidal form, it is for all practical purposes non-toxic. Silver has been proven to be effective against hundreds of infectious conditions.

    It has tremendous anti-microbial power; the history of safe and successful colloidal silver use is extensive, and the number of current health professionals and individuals that successfully utilize colloidal silver to reduce the length and severity of infectious disorders is growing exponentially."

    Kind regards,

    Geofffrey

  8. gmarmot

    Informative article that should he read and understood by everyone. One minor problem here is this statement: "For instance, in some countries, antibiotics are available without a prescription". This is not exactly accurate, as antibiotics are generally available in more places without a prescription than with one. Having spent over 8 years in 21 third world countries in Central/South America and western Asia, I've seen antibiotics being sold cheaply nearly everywhere, despite any applicable laws. This and use in livestock here are indefensible, and we'll continue to pay a huge price for our insistance on making money regardless of consequences.

  9. Alex Micu

    Education certainly plays a part. People want to make money so they sell meds off the books but I don't think they even know drug resistance is a thing.

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