AMR and the impact of how we tackle infections in humans
As consumers of antibiotics for treating infections that we face, what is our role in increasing the occurrence of Antimicrobial resistance ?
When we talk about Antimicrobial Resistance (AMR), changing the mindset around using antibiotics for treating infections in humans is an important problem that needs to be addressed. With 4.95 million deaths in 2019 and a reported 1.27 million people dying as a direct result of drug-resistant infections, the number of deaths, globally, due to AMR is expected to reach 10 million deaths by 2050. This is a huge public health challenge and therefore requires a concerted action to tackle the issue.
There are several problems with how we currently use antibiotics. Ever since the golden age of antibiotics when several antibiotic classes entered the market, incorrect and ever-increasing usage of antibiotics has meant that a large number of weapons from our arsenal of antibiotics have already been exposed to our pathogenic adversaries. This means that pathogenic bacteria over the years have become more and more familiar with the mechanism of action of these antibiotics and have developed new and evolving defence mechanisms, a resistance for survival.
Source: Antibiotics: Past, present and Future
The assimilation of several resistance genes (all resistance genes in a pathogen make up the resistome) has meant that a large number of the antibiotics that we have developed are ineffective in protecting us from our pathogenic adversaries. WHO's Priority Pathogens List is a reminder of our toughest adversaries today, against whom the drugs in our arsenal are no longer effective.
Source: WHO's Priority Pathogens List for Research and Development of New Antibiotics
These pathogens have become resistant to both bacteriostatic (blocking replication) and bacteriocidal (killing bacteria) effects of several antibiotics which renders them difficult to stop once they cause an infection. Pathogens like MRSA which previously could be tackled by broad-spectrum antibiotics like penicillin now require the use of specialist classes of antibiotics like vancomycin, daptomycin, and linezolid.
Our contribution to the increased likelihood of AMR
The behaviours around how we use antibiotics for treating human infections which contribute to the increased incidence of antimicrobial resistance are
Non-adherence to the recommended dosage and course of antibiotic treatment.
Overuse of antibiotics to treat non-bacterial infections and for minor ailments which did not require antibiotics.
Failure to prevent the incidence of new infections.
Failing to finish a full course of antibiotics treatment and not adhering to recommended dosage can fail to clear the bacteria from the body and applies a selective pressure where pathogens resistant to the antibiotic survive and proliferate. If more antibiotics than recommended are taken, then it increases the exposure of the bacteria to this adversary and the likelihood that it accumulates resistance genes, leading to the emergence of new resistant variants.
Overuse of antibiotics, especially by using them to treat non-bacterial infections exacerbates the issue as it results in the intended target infection never being resolved. It instead exposes the consumed antibiotics unnecessarily to other germs present inside your body and leads to them developing resistance to the antibiotics which they wouldn't have encountered otherwise.
Frequent incidences of infections and infectious outbreaks lead to an increase in the usage of antibiotics along with the likelihood of AMR. Reducing the chance of infections occurring can help to reduce the need for consuming antibiotics and in turn reduce the likelihood that the pathogen picks up resistance genes.
These behaviours weaken our defence against our pathogenic adversaries, especially considering that we have a limited antibiotic arsenal and an antibiotic innovation funnel which is slowly drying out due to a lack of funding and limitations in establishing sustainable business models. We will explore the challenges of the business models involving antibiotics in a separate future post.
Video from Michael Baym’s lab showing the emergence of antimicrobial resistance in a bacterial culture exposed to increasing levels of antibiotics.
Actions to address the misuse of antibiotics
The above-discussed misuse of antibiotics is fuelled by a lack of awareness, insufficient engagement and discussions about its impact [1] and easy access due to the over-the-counter nature of distribution for a number of these antibiotics, especially in LMIC countries. Considering this, addressing the misuse of antibiotics in treating human health will require actions like
Increasing awareness about the impact of misuse of antibiotics: speaking to a wider audience and the general public, not just research circles, public health conferences and funding bodies.
Improved public health data on how and where antibiotics are used: gathering more data about how antibiotics are used and give better visibility to the problem to empower meaningful action.
Better visibility and regulations around antibiotics and infections they can be recommended: data-led decision-making platforms for healthcare practitioners and regulators to inform both consumption and enable oversight on antibiotic usage.
Innovative frameworks both legal and business - to encourage good behaviour across all stakeholders ranging from producers of antibiotics to healthcare practitioners and consumers.
Setting SMART policy objectives - aspirational and direction-setting objectives are no longer meaningful. The magnitude of the problem and the impact that it can have requires specific, measurable, achievable, relevant and time-bound objectives from all stakeholders.
If we do not tackle the impact of AMR effectively, some of the most common easily curable infections start becoming untreatable. UTIs, infections during organ transplants, and post-chemotherapy recovery have already started to become hard to cure. These common infections could very easily become life-threatening, especially if we run out of antibiotics that are unable to stop these pathogens.
To summarise, there will always be an ongoing battle between evolving pathogens and humans developing antibiotics. The best protection for us is strong monitoring of new emergent variants, informed strategic usage of antibiotics, and creating more awareness on best practices for using antibiotics for treating infections in humans through improved dialogue with consumers and innovation in legal, policy and business frameworks that encourage better behaviour by all stakeholders.
COVID-19 has shown us that tackling infectious diseases is no longer a local problem. It is glocal in the truest sense where public health actions both globally and locally are essential to building a robust defence against future outbreaks.
I hope this post has given you more insights into how our current manner of using antibiotics for treating infections is affecting our future abilities to stay protected against outbreaks.
Additional Reading