The Next Pandemic: Antibiotic Resistance Where is it coming from & how do we stop it?
If a two-year-old child living in poverty in India or Bangladesh gets sick with a common bacterial infection, there is more than a 50% chance an antibiotic treatment will fail. Somehow the child has acquired an antibiotic resistant infection – even to drugs to which they may never have been exposed.
As recent recommendations on AMR from the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and World Health Organization (WHO) suggest, the “superbug problem” will not be solved by more prudent antibiotic use alone. It also requires global improvements in water quality, sanitation, and hygiene. Otherwise, the next pandemic might be worse than COVID-19.
Bacteria under stress
To understand the problem of resistance, we must go back to basics. What is antibiotic resistance, and why does it develop?
• Exposure to antibiotics puts stress on bacteria and they defend themselves by acquiring resistance genes especially from our digestive systems, throat and on our skin. This allows them to change quickly, readily obtaining the ability to make proteins and other molecules that block the antibiotic’s effect.
• The pharmaceutical industry initially responded to increasing resistance by developing new and stronger antibiotics, but bacteria evolve rapidly, making even new antibiotics lose their effectiveness quickly.
• When you take an antibiotic, some resistant bacteria always survive, and can pass to the environment via inadequately treated faecal matter, spreading resistant bacteria and genes wider.
Spreading Through Faeces
One might cynically argue that “foreign” resistance is a local issue, but antibiotic resistance spread knows no boundaries.
Researchers from Denmark compared antibiotic resistance genes in long-haul airplane toilets and found major differences in resistance carriage among flight paths, suggesting resistance can jump-spread by travel. Migratory birds can acquire resistant bacteria and genes from contaminated water or soils and then fly great distances carrying resistance in their gut and during travel, they defecate along their path, planting resistance almost anywhere.
Drivers of Antibiotic Resistance
Industrial wastes, hospitals, farms, and agriculture are also possible sources or drivers of antibiotic resistance.
1. Toxic metals can stress bacteria, which makes them stronger, incidentally making them more resistant to anything, including antibiotics.
2. Hospitals are both reservoirs and incubators for many varieties of antibiotic resistance. Resistant bacteria can be enriched in hospitals and the wastewater release from hospitals also may be a concern.
3. Agriculture and Aquaculture could be another critical source. Drugs used in veterinary care can be very similar to the antibiotics used in human medicine. Waste management from agricultural activity is usually less sophisticated and antibiotic resistance can spread from farm animals to farmers to food workers.
Prevention and Control
Antibiotic resistance is accelerated by the misuse and overuse of antibiotics, as well as poor infection prevention and control. Steps can be taken at all levels of society to reduce the impact and limit the spread of resistance.
1. Prevent infections by ensuring your hands, instruments, and environment are clean.
2. Only prescribe and dispense antibiotics when they are needed, according to current guidelines.
3. Report antibiotic-resistant infections to surveillance teams.
4. Talk to your patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
5. Talk to your patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).
Other simple steps:
1. It is clear we must use a holistic approach to reduce the spread of resistance across people, animals, and the environment.
2. Global improvements in sanitation and hygiene should bring the world closer to solving the problem of antibiotic resistance.
3. Simple is more sustainable. We need to reduce open defecation in a cheap and socially acceptable manner. This is the best immediate solution in places with limited or unused sanitation infrastructure.
4. Resistance also is lower in places with greater public health expenditure, which implies social policy, community action, and local leadership can be as important as technical infrastructure.
1. World Economic Forum