Nikki (Year 11)
Editor’s note: Year 12 student Nikki wrote this fascinating article whilst still in Year 11. Antimicrobial resistance (AMR) occurs when bacteria become resistant to antibiotics, making infections harder or impossible to treat and posing a serious threat to global health systems. It burdens healthcare with prolonged hospital stays, increased costs, and higher mortality, while misuse of antibiotics in humans and livestock farming accelerates resistance development. CPD
Antimicrobial Resistance (also known as AMR) occurs when antibiotics no longer work against bacteria. Consequently, antibiotics become less effective and pose a wider threat to elderly patients developing AMR wherein the same antibiotics are no longer effective, leading to stronger antibiotics being required for successful treatment of a disease. Such resistance makes certain infections harder to treat, in some cases impossible, as resistant “superbugs” evolve, a typical example being MRSA, which is responsible for 12,000 deaths per annum in the UK. AMR is considered a significant threat to the public health systems, not only in developing countries, but throughout the world and could exhibit an “unknown future” in healthcare as infections can be difficult to treat or impossible.
AMR burdens global healthcare systems
AMR generates huge burdens piled on public healthcare systems and pressures on healthcare workers due to prolonged hospital admissions, higher healthcare expenses and higher costs in second-line drugs and failures in treatment. In Europe, it has been estimated that antimicrobial resistance is responsible for wasting more than nine billion euros per year. If AMR was mitigated, this money could have been used on developing new drugs or advancements into cancer research for example, instead of being plunged into an issue completely preventable from controlling the misuse of antibiotics. Furthermore, according to the Centres for Disease Control and Prevention, in the USA, antimicrobial resistance amounts to a 20 billion dollar sum, losing 35 billion dollars of productivity every year. A notable case of AMR, Methicillin resistance in Staphylococcus aureus (MRSA), is to blame for high mortality rates globally. The risks posed by the increasing antibiotic-resistant microbes have been recognised as a global challenge, some may say unprecedented, as seen in the figure of 1.27 million AMR deaths in 2019.
Human misuse is a factor encouraging AMR
Human misuse of antibiotics is a crucial factor that influences AMR today. Moreover, drug resistance to tuberculosis, gonorrhoea and typhoid fever are increasing annually and dramatically contribute to the enormous cost of healthcare systems around the world. Currently, 4.1% of tuberculosis cases are considered to be multi-drug resistant. Without effective antibiotics, harmless infections could become fatal and many common treatments such as caesareans, chemotherapy and surgery could become too unsafe. Thus, the effect this amounts to on modern medicine is tremendous. Despite posters and other regulatory mechanisms in place to cease the abuse of antibiotics, human misuse leads to gaps in the healthcare system due to strain on NHS resources that may not be readily available for every person if antibiotic resistance continues down this trajectory. The NHS in particular has a policy of being “free at the point of delivery” from “cradle to the grave” since its founding in 1948, meaning AMR should be tackled before the issue goes out of hand.
Prescribing antibiotics when they are not required or when having not a strong indication is a very common example of misuse. Luckily, in many developed countries like the United Kingdom, the supply of antibiotics without prescription is prohibited but in many other countries, over the counter antibiotics are often administered, some of a very poor quality. This may be due to inadequate regulation policies for manufacturing and prescribing medicine, encouraging patients to self-treat for diseases that do not need antibiotics for recovery. For example, some countries such as China incentivise doctors to overprescribe antibiotics for lengthy periods of time to increase profit margins, an example of unethical healthcare procedures.
Raising awareness
A way to tackle AMR for instance is to monitor the numbers of antibiotic prescriptions issued. Research found that simply sending a letter informing GP surgeries that they were in the top 25% of prescribers, reduced their inappropriate prescriptions by an average of 3%.
Antibiotics are overconsumed for livestock farming
Antibiotic use in livestock farming is another crucial contributor to AMR in the world. 66% of all antibiotics are not used for humans, but for farm animals. Antibiotics are sometimes added to the animal feed and drinking water of healthy animals in order to prevent illness. By doing so, farmers aim to increase the weight of the animal, hence increase the profit. In fact, some farmers feed pigs colistin- a critical last-line antibiotic used to treat severe infections in humans. Roughly 160,000 tonnes of antibiotics were fed to farm animals annually in 2020. Observing current patterns, by 2030, this number is estimated to increase to 200,000 tonnes. The World Health Organisation (WHO) are advising the food industry to restrict antibiotic usage in healthy animals since the calculated risk of developing superbugs (multi-resistant pathogens) is too high. Additionally, the World Bank warn that drug-resistant infections could cause economic distress similar to the 2008 financial crisis.
Mechanisms
Biologically, AMR may have come about due to bacterial evolution and mutation that happened spontaneously. It can also so happen that bacteria can actively develop defence mechanisms against antibiotics. For example, some bacteria have developed biochemical “pumps” that can remove an antibiotic before it reaches its target, while others have evolved to produce enzymes to inactivate the antibiotic. Alternatively, by acquiring resistance genes from other bacteria, some species are now immune to antibiotics. More specifically, when antibiotics are used, some bacteria die but resistant bacteria can survive and even multiply. The overuse of antibiotics makes resistant bacteria more common. The more unnecessary antibiotics are used, more are the chances of resistance.
In conclusion, antimicrobial resistance is caused when medication can no longer fight microorganisms that cause disease, infections becoming more difficult to treat, and those that can be treated, the more risks there are that pose as difficult. This preventable resistance pressurises healthcare staff, urges prolonged hospital stays and increases chance of death. In order to prevent AMR, cautionary measures like preventing infections and awareness of misuse are advisable which the NHS are currently doing through awareness campaigns as shown in the image. The impact of antimicrobial resistance is detrimental on every persons life expectancy and, most importantly, hinders medical progress.
References
Poroshat Dadgostar Infection and Drug resistance 2019:12 (3903-09)
The GSAL Journal 