By Yasser Arafath‚Äč

Antibiotic Resistance- An alarming concern for the global population

Antibiotics are potentially powerful drugs that can be employed to combat several deadly diseases. Like many other medications, antibiotics also carry a wide range of serious adverse effects. The appropriate use of such medications would have a high beneficiary effect that outweighs the risks or threats associated. However, if antibiotics are unnecessarily used, patients may experience zero advantages but their susceptibility to the adverse effects might remain high. Moreover, antibiotics disrupt the composition of the infectious agent, leading to bacterial adaptation or mutations, which may give rise to new strains which can be resistant to the recent medication regimen. The inappropriate use of antibiotics in one patient might develop a resistant strain that spreads to other patients through coughing, sneezing, fomites, and touch who do not use antibiotics, which makes this issue an alarming health concern for populations globally. According to reports, in 2015, almost 30% of the outpatient antibiotics prescribed were unnecessary. It was also observed that acute respiratory infections hold the highest unnecessary use of antibiotics, which is at 50%.

What may happen due to the unnecessary overuse of antibiotics?

Antibiotic resistance occurs when over a while microorganisms evolve to hijack the effect of antibiotics through multiple defense mechanisms. Dissemination of antibiotic resistance genes in microbes is a serious health concern. A certain group of bacteria can easily neutralize an antibiotic by altering its component to make it ineffective. Others might be able to export the antibiotics out of the bacteria, and some can modify their outer structure and receptors so that antibiotics cannot attach to them. Such defense mechanisms might lead to the survival of some bacteria with the use of the specific antibiotic and develop a resistance that can be passed to other bacteria as they multiply. Bacteria also can become resistant through mutation of their genetic material.

The mechanism of antibiotic resistance is commonly categorized into the following four groups:

Intrinsic Resistance: Bacteria might survive an antibiotic due to intrinsic resistance through evolution by changing their structure or components. For example, an antibiotic that affects the wall-building mechanism of the bacteria, such as penicillin, cannot affect bacteria that do not have a cell wall.

Acquired Resistance: Bacteria can obtain the ability to resist the activity of a particular antimicrobial agent to which it was previously susceptible. Bacteria can acquire resistance through a new genetic mutation that helps the bacterium survive or by getting DNA from a bacterium that already is resistant. An example is Mycobacterium tuberculosis’s resistance to rifamycin.

Genetic Change: Bacterium DNA may change its makeup and alter the production of some proteins, leading to the rise of different bacterial components and receptors which might make the bacteria unrecognized by an antibiotic. Bacteria sharing the environment might harbor intrinsic genetic determinants of resistance that affect the genomics of the bacteria. An example is Escherichia coli (E. coli) and Haemophilus influenza resistance to Trimethoprim.

DNA Transfer: Bacteria can share genetic components with other bacteria and transfer the resistant DNA through a horizontal gene transfer process. Usually, bacteria acquire external genetic material through three main stages:

-Transformation (through naked DNA incorporation)

-Transduction (through the process of phagocytosis)

-Conjugation (through direct contact)

Why do we need to be extra cautious?

Antibiotic-resistant infections add a significant burden of costs to the nation’s health care system. When first-line and then second-line antibiotic treatment options are limited or unavailable only then healthcare professionals should be critically permitted to use antibiotics that are having strong dosage regimens and are more expensive. Even when effective treatments exist, recent clinical insights worldwide show that in several cases patients with resistant infections require significantly longer hospital stays, more visits to the doctor’s chamber for examination, and experience a higher incidence of poor health-related quality of life.

Combined efforts must be made at greater levels to implement new policies, improve research efforts, and take proper steps to mitigate this crisis.