Antimicrobial resistance: what you need to know

Apr 14, 2016

Photo credit: Helen Sessions/Alamy

By Matthew Weaver

What is antimicrobial resistance?

Bacteria and other microbes that cause diseases in humans and animals are becoming increasingly resistant to previously effective drugs. And this is potentially a big problem. The World Health Organisation fears we are heading for a “post-antibiotic era in which common infections and minor injuries, which have been treatable for decades, can once again kill”. One health expert described resistance to antibiotics as “a silent tsunami, crumbling down the pillars upon which modern medicine is built”.

Why is it in the news?

Antimicrobial resistance will become “an even greater threat to mankind than cancer” without global action, according to the UK’s chancellor, George Osborne.

Is Osborne right?

If efforts to curb antimicrobial resistance fail, the number of people who die each year from drug-resistant infections could increase to 10 million by 2050. This would surpass the 8.2 million deaths a year caused by cancer. Dame Sally Davies, England’s chief medical officer, has said the threat was so serious it should be added to the government’s national risk register of civil emergencies.

What is the difference between antimicrobial resistance and antibiotic resistance?

Antibiotic resistance is a narrow term referring to the resistance to antibiotics in bacteria-based diseases such as tuberculosis and hospital infections like MRSA. Antimicrobial resistance is broader covering infections caused by other microbes such as the parasite that causes malaria, HIV and the fungus that causes candida.

How does it occur?

The development of resistant strains is an inevitable consequence of natural selection. It happens when the DNA of micro-organisms mutates and when resistant traits are exchanged between them. The drug expert David Cox explains what happens at the molecular level:

Such mutations can prevent an antibiotic entering the bacteria cell at all, altering the target molecules so that they don’t bind to the antibiotic anymore, or enhancing the efficiency of efflux mechanisms within the bacteria which allow it to simply pump a drug back out again. Certain genes, if acquired, can actively degrade antibiotics, limiting their effectiveness once they’ve entered the cell.

Why is it a problem?

Infections caused by resistant micro-organisms do not respond to normal treatments, resulting in longer illness and greater risk of death. It therefore also increases the cost of healthcare as more expensive treatments are required and longer-term care needed.

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3 comments on “Antimicrobial resistance: what you need to know

  • How about the use of antimicrobial viral treatment? I’ve always understood that the pre-war work on the use of viruses in treating infection was quite promising and that it continued in the Soviet Union after penicillin wiped out the necessity for it in the West. I have read that it is still available in Georgia. Surely with the limitless increase in knowedge and understanding of the arcane world of microbes, this line of research should be re-commenced, but perhaps that would make it difficult for the Pharma Industry, which relies on being able to invent and patent new substances, rather than discovering how to use existing ones.

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  • What do we need to do?
    1. Always use antibiotics in multi-drug cocktails so the bugs have a very tough time evolving resistance, the way we do with HIV drugs.
    2. ban the use of human antibiotics in animal feed just to promote growth. Low dose is the ideal way to develop resistance.
    3. criminal penalties for prescribing antibiotics frivolously — e.g. because patient foolishly demanded it.
    4. hire drug companies to develop a spectrum of unpatented new antibiotics.

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  • The problems are escalating as people become dependent on trying to retrospectively fix medical problems, instead of trying to prevent them!

    Doctors have expressed “huge concern” that super-gonorrhoea has spread widely across England and to gay men.

    The new superbug prompted a national alert last year when it emerged in Leeds, as one of the main treatments had become useless against it.

    Public Health England acknowledges measures to contain the outbreak have been of “limited success”.

    Doctors fear the sexually transmitted infection, which can cause infertility, could soon become untreatable.

    Cases of super-gonorrhoea have now been detected in the West Midlands, London and southern England.

    Only 34 cases have been officially confirmed in laboratory testing, but this is likely to be the tip of the iceberg of an infection that can be symptomless.

    The outbreak started in straight couples, but is now being seen in gay men too.

    “We’ve been worried it would spread to men who have sex with men,” Peter Greenhouse, a consultant in sexual health based in Bristol, told BBC News.

    “The problem is [they] tend to spread infections a lot faster simply as they change partners more quickly.”

    They are also more likely to have gonorrhoea in their throats. There further resistance is more likely to develop as antibiotics get to the throat in lower doses and the area is also teeming with other bacteria that can share the resistance to drugs.

    The bacterium that causes gonorrhoea is extremely adept at shrugging off our best antibiotics.

    So two drugs – azithromycin and ceftriaxone – are used in combination.

    But now resistance to azithromycin is spreading, doctors fear it is only a matter of time before ceftriaxone fails too.

    The disease is caused by the bacterium called Neisseria gonorrhoeae.

    The infection is spread by unprotected vaginal, oral and anal sex.

    Of those infected, about one in 10 heterosexual men and more than three-quarters of women, and gay men, have no easily recognisable symptoms.

    But symptoms can include a thick green or yellow discharge from sexual organs, pain when urinating and bleeding between periods.

    Untreated infection can lead to infertility, pelvic inflammatory disease and can be passed on to a child during pregnancy.

    England’s most senior doctor has already warned gonorrhoea is on the cusp of becoming untreatable.

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