[Answered] “Antibiotic resistance is a slowly developing epidemic of 21st century”. Comment. Discuss various causes of antibiotic resistant. Suggest some measures.

World health Organisation WHO released top 10 threats to global health in 2019, among which antimicrobial resistance (AR) accounted for a huge contribution with 1.6 million deaths every year due to the tuberculosis drug resistant microbe. The study ‘Understanding drivers of antibiotic resistance genes in High Arctic soil ecosystems’ by Environment International journal shows that a total of 131 Antibiotic-Resistant Genes (ARGs) material were detected, among which the blaNDM-1 gene, first found in surface water in India in 2008, has spread to the Arctic in just 11 years. This reflect that antibiotic resistance is a new epidemic threat of 21^st century.

A global epidemic:

This is no more a local problem and has to be looked as a global health concern. Annually, 700,000 deaths occur worldwide due to the AR bacteria, says a report titled “anti-microbial resistance benchmark”.

Bacteria are carried in the gut of animals and people, and were likely spread through the faecal matter of these animals, humans as well as migratory birds. India has witnessed an increase in antibiotic consumption — about 65 per cent in 2015 compared to 2000, while the rate of consumption increased from 3.2 to 6.5 billion daily defined doses (DDDs) in the same period.

Various Causes of antibiotic resistance: Microbes can become resistant to drugs for both biological and social reasons.

Microbial behaviour: As soon as scientists introduce a new antimicrobial drug, there is a good chance that it will become ineffective at some point in time. This is due primarily to changes occurring within the microbes. These changes can come about in different ways:

1. Mutation: When microbes reproduce, genetic mutations can occur. Sometimes, this will create a microbe with genes that help it survive in the face of antimicrobial agents.
2. Passing on of genes through generations: Microbes that carry these resistance genes survive and replicate. The newly generated resistant microbes carry gene from their parents and eventually become the dominant type.
3. Gene transfer: Microbes can pick up genes from other microbes. Genes conferring drug resistance can easily transfer between microbes.
4. Phenotypic change: Microbes can change some of their characteristics to become resistant to common antimicrobial agents. This occur in environment of already resisting microbes.

People’s behaviour: Not following recommendations for the use of some drugs can increase the risk of antimicrobial resistance. The way in which people use antimicrobial drugs is a significant contributing factor. Some individualistic reasons:

• Inexact diagnosis: Doctors sometimes prescribe antimicrobials “just in case,” or they prescribe broad-spectrum antimicrobials when a specific drug would be more suitable. Using these medications in this way increases the risk of AMR.
• Inappropriate use: If a person does not complete a course of antimicrobial drugs, some microbes may survive and develop resistance to the drug. Resistance can also develop if people use drugs for conditions that they cannot treat. For example, people sometimes take an antibiotic for a viral infection. Also antibiotics recommended by quacks or pharmacist contribute to magnify the issue.

• Agricultural use: Using antibiotics in farm animals can promote drug resistance. Scientists have found drug-resistant bacteria in meat and food crops that have exposure to fertilisers or contaminated water. In this way, diseases that affect animals can pass to humans.
• Hospital use: People who are critically ill often receive high doses of antimicrobials. This encourages the spread of AMR microbes, particularly in an environment where various diseases are present.

Prevention and control measures: 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.

• Individuals: To prevent and control the spread of antibiotic resistance, individuals should:
  • Only use antibiotics when prescribed by a certified health professional.
  • Never demand antibiotics if your health worker says you don’t need them.
  • Always follow your health worker’s advice when using antibiotics.
  • Never share or use leftover antibiotics.
  • Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practising safer sex, and keeping vaccinations up to date.
  • Prepare food hygienically, following the WHO Five Keys to Safer Food (keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, use safe water and raw materials) and choose foods that have been produced without the use of antibiotics for growth promotion or disease prevention in healthy animals.
• Policy makers: To prevent and control the spread of antibiotic resistance, policy makers should:
  • Ensure a robust national action plan to tackle antibiotic resistance is in place.
  • Improve surveillance of antibiotic-resistant infections.
  • Strengthen policies, programmes, and implementation of infection prevention and control measures.
  • Regulate and promote the appropriate use and disposal of quality medicines.
  • Make information available on the impact of antibiotic resistance.
• Health professionals: To prevent and control the spread of antibiotic resistance, health professionals should:
  • Prevent infections by ensuring that their hands, instruments, and environment are clean.
  • Only prescribe antibiotics when they are needed, according to current guidelines.
  • Report antibiotic-resistant infections to surveillance teams.
  • Talk to their patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
  • Talk to their patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).
• Healthcare industry: To prevent and control the spread of antibiotic resistance, the health industry should invest in research and development of new antibiotics, vaccines, diagnostics and other tools.
• Agriculture sector: To prevent and control the spread of antibiotic resistance, the agriculture sector should:
  • Only give antibiotics to animals under veterinary supervision.
  • Not use antibiotics for growth promotion or to prevent diseases in healthy animals.
  • Vaccinate animals to reduce the need for antibiotics and use alternatives to antibiotics when available.
  • Promote and apply good practices at all steps of production and processing of foods from animal and plant sources.
  • Improve biosecurity on farms and prevent infections through improved hygiene and animal welfare.

There is need to urgently address antimicrobial resistance through the lens of one (human, animal and environment) health. All countries need to work together to limit the spread of ARGs and antibiotics between humans, animals and the environment in the globalised world where we live. Even though national action plans have been laid down by most countries, these plans have yet to move from paper to the ground as antibiotics continue to be freely used.