Antimicrobial Resistance threat looms large: What can we do about it?
By Asmithaa Vinukonda
Antimicrobial resistance (AMR) is declared to be one of the top ten global health threats facing humanity by the World Health Organization. The growing resistance in pathogens to anti-microbial drugs coupled with the lack of new drugs in the pipeline has given rise to “superbugs”.
In 1928, Sir Alexander Fleming stumbled upon penicillin by accident. While sifting through old dishes, the Scottish physician found a mold that had contaminated a plate and had begun killing the bacteria it touched. He had found the first antibiotic. But Fleming’s discovery came with a warning. In a 1945 interview, shortly after winning the Nobel Peace Prize, Fleming said: “The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism."
And so, Fleming predicted resistance to antimicrobials and provided the solution. But it can be argued that even Fleming was not able to predict the true extent of the damage AMR has caused.
AMR happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. It occurs when antibiotics are misused and overused, overexposing harmful bacteria and fungi to a drug and therefore introducing a greater possibility of a resistant form of bacteria or fungi. In a TED Talk, journalist Maryn McKenna notes that about 50% of the antibiotics given in US hospitals are unnecessary, and about 45% of prescriptions written in doctors’ offices are for illnesses that antibiotics cannot help. Additionally, 80% of antibiotics sold every year are for farm animals. As a result, each year in the U.S., at least 2.8 million people are infected with antibiotic-resistant bacteria or fungi, and more than 35,000 people die as a result. These statistics are reflected in all parts of the world and are more prevalent in low and middle-income countries due to weak governance and lack of precautions. The increasing resistance in pathogens towards antimicrobials is a threat that can significant implications for the future of our health and our healthcare systems.
It is alarming how quickly bacteria and fungi can become resistant to the drugs meant to treat them. Penicillin-resistant Staphylococcus aureus was discovered in 1942, just one year after penicillin’s release in 1941. Methicillin-resistant Staphylococcus aureus was identified the same year that methicillin was released in 1960. Daptomycin-resistant Staphylococcus aureus was recognized in 2004, the year after daptomycin’s release in 2003. The lack of these treatments can lead to higher medical costs, prolonged medical stays, and increased mortality. Additionally, AMR can be a significant barrier in eradicating diseases that are common in low and middle-income countries. One of the most frustrating of these cases is malaria. P. falciparum, the most difficult malaria pathogen to control, has developed resistance to almost all antimalarial drugs, such as sulfadoxine/pyrimethamine, mefloquine, chloroquine, halofantrine, and quinine. This has caused P. falciparum to become incredibly common and harmful.
The good news is, there are steps we can take to reduce the spread of AMR. In keeping with Fleming’s warning and WHO’s guidance, individuals should only use antibiotics that are prescribed by a certified health professional, and patients who have been prescribed antibiotics should not share them with others or save them for later use. Additionally, people should refrain from eating meat from animals that have been fed unnecessary antibiotics. Health professionals should review how to take antibiotics correctly with patients and not prescribe antibiotics when they are not needed. Many large organizations are also making efforts to combat AMR. The FDA and CDC are approving new antibiotics, labeling antibiotics to ensure that they are being prescribed and taken correctly, encouraging the development of new antibiotics, and are partnering together to promote public awareness. WHO endorsed a Global Action Plan on AMR (GAP) in May 2015, and has been leading multiple initiatives since, including the Global Action Plan on AMR and the Tripartite Joint Secretariat on AMR. The Tripartite Joint Secretariat includes WHO, Food and Agriculture Organization, and the World Organization for Animal Health.
Although we are already fighting the threat of AMR and are taking action, the cause of AMR cannot succeed without better public knowledge. The majority of the general population either does not understand the dangers of AMR or does not know the challenge even exists. More effort is needed in educating the public and providing resources with which to gain knowledge about the problem. Therefore, global and local level organizations, government, and us as individuals have a responsibility to step up our efforts in educating the public about the dangers of AMR. Perhaps with all these efforts, we can set the world on a path where AMR can be successfully fought off. Yet, till then, Fleming’s warning still rings true.
Until AMR is no longer a problem, we all carry a responsibility to mitigate this global health security threat and to help prevent deaths caused by it.
About the Author
Asmithaa Vinukonda is a freshman at Forsyth Country Day School in Lewisville, North Carolina. She is passionate about problems facing global health and is interested in educating others about these problems.