Antibiotic resistance is when microorganisms, such as bacteria, are able to survive an exposure to antibiotics and these bacteria are now resistant to the effects of these antibiotics. Antibiotic resistance in bacteria has been an issue since antibiotics were discovered. The fact that bacteria can become resistant to our medical treatments such as antibiotics is a natural evolutionary process, but there are certain human contributions that definitely speed up the process. For example, one of the main contributions that will be discussed is the problem of over prescription of the antibiotic drugs.
The bacteria are constantly being exposed to the antibiotics and being forced to evolve at a high rate into resistant forms of the bacteria. If antibiotic resistance is a known problem then why are doctors still over prescribing antibiotics? There are definite obvious solutions to the problem such as cutting down on the unnecessary over prescription of these antibiotics, but there are also other precautions that need to be taken.
Introduction For more than 50 years, physicians worldwide have relied on antibiotics for rapid and effective management of many of the most common infections.
Antibiotics have changed the way both doctors and the public perceive bacterial infections and their treatment. Doctors have been confronted with antibiotic resistance for as long as they have been using antibiotics (Stearns and Koella, 2008). Modern antibiotics basically began with penicillin. A British scientist discovered penicillin by the name of Alexander Fleming in 1928. It was not until 1942 that the British and Americans began mass-producing the drug. Its use became widespread during World War II, it became quite popular through its heavy public marketing.
During this time penicillin was widely thought of as a miracle drug. People were amazed at the ability of antibiotics to cure illnesses overnight that had previously been known to be fatal. But the thoughts of invincibility and miracles were short lived. Fleming himself warned early on that the drug required careful dosing and those bacteria mutate quickly in response to exposure. In 1945, when Alexander Fleming accepted his Nobel Prize, he warned of bacterial resistance. His main concerns were about misuse of the drug.
Specifically he worried about over prescription and under dosing. In the case of under dosing, a patient my not take enough of the drug to kill all the bacteria and the surviving ones become resistant and reproduce with a antibiotic resistant gene (Stivers, 2007). As expected by Fleming, reports of penicillin resistance came within a year, and by 1945, a British hospital reported that nearly 8% of staphylococcal isolates were resistant to penicillin. Four years later, almost 60% of British clinical isolates were penicillin-resistant.
Similar patterns occurred in the United States. And this is where a battle between antibiotic development and resistance evolution began (Stearns and Koella, 2008). Move forward just 30 years to the early 1970s, and antibiotic resistance had already come to be considered a real public health threat. Strains of bacteria that cause meningitis and ear infections in children, and a strain that caused gonorrhea, once again proved fatal. Both had previously been treated successfully with penicillin.
At present day, a little over 60 years since the beginning of large-scale antibiotic use, the problem of bacterial resistance to antibiotics is widely recognized as one of society’s biggest health threats. Bacterial resistance could pose a still larger problem soon because the manufacturing of new drugs has almost been at a standstill since 1968. Some theorists believe that we could be on the edge of an era where common illnesses, thought to be conquered already, could again be fatal. Today, illnesses caused by bacteria are more difficult and expensive to treat.
For all of these reasons the problem of bacterial resistance is seen a very serious health concern worldwide (Stivers, 2007). Human Contributors to Resistance What are the real reasons behind the problem of bacterial resistance to antibiotics? There is not really any clear-cut answer to this question but there are some known factors that do contribute to the problem. Some of these include the overuse of antibiotics in livestock, international travel that can spread resistant bacteria, and the biggest single factor across the globe appears to be the very problem of misuse that Fleming warned of in 1945.
Over prescription unnecessarily is still quite common today, and this is a primary contributor to the generation of bacterial resistance (Stivers, 2007). One environment where bacteria are regularly exposed to antibiotics is in large livestock operations, where producers very often treat their cows and other animals with drugs to prevent epidemics in the unsanitary and overcrowded conditions, which are common in the livestock industry. The simple reason for this is that in the short term it is cheaper to drug up the animals with antibiotics than to keep a clean living environment for them.
Another big reason for these producers to drug up the animals is the fact that feeding antibiotics to the livestock makes for larger animals. The problem occurs when bacteria in these animals survive the bombardment of antibiotics, and some always do, the surviving bacteria are highly resistant to antibiotics. And then finally what happens is, humans get infected with these resistant bacteria by either eating some undercooked meat or any other possible way of indirect infection (Walters, 2003). As stated before the primary contributor to the problem of resistant bacteria is over prescription of antibiotics.
One thing that should be made clear about antibiotics, they will only treat bacterial infections, not viral infections. Research suggests that 89% to 97% of U. S. doctors do understand the relationship between viral infections and antibiotics, so the question still stands as to why doctors continue to overprescribe antibiotics in the face of the antibiotic resistance problem. One answer to this question that researchers have found is that a doctors’ perceptions of patients’ expectations for antibiotics have a significant effect on whether doctors prescribe antibiotics or not. In one study there was a 25. % increase in the likelihood that the physician would prescribe an antibiotic if he or she perceived that the patient expected it. One factor contributing to these patients’ expectations is advertising. Advertising is encouraging patients to ask about medication and physicians are likely to prescribe or consider prescribing a drug requested by a patient (Stivers, 2007). This misuse of drugs is a serious issue and needs to be taken seriously. Antibiotic misuse is not like most types of medical errors in that it is an error that has much greater social impact than individual impact.
As Avorn and Solomon said, “Antibiotics are the only drug class whose use influences not just the patient being treated but the entire ecosystem in which he or she lives, with potentially profound consequences. ” Biology of Resistance Now to discuss the biological aspect of how these bacteria are actually evolving to become resistant to our antibiotics. Three main ways that bacteria are able to become resistant are mutation, transfer of genetic material, and selection of resistant species. Resistance in species that were previously sensitive to antibiotics can arise through mutations.
A mutation can be defined as random and spontaneous genetic change. Antibiotics do not cause mutations to occur, but their frequent use can generate an intense pressure for the selection of resistant mutated bacteria that evolve naturally. This selection of naturally resistant bacteria can be considered an extreme form of Darwinian evolution. The short generation time for bacterial replication mean that this “survival of the fittest” may take place within the time period that a patient receives one course of antibiotic treatment.
The rapid emergence of mutational resistance can greatly and quickly reduce the effectiveness of an antibiotic (Galley, 2001). Transfer of genetic material is also a source of bacterial resistance to antibiotics. Bacteria can obtain genetic resistance material from other bacteria, either as plasmids, which are loops of non-chromosomal DNA, or as chromosomal inserts. Chromosomal inserts include transposons, which are sticky ended sections of DNA able to jump from one DNA molecule to another, and genes transferred by viruses that infect bacteria, called bacteriophages.
A few species can also absorb and incorporate fragments of DNA released from dead cells of related species. These fragments then combine with existing genetic material to form “mosaic” genes. This is the basis of penicillin resistance in certain bacteria (Galley, 2001). The third cause of bacterial resistance is the selection of resistant bacteria species. This is the phenomenon many people are familiar with, Charles Darwin’s theory of natural selection. With natural selection comes the idea of “survival of the fittest”. Bacteria that are frequently challenged by antibiotics in a way become used to their presence.
Just as every human is different, so are most individual bacteria. And just as some people seem more “fit” and resistant than others to a particular illness, so are some bacteria better equipped and more “fit” than others to survive in certain environments. When the immediate environment is loaded with bacteria killing antibiotics, the vast majority of bacteria will die, but some of the better suited “fit” ones will survive. The surviving bacteria form the basis for the next generation and will pass their traits to their offspring. As a result, more bacteria in the next generation will survive exposure to the same antibiotic.
Through the process of natural selection, with continual exposure to drugs, each generation grows more resistant (Walters, 2003). Solutions For such a serious and large-scale issue there must be some possible solutions being looked into. One of these possible solutions to help in slowing down the resistance process is antibiotic rotation or cycling. It has been speculated that antibiotic cycling, in which drugs are rotated on a regular scheduled basis, may be an effective way to slow down resistance evolution and spread of bacteria.
The logic behind this is that by confronting bacteria with a changing environment, their ability to adapt to the environmental conditions and evolve to them may be reduced. Unfortunately research shows that this drug cycling has been less than effective (Stearns and Koella, 2008). Helen Galley states that, “Rapid removal of selection pressure may result in reversion to sensitivity, but this is likely to take longer than the original process of resistance” (2001). It is almost certain that there is an association between antibiotic use and the development of resistance.
Given the recent escalation in resistance and the evidence of unnecessary antibiotic use, the most reasonable approach to the control of antibiotic resistance is to control antibiotic use. The important question is how, but much research is still needed. It is most likely that limiting antibiotic prescribing along with advances in microbiology, and not conscious antibiotic cycling, is the way toward limiting antibiotic resistance (Stearns and Koella, 2008). Conclusion
Antibiotic resistance is a serious issue that could possibly become even more threatening as time goes on. It as issue that needs to be looked at by not only the scientific world but also the general public, because it is the only way anything effective will be accomplished against bacterial resistance. We know how bacteria’s resistance evolves and we know what human factors contribute to their evolution of resistance. Everything now must be put into place and put into action so that this potentially dangerous issue does not get to a place that we do not want to see.
Cite this Antibiotic Resistance
Antibiotic Resistance. (2016, Oct 15). Retrieved from https://graduateway.com/antibiotic-resistance-2/