Antibiotics and antifungals are the wonder drugs of the 20th and 21st century, but what happens when the germs they fight start fighting back? Antimicrobial resistance (AMR) is exactly that: germs like bacteria, fungi, protozoa, parasites, and viruses fighting back.
Understanding Antimicrobial Resistance
To understand AMR, we need to delve into the mind of a pathogen, or a harmful germ that causes infection (most germs are actually harmless). Of course, most germs are minute single-cell organisms without a mind, but that doesn’t stop them from adapting. And with the widespread use of antibiotics, germs have been incentivized to adapt to survive.
When antibiotics are used—especially too much or incorrectly—they put tremendous selective pressure on common germs. That means while most of the germs are killed, the few that happen to survive are able to grow and multiply. Over time, these successfully resistant strains become more common, leading to infections that are harder, and sometimes impossible, to treat with existing drugs. The more we use antibiotics recklessly, the more we tip the balance in favor of these resistant germs.
Antimicrobial resistance not only impacts personal health—it’s an emerging international danger. Resistant infections can result in extended hospital stays, increased medical expenses, and even death, claiming 1.27 million lives worldwide in 2019. To battle AMR, it’s important to utilize antibiotics sensibly, invest in the development of new drugs, and enhance infection prevention measures. Learning about how germs adapt enables us to remain a step ahead in safeguarding public health.
How it Happened
There is no one reason or person at faultm but just to put the problem into perspective; according to the Centers for Disease Control (CDC), in 2022, the US prescribed a whopping 236.4 million antibiotic prescriptions, and those are only the pills dispensed in an outpatient setting, not accounting for antibiotics used in hospitals, often for more serious conditions.
Numbers vary on how many people are prescribed antibiotics who don’t actually need them, with the CDC citing 28%, and other estimates anywhere from 1 in 3 to 1 in 7. The point is it’s high, too high, and isn’t coming down anytime soon.
So why are antibiotics so overprescribed? It’s not like they’re good-time drugs of abuse like OxyContin or Adderall. Well, the poor old family doctor is at least partially culpable, as they prescribe well over half of all antibiotics.
But it takes two to tango; we need an informed public that does not push prescribers for antibiotics, and increased focus from healthcare workers to approach antibiotics and antifungals with AMR in mind. That’s why new nurses training under BSN to DNP programs online, as well as doctors, assistants, and other critical healthcare staff, need to be educated on the challenge AMR poses.
The Impact of AMR
The aforementioned global mortality rate is high, higher than malaria, HIV, Tuberculosis, and many other common ailments. To make it worse, current projections only show the mortality rate to rise, and steadily.
But why is microbial resistance so fatal? To understand that, many of us will have to see the common cold or a bad flu season in a different light. Imagine going to the doctor with a chest infection and being told there are no antibiotics that can treat your particular strain. Or your kid has an ear infection that would normally clear up with a short course of antibiotics, which unfortunately no longer work, resulting in potential hospitalization and more risky second-line treatments.
When the Backup Becomes the Treatment
That is really the crux of it–if a range of diseases become untreatable by antibiotics and antifungals, the current second resort becomes the only option. Take Colistin and Amikacin, two drugs that are used to treat what are known as “resistant gram-negative bacterial infections,” or infections caused by bacteria that are known to develop resistance to antibiotics. The problem with both of these drugs is their harsh side effects, which can cause neurotoxicity and kidney problems.
Luckily, it’s not all doom and gloom, there are some great new developments that give hope in the battle against AMR. Researchers are looking into cutting-edge strategies like phage therapy, an alternative to antibiotics that uses viruses (the “good” kind) to target the “bad” kind, in order to eradicate resistant strains.
Overcoming AMR: A Global Effort
Another promising field is synthetic biology, where researchers are creating brand-new antibiotics from the ground up or altering preexisting ones to get around resistance mechanisms. Rapid diagnostic tools are also being developed to help prescribers rapidly determine whether or not an infection is bacterial or viral, thereby reducing the number of unnecessary prescriptions and leaving less room for error.
At the end of the day, germs do not care about borders, so it will take a global effort to face AMR. As is so often the case in healthcare, it will take time for novel treatment and cutting-edge research to make it to the poorer nations that need help more than ever. But progress is happening. Public education campaigns are gaining momentum, helping people understand that not every cough or fever needs antibiotics. New scientific breakthroughs coupled with an educated workforce and public will help us to turn the tide.