Who is to Blame for the Rise in Antimicrobial Resistance?

A couple of days ago Keiji Fukuda, Assistant Director-General for Health Security in the World Health Organisation (WHO), sounded a general alarm with the publication of a working paper entitled Antimicrobial resistance: Global report on surveillance. In his statement, Dr Fukuda warned that “without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill”.

It is well known that resistance to antibiotics has been increasing steadily in recent decades. While the situation is already a cause for grave concern, there is still time to try to reduce bacterial resistance to antibiotics, but any such effort would need to involve the coordinated action of all those involved. We might ask how we got into this situation and who is to blame.

Bacteria adapt to an antibiotic environment by way of a Darwinian process. They can acquire resistance during cell replication as a result of mutations in certain genes that cause them to express proteins associated with resistance. When this occurs, the mutated microorganism acquires resistance to the antibiotic and can survive in an environment in which susceptible bacteria are eliminated. This mechanism is known as selective pressure. Bacteria can also acquire resistant genes through the transfer of genetic material from one bacterium to another. The bacteria that supply the resistant genes in such cases are usually environmental bacteria that have a significant resistance gene pool. Consequently, the use and abuse of antibiotics leads to the selection of resistant strains, and this is where we should look for the culprits responsible for the current situation. A number of factors are involved in the misuse and overuse of antibiotics :

Illegal Use. Although the use of antibiotics to promote animal growth is illegal, they have, for a long time, been used as a growth factor and added to animal feed. Resistant bacteria from animal sources can obviously be transmitted to humans and cause infections.

Inequality. Many developing countries lack the infrastructure needed to make accurate microbiological diagnoses and to identify the antibiotic most appropriate for use in each case. As a result, any available antibiotic is often administered and this usually means the cheapest one. The situation is further exacerbated by the fact that in these countries antibiotics are sold not only in pharmacies but also in other shops and in markets, and furthermore the drugs sold in these channels are usually out of date or low strength. The resistant bacteria that emerge in these countries can spread to our country by way of travellers and contaminated food.

Social pressure. Some primary care physicians give in to patient pressure and prescribe antibiotics for a sore throat that is probably viral in origin. But it is important to remember that antibiotics are ineffective against viruses.

Disinformation or disregard of information. The Ministry of Health regularly runs public campaigns to promote the rational use of antibiotics. Among other recommendations, these campaigns emphasise that antibiotics should be used only when prescribed by a doctor and that patients should carefully adhere to the prescribed dose and regimen.

The profit motive driving pharmaceutical policy. The pharmaceutical industry finds it more profitable to develop drugs to treat chronic diseases than to develop antibiotics that are used for only a short period in each patient. Moreover, any antibiotic will over time lose its efficacy against the target bacteria, which will eventually become resistant.

Government neglect of the issue. Governments are not supporting research in this field. On the positive side it is true that in recent years the European Union has started to provide funding for research into new antibiotics, but it may perhaps be a little late to save the situation.

The logical answer to our question is therefore that WE ARE ALL TO BLAME.

Post by Jordi Vila Estapé, Director of the ISGlobal Antibiotic Resistance Initiative. Head of the Department of Clinical Microbiology at the Hospital Clínic and professor at the University of Barcelona in the Faculty of Medicine.

More information

Infographic: 7 facts on Antibiotic Resistance

Initiative: Antibiotic Resistance

[This post was published simultaneously in the El País blog 3.500 millones]