Commercially available since 1945, antibiotics were a medical marvel during their introduction. Over the past 60 years, they’ve curbed the rate of infectious disease and are commonly credited with the rise in life expectancy (1). In the modern world, however, antibiotics have been taken for granted, and the threat of a society with rampant antimicrobial resistance looms in the distance. In a publication released earlier this month by the World Health Organization (WHO), entitled “The Evolving Threat of Antimicrobial Resistance: Options for Action”, health officials raise alarming concerns about the future of modern medicine in a post-antibiotic world. Antimicrobial resistance, while not a new issue, presents a global health threat if worldwide action is not initiated soon. As Dr. Margaret Chan, director general of the WHO, warns, “Things as common as strep throat or a child’s scratched knee could once again kill” (2).
Antimicrobial resistance (AMR) occurs through gene action in bacteria in one of three ways: spontaneous mutation (e.g. Drug-resistance tuberculosis), transformation by taking DNA from another bacterium (e.g. Penicillin-resistant gonorrhea), or in the most serious of cases, when a small circle of DNA moves quickly from one type of bacterium to another providing a variety of different resistances (1968 Shigella diarrhea epidemic in Guatemala) (3). This process of AMR is brought about by many different factors, but most notably by overprescription and overuse in food industries, such as the meat industry.
The issue of overprescription appears to be a large oversight in the training of medical professionals that can prescribe antibiotics. Recently, the University of Zambia School of Medicine revised its curriculum to include the topics of AMR and the rational use of medicines. As a future physician, it will be interesting to see if any steps are taken in the United States to curb this problem. There also seems to be a lack of information available to the public regarding the proper use of antibiotics. The success in Thailand through their “Antibiotic Smart Use” program have highlighted the need for such information. There was an 18-46% decrease in use through the combined effects of a reduction in prescription and demand by patients (4). The idea of quick fix for an ailment overrides the concern of whether the illness is viral or bacterial in nature, so as the case of Thailand’s program demonstrated, the public needs to be made more aware of the grave dangers that could result if this type of behavior is carried on.
While education is necessary to prevent overprescription and overuse, without concurrent pressure on organizations such as the FDA to reduce antibiotic use in animal products and agriculture, efforts to prevent AMR will be futile. Increased regulation and surveillance will be required to ensure appropriate actions are being taken. And as a last ditch effort and fail safe, incentives should be provided to pharmaceutical companies that produce stronger and more effective antibiotics.