Antimicrobial resistance (AMR)

It is time to look at antibiotics as a global public good, which are getting increasingly ineffective in killing the microbes, and lead to some 5 million deaths in 2019.
This silent pandemic of antimicrobial resistance (AMR) is caused by overuse and misuse of antibiotics, which has made pathogens mutate and build defence mechanisms against these drugs.

Historical Background:

The post-Second World War saw mass production of penicillin — the first antibiotic, discovered in 1928 — and the world’s dependence on this line of medicines grew substantially. More discoveries were made in the decades that followed.
By the 1980s, there were no discoveries of novel classes of antimicrobials, and focus was shifted to reformulation of the same classes of drugs against which bacteria can develop resistance easily.
The problem is compounded because there are ‘priority pathogens’, sub-categorised into ‘critical’, ‘high’ and ‘medium’, as classified by the World Health Organization (WHO).
Most of these priority pathogens are Gram-negative bacteria that have complex cell walls and cause some of the worst infections in the world, including pneumonia.

What is antimicrobial resistance?

AMR occurs when the microorganisms which cause disease (including bacteria, viruses, fungi and parasites) are no longer affected by antimicrobial medicines such as antibiotics, antivirals, antifungals and antiparasitics that we use to kill them, prevent and treat the disease.

While resistance is a natural phenomenon and not just a health issue, from a human healthcare perspective it is accelerated by:

inappropriate use of antimicrobial drugs
poor infection prevention and control practices
a lack of new antimicrobial drugs being developed
insufficient global surveillance of infection rates.

What is needed from a healthcare perspective to tackle resistance?

early prevention of infections
timely, accurate diagnosis
appropriate prescribing and use of antimicrobials only when there is an infection for which they are the most appropriate treatment
effective management of infections
development of alternatives to current antimicrobials.

Concerns:

Major pharmaceutical companies in the business of research, development and discoveries are opting out of this line of antibiotic medicines.
It would mean that in the years to come we are in for a triple jeopardy:

The antibiotics we know today would be increasingly ineffective;
There would be no new antibiotics available; and,
There would be a critical need for access to these medicines for all.

As per WHO, 80% of the pre-clinical novel drug finds are in businesses with less than 50 employees. But as the drug moves up the ladder, the costs of development increase, and innovation falls through the cracks.

Way ahead:

We need new classes of antibiotics to address priority pathogens and to be accessible to people across the world.
Recently, the G-7 countries incentivise companies to invest in novel antibiotics has two imperatives:

Their usage has to be limited and must be conserved. Misuse and overuse is creating the problem of AMR.
Access to these antibiotics is to be ensured and will have to be affordable.

So, it is time to look at antibiotics as a global public good. This would perhaps mean new taxes — on profits of pharmaceutical firms — and creation of conditions that ensure public research is used for common good.

MCQs about Antimicrobial resistance (AMR)

Question 1: What is the main cause of antimicrobial resistance (AMR)?

a) Lack of global surveillance of infection rates

b) Inaccurate diagnosis of infections

c) Overuse and misuse of antimicrobial medicines

d) Natural mutation of microorganisms

Question 2: Which type of bacteria, as classified by the World Health Organization, are categorized as priority pathogens causing some of the worst infections?

a) Gram-positive bacteria

b) Gram-negative bacteria

c) Anaerobic bacteria

d) Viruses

Question 3: What is the potential triple jeopardy highlighted in the article?

a) Lack of access to antibiotics

b) Decreasing effectiveness of known antibiotics, absence of new antibiotics, and limited access

c) Development of resistance against antibiotics

d) Inaccurate diagnosis of infections

Question 4: According to the article, what is needed to tackle antimicrobial resistance from a healthcare perspective?

a) Overuse of antimicrobials

b) Inaccurate diagnosis of infections