How can antibiotic resistance occur

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To receive email updates about this page, enter your email address: Email Address. What's this? Links with this icon indicate that you are leaving the CDC website. This may have simply moved the selection pressure for the development of resistance from the cephalosporins and fluoroquinolones to these antibiotics instead. Antibiotic resistance in Neisseria gonorrhoeae has increased over the years leading to abandonment of traditional treatment regimens using penicillin, followed by those using ciprofloxacin and other fluoroquinolones.

The major emerging resistance issue in many countries is among Gram negative bacteria, particularly Enterobacteriaceae, P.

Between and , E. Tuberculosis is another example of a disease caused by an organism that has gradually developed resistance over time. Multidrug-resistant MDR tuberculosis i. Mycobacterium tuberculosis resistant to at least rifampicin plus isoniazid emerged in the s, whilst extensively drug resistant [XDR—resistant to isoniazid and rifampicin, any fluoroquinolone, and at least one of the three injectable second-line drugs amikacin, capreomycin or kanamycin ] subsequently emerged.

Antibiotic resistance is an international concern. Broadly, interventions can be categorized into two main approaches.

Firstly, there are strategies aimed at protecting the existing antibiotics and preventing the emergence and spread of further resistance. Then, there are strategies aimed at reinvigorating drug development and bringing new antibiotics to market.

Alternatives to current antibiotic therapy also need to be assessed, either through the development of new drug classes or through the use of vaccines or other therapeutic strategies.

Globally, the resistance problem has been recognized for many years. The WHO has held meetings, consultations and workshops since The WHO's first World Health Assembly on antibiotic resistance was held in where member states were urged to take action. WHO also targets the veterinary and food sectors by publishing booklets on antibiotics for a food safety perspective, running national and sub-regional workshops and creating an advisory group on integrated surveillance.

The World Health Assembly may be a forum through which international collaboration can be facilitated. Most countries have strategies that are based on governance, surveillance, infection prevention and control, regulation, international engagement, communication and research. Effective antibiotic stewardship is required globally, together with better diagnostic tests to identify or rule out infection quickly.

Several international groups and societies have been established to tackle antibiotic resistance. In , the British Society of Antibiotic Chemotherapy BSAC convened a working party to consider issues relating to the lack of antibiotic discovery and development. It suggested increased funding to support antibiotic research and development and promoted the establishment of a BSAC Chair of Public Engagement in order to increase the public and political awareness of antibiotic resistance and promote dialogue.

In India, the Chennai Declaration aimed to tackle the challenge of antibiotic resistance in a developing nation. There were no restrictions in purchasing antibiotics and no standardized infection control practices.

The first meeting laid out a roadmap for tackling antibiotic resistance. It managed to create awareness among policymakers and the highest authorities on the need of effective antibiotic policies in India. More than hospitals in 14 countries participate.

The first UK strategy against antimicrobial resistance was published over a decade ago and aimed to improve antibiotic prescribing practice and increase funding for drug discovery programmes and research. Some have argued that its impact was limited. Its main objectives were to improve the knowledge and understanding of antibiotic resistance, to conserve and steward the effectiveness of current antibiotics and stimulate the development of new agents, diagnostics and novel therapies.

In the strategy and her annual report, published in February , the Chief Medical Officer in England recommended that antibiotic resistance be placed on the national risk register. Seven key priorities were outlined: Optimizing antibiotic prescribing has been targeted in both community and hospital settings. Antibiotic stewardship programmes aim to ensure the effective treatment of patients with infection whilst minimizing collateral damage from antimicrobial use.

Education, audit, guidelines and policies, IV to oral conversion and appropriate de-escalation are all potential elements. These interventions to reduce excessive antibiotic prescribing in hospital inpatients can reduce antimicrobial resistance, hospital-acquired infections and can improve clinical outcomes. Antibiotic cycling or rotating i. The goal of antibiotic cycling or rotation is a sustainable decline or stabilization in antimicrobial resistance through successive, prospective alterations in antibiotic selection pressures that prevent the selection of specific resistance mechanisms.

Abel Zur Wiesch et al. In the UK, a number of tools are available to support antimicrobial stewardship in primary care. In , the Health Protection Agency established a multiagency collaboration to improve antimicrobial prescribing in primary care.

From this, epidemiological data collections and primary care-directed guidelines were produced e. This programme was introduced in England in but was updated in as an evidence-based toolkit for hospitals and explains the importance of antimicrobial stewardship for treatment and prophylaxis. Biomarkers such as C reactive protein CRP or procalcitonin can potentially reduce unnecessary antibiotic use.

Automated susceptibility testing also has the potential to deliver results more quickly. The need for new antibiotics was illustrated in the TUN report. In addition, increasing levels of bureaucracy and lack of clarity within regulatory frameworks and variation in the clinical trials process in different countries hinder the development of new agents. Several antimicrobials have failed to reach the market at this final hurdle. Lack of international harmonization, continual changes to processes and ineffective pathways for dialogue between organizations, industry and regulators are all significant deterrents to the research and development of new antibiotics.

However, it is clear that there is now political engagement with this issue and many initiatives are now ongoing around the world. A number of novel approaches to reinvigorate antibiotic development have been proposed. Public—private partnerships could be set up to mitigate the up-front costs of drug discovery. Orphan drug legislation could help address the issue of needing large numbers of patients in clinical trials, thus shortening the length of a trial.

Other examples laid out in the English Chief Medical Officer's Annual Report to foster research and development of new drugs include research-related tax incentives, patent buyouts, health impact funds and funding of translational research. This provided a pay-out at the end of the development process with 5 years of guaranteed market exclusivity and priority review for antibiotics that target certain qualifying pathogens.

It is due to produce a final report in , but the initial findings have been published and include a proposal to set up a global antimicrobial resistance innovation fund to boost the number of early research ideas, ensuring that existing drugs are used appropriately, improving the use of diagnostics wherever they can make a difference, attracting and retaining a high-calibre skills base and modernizing the surveillance of drug resistance globally.

The relentless rise in antibiotic resistance is a major public health concern, which will need to be acted upon now. We might not be able to stop antibiotic resistance or, in many cases, reverse the trend to ever-increasing resistance, but we certainly need to contain the speed to which this is happening.

No single action or initiative by a single country would be able to achieve this. It requires participation and support from all levels; political, medical, veterinary, agricultural, environmental, academic, industry and the general public.

It is clear that there is political engagement with this issue and many different bodies are considering potential options to tackle it. However, it remains to be seen if activities can be sufficiently coordinated worldwide to effect a change in the situation. Conly J , Johnston B. Where are all the new antibiotics? The new antibiotic paradox. Google Scholar. Livermore DM. Has the era of untreatable infections arrived?

J Antimicrob Chemother ; 64 Suppl 1 : i29 — Department of Health. Annual Report of the Chief Medical Officer. Volume 2. Infections and the Rise of Antimicrobial Resistance.

Department of Health , Livermore D. Can better prescribing turn the tide of resistance? Nat Rev Microbiol ; 2 : 73 — 8. ECDC: The bacterial challenge: time to react. Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States , Infectious Diseases Society of America. Clin Infect Dis ; 50 : — 3.

Nursing homes as a reservoir of extended-spectrum beta-lactamase ESBL -producing ciprofloxacin-resistant Escherichia coli. Salmonella are a group of bacteria that cause a wide spectrum of diseases. They are able to cause significant morbidity, and in some case, mortality, in both humans and animals. Tuberculosis is a disease caused by a bacterium that mainly affects the lungs to cause a persistent and, occasionally bloody, cough. This animation shows how bacteria exchange genes on small pieces of DNA called plasmids through a process called horizontal gene transfer.

If you have any other comments or suggestions, please let us know at comment yourgenome. Can you spare minutes to tell us what you think of this website? Open survey. In: Facts Targeting Disease. What are antibiotics? Antibiotics are medicines used to treat or prevent infections caused by bacteria. They work by inhibiting the growth of or destroying the bacteria. They do this in various ways, such as destroying the bacterial cell wall or inhibiting the generation of energy from glucose within the bacterial cell.

What is antibiotic resistance? Antibiotic resistance occurs when bacteria develop the ability to survive exposure to antibiotics that were designed to kill them or stop their growth. Antibiotic resistant bacteria are free to grow, multiply and cause infection within the host even when exposed to antibiotics.

Antibiotic resistance is a major obstacle in the treatment of infectious diseases caused by bacteria.