Antimicrobial Resistance and their Effects

Antimicrobial Resistance is very important topic for government exams. We are going to discuss antimicrobial resistance in detail so that aspirants get conceptual clarity about the topic and they will be able to solve questions coming from this topic.

Antimicrobial Resistance:

• Antibiotics also include antivirals, antifungals, and antiparasitics.
  
• WHO defines antimicrobial (antibiotic, antiviral, antimalarial) resistance as the resistance of an organism to antibiotics after the infection caused by that organism can be treated.  
  
• For example, in multidrug-resistant tuberculosis (MDR-TB), Mycobacterium tuberculosis is resistant to her two major tuberculosis drugs, isoniazid (INH) and rifampicin (RMP).  
  
• Artemisinin-based combination therapy (ACT) is the recommended first-line treatment for uncomplicated Plasmodium falciparum and is used in most malaria-endemic countries.   Partial artemisinin resistance has been identified in Southeast Asia.

Main Causes of Antimicrobial Resistance:

• Antibiotic resistance occurs when bacteria, viruses, fungi, and parasites change over time and become unresponsive to drugs. They become Super Bugs and become resistant to drugs that would normally destroy them.
  
• Microorganisms can acquire resistance mainly in two ways, 

  Intrinsic resistance – The ability of an organism to resist a class of antimicrobial agents. Intrinsic antimicrobial resistance (AMR) occurs spontaneously over time, usually through genetic alterations. 

  Acquired resistance – Microorganisms4 acquire genes that code for resistance (genetic mutation). Acquired resistance is more common than specific resistance.

• Overuse, and inappropriate use of antibiotics (such as taking antibiotics to treat viral illness).
  
• Better access to commercial antibiotics in developing countries.
  
• The use of broad-spectrum and narrow-spectrum antibiotics (which target only specific microorganisms).
  
• Dumping of improperly treated wastewater from the pharmaceutical industry. Use of low-dose antibiotics in livestock feed to promote growth in developed countries.
  
• Poor hygiene necessitates the widespread use of antimicrobials.

Major Concerns related to Antimicrobial Resistance:

• Drug resistance makes some diseases increasingly difficult or impossible to treat.
  
• Treatment of resistant organisms requires alternative or high-dose drugs (expensive and toxic). In 2016, up to 490,000 people worldwide contracted multidrug-resistant tuberculosis.
  
• Drug resistance is beginning to complicate the fight against HIV and malaria.
  
• Without effective antibiotics, organ transplantation, chemotherapy, and surgery are jeopardized. Medical interventions such as surgery have become more dangerous.
  
• Antimicrobial resistance increases health care costs through longer hospital stays, additional testing, and the use of more expensive drugs.
  
• This could eventually lead to an antibiotic apocalypse. In the future without antibiotics, bacteria could become completely resistant to treatment, and frequent infections and minor injuries could again be deadly.

Why Antibodies are more effective on bacterial infections than viral infections?

Taxonomically, all bacteria are more closely related to each other than to viruses and vice versa. This means that many important life processes are similar in bacterial groups but not shared with viral groups. As a result, a drug that blocks any of these life processes in one group member may act on many other members. However, the same drug does not work against microorganisms belonging to different groups. Take antibiotics for example. They often block important biochemical pathways for bacteria. For example, many bacteria build cell walls to protect themselves. The antibiotic penicillin blocks the bacterial process of building cell walls. As a result, the growing bacteria can no longer form cell walls and easily die. In any case, human cells do not form cell walls, so penicillin cannot have such an effect on us. Similarly, many antibiotics act against many types of bacteria, not just one group. However, viruses do not use any of these pathways, so antibiotics are ineffective against viral infections. If you have a cold, taking antibiotics will not reduce the severity or duration of your illness. However, if you have a bacterial infection in addition to a viral cold, taking antibiotics can help. Still, antibiotics only work against the bacterial part of the infection, not the viral infection.

Measures Taken Against Antimicrobial Resistance:

A. Global Efforts:

1. Global Antimicrobial Resistance Action Plan (GAP)
Countries around the world committed to the framework set out in the 2015 Global Action Plan (GAP) on AMR during the 2015 World Health Assembly.
The States are required to develop and implement national action plans to combat microbial resistance.

2. Tripartite Secretariat
A tripartite secretariat (FAO, World Organization for Animal Health (OIE), and WHO) will be established in 2016.
This is intended to promote multi-stakeholder involvement in AMR.

3. World Antimicrobial Awareness Week (WAAW)
Held every year since 2015. This is a global campaign aimed at raising awareness of antimicrobial resistance around the world.

4. Global Antimicrobial Resistance and Use Surveillance System
Launched by WHO in 2015, it continues to fill knowledge gaps and inform strategies at all levels. It is designed to progressively incorporate data from antimicrobial resistance investigations in humans, pharmaceuticals, the food chain, and the environment.

5. Global R&D priorities for AMR
To guide the research and development of new antimicrobials, diagnostics, and vaccines, WHO produced its WHO list of priority pathogens in 2017. It will be updated in 2022.  Global Antibiotic Research and Development Partnership (GARDP)

6. A joint initiative of WHO and the Drugs for Neglected Diseases Initiative
The partnership aims to develop and deliver five new therapies by 2025 that target drug-resistant bacteria identified by WHO as the greatest threat.

B. By India:

• India has launched a national action plan to combat antimicrobial resistance.
  
• The 2017 National Health Policy highlights the problem of antibiotic resistance and calls for effective measures to combat it.
  Since 2014, another Schedule H-1 has been included in the Pharmaceuticals and Cosmetics Regulations, regulating the sale of antimicrobials in the country.
  
• The Redline Campaign was launched by the Ministry of Health. It urged people not to use drugs marked with a red vertical line without a prescription.
  
• The Food Safety and Standards Authority of India (FSSAI) has banned the use of antibiotics and some pharmacologically active substances in fisheries. The Department of Health and Family Welfare prohibits the manufacture, sale, or distribution of colistin and colistin formulations for food animals, poultry, aquaculture, and animal feed additives. The move is a “big win” for the movement against antimicrobial resistance.
  
• National action plans to combat antimicrobial resistance are aligned with the World Health Organization’s Global Action Plan (GAP) against AMR.
  
• The plan highlights the need to address her AMR in multiple areas such as human health, animal husbandry, agriculture, and the environment, considering the One Health approach.