We’ve all likely been exposed to antibiotics at some point in our lives, whether it was utilized for a mild infection like strep throat or something more life-threatening. When researcher Alexander Fleming found a fungus contaminating his research and killing the bacteria in his petri dishes, he accidentally stumbled upon one of the first antibiotics: penicillin. The discovery of penicillin marked the “golden era” of antibiotic research and usage — we finally had a way to fight the microscopic menaces that had been killing us for centuries.

Antibiotics and AMR

Antibiotics are prescribed chemical agents for treating bacterial infections in humans and animals. They are derived from chemical compounds produced by bacteria that can kill or slow the growth of other microbes in their vicinity to gain a fitness advantage over their biological competitors. Charles Darwin’s theory of evolution explains this: the microbes best adapted to survive their environment are naturally selected for — something he terms the ‘survival of the fittest.’ Microbes’ production of antibiotic agents is an evolutionary process. Sometimes, the target bacteria of an antibiotic resist and continue to grow and change in their presence. 

Mutations — distortions in bacterial genetic material — can cause bacteria to acquire proteins that pump the antibiotic out of their cells, develop a protective biofilm around them, or even produce enzymes that break the antibiotic drugs down. 

These mechanisms are the basis of antibiotic resistance — or more broadly, antimicrobial resistance (AMR). This includes resistant bacteria, viruses, and fungi, among other microbes. These infection-causing bacteria or microbes are no longer susceptible to the antimicrobial agent. These resistant bacteria or “superbugs” cause “resistant infections,” which can be difficult and sometimes impossible to treat. Oftentimes, these infections can become fatal.

Some of the superbugs of our times are methicillin-resistant Staphylococcus aureus and drug-resistant tuberculosis. The problem with these drug-resistant strains of bacteria is that we’re back to square one. We’re quickly running out of antibiotics to treat resistant infections and the production of new antibiotics is slow and insufficient to keep up with the rising antibiotic resistance.

What are the concerns?

With microbial resistance rates rising rapidly and a lack of new antibiotics, AMR has emerged to be one of the greatest global health concerns in the twenty-first century. AMR has killed 1.27 million people worldwide and is estimated to result in 10 million deaths by 2050.

It even has a massive economic cost. The World Health Organization (WHO) estimates a global GDP loss of one to three trillion USD per year by 2030 due to increased healthcare costs owing to AMR. This threat is quite real, imminent, and transcends international boundaries.

Scientists and healthcare practitioners are working hard to determine the drivers and contributors of AMR and gather evidence for practices that can slow the development of further resistance. In the Canadian Medical Association Journal podcast, medical professionals tackle emerging trends in medical practice. In its January 13 episode, UHN staff emergency physician Dr. Maria Ivankovic noted that long and routine courses of antibiotics — which were thought to prevent AMR — are actually the drivers of microbial resistance rates. In short, the longer an antibiotic is in use, the more time the infecting bacteria has to adapt and grow resistant. 

There are also systemic practices propagating this ‘silent pandemic.’ Poor regulation of antimicrobial prescription practices by health regulatory bodies in various parts of the world breeds misuse of these limited resources. Additionally, very little has been done over the years to implement a comprehensive monitoring protocol for keeping track of resistant bacteria and the healthcare settings in which they emerge. 

Some researchers are now advocating for prescribing shorter courses of antibiotics, but they warn that there are exceptions to the ‘shorter is better’ rule. For instance, there is evidence that inner ear infections in children under two years have better cure rates with a 10-day course of the relevant antibiotic than five days. 

The WHO believes that the way forward is universal access to quality diagnostics and treatments, as well as increased efforts into research and development directed at novel antimicrobial therapies and vaccines. Furthermore, the Global AMR Research and Development Hub advocates for a “One Health Framework” involving a collaboration of diverse stakeholders: veterinarians, healthcare professionals, environmental scientists, and policymakers, among others. 

What can we do about AMR? The next time your doctor advises against antibiotics for your common cold, know they might be trying to prevent tiny superbugs from taking over the world! It is time to educate ourselves, take greater precautions to prevent infection, and advocate for judicious and appropriate antibiotic use. Most common colds are viral and should be treated with antiviral medicine or over-the-counter painkillers instead of prescription antibiotics.