INTRODUCTION:
Antibiotics either cytotoxically or cytostatically destroy microorganisms, enabling the body's defense mechanisms, including the immune system, to eradicate them. Often, they function by preventing the formation of proteins, ribonucleic acid, deoxyribonucleic acid (DNA), and bacterial cells by an agent that disorganizes membranes, by acid (RNA), or by other particular methods 1. The energy-dependent transport mechanisms at ribosomal sites allow antibiotics to bind to bacteria and penetrate their cell walls, which in turn inhibits the protein synthesis 2. Antibiotics have surely been a blessing to human civilization, saving millions of lives by fighting against diseases and microorganisms [3]. There was a hopeful perception at the time that the spread of infectious diseases had almost completely stopped. Paul Ehrlich and Alexander Fleming were widely recognized as the founders of the modern "antibiotic era" 4. Antibiotics were taken into consideration. A miracle treatment that would not harm the host while specifically targeting the bacteria that caused the sickness. The first person to warn about the possibility of penicillin resistance if the drug is taken insufficiently or for an extended length of time was Fleming 4. It was therefore believed that the 1950s to 1970s marked the pinnacle of new scientific discoveries antibiotic classes 5. Since its inception sixty years ago, millions of metric tons of newer kinds of antibiotics have been created. The increased demand for antibiotics in various industries has made it possible to use medications off-label and at a lower cost. In contrast, as a result of the massive and careless usage of Antibiotics have been a major factor in the emergence of resistant strains 6. The emergence of resistant strains of bacteria was formerly directly correlated with the introduction of new antibiotics. Nonetheless, the current standard of care in the fight against these illnesses centers on altering already available medicines to counteract pathogen resistance that is constantly evolving and resurfacing worldwide 5. Antibiotic resistance is a serious concern since it can arise quickly 7. Since technology has advanced, more people are aware of the negative impacts of medication resistance; however, very few take proactive measures to reduce resistance by not taking antibiotics in excess 8. One of the main causes of resistance in the developing world is that practically all antibiotics are sold over-the-counter and without a prescription, making them easily accessible to the general public. Consequently, the only method to reduce antibiotic resistance is to educate patients and the wider public. The current review is one such method of educating the public by illustrating the emergence, potential future course of antibiotic resistance, and current policies aimed at mitigating the crisis of antibiotic resistance.
Origin of antibiotic resistance:
Antibiotic resistance has been described as happening when a medication can no longer effectively stop the growth of microorganisms. When therapeutic concentrations of antibiotics are present, bacteria develop a resistance and keep growing 9. When bacteria grow again, even when there is Resistance bacteria are treated with antibiotics. Antibiotics are typically successful against them, but when the microorganisms develop resistance or reduced sensitivity, a larger concentration of the same medication is needed to produce a result. Soon after the introduction of novel antibacterial chemicals, the evolution of antimicrobial resistance was noted 10. Natural selection may lead to the emergence of antibiotic resistance, as all bacteria possess a certain level of low-level resistance [3]. One study, for instance, established that ampicillin, trimethoprim-sulfamethoxazole (TMP-SMZ), and Tetracycline, which was once widely used, is no longer useful in Thailand for treating diarrheal illnesses other than cholera 11. The same medications were shown to be beneficial in treating them at the same time in a different trial carried out in Bangladesh [12]. Actually, resistance to the infection was known to exist long before antibiotics were first used to treat it 13. Aminoglycoside-resistant strains of Staphylococcus aureus were created within six years of the aminoglycosides' manufacture 14. Initially released in Methicillin was the first semisynthetic penicillinase-resistant antibiotic to be used against strains of Staphylococcus aureus that produced penicillinase in 1961. However, it wasn't long before methicillin resistance was documented 15. Moreover, fluoroquinolone resistance later demonstrated that, despite the fact that these medications were initially approved in the 1980s to treat Gram-negative bacterial infections, they were also utilized to treat Gram-positive infections 16. Particularly in the methicillin-resistant bacteria, quinolone resistance surfaced as a progressive acquisition of chromosomal alterations [Figure 1]. Most recently, in 2002—44 years after Vancomycin was first introduced to the market—clinical isolates of Vancomycin-resistant Staphylococcus aureus (VRSA) were discovered 17. Antibiotic chemicals used in therapeutic settings are frequently same to those used in agriculture 18, and overuse of these compounds may to drug resistance. Antibiotic-resistant microorganisms are mostly transmitted between animal and human populations through the food chain 19. Antibiotic-resistant microbes may be present in certain developed countries due to the administration of antibiotics to animals through food, drink, or parenteral means 18. For instance, the addition of antibiotics to cattle feed to stimulate growth results in an increase in antibiotic resistance 20.
Development of antibiotic resistance:
Antibiotics strive to get rid of germs. Bacteria therefore frequently have an innate mechanism that promotes resistance. Gene-level mutations trigger the resistance mechanism. 21. Genes function in tandem with selection pressure, which is induced by antibiotics.22. The bacteria possess the ability to transmit genetic material directly to one another through plasmid transfers, indicating that resistance emerges through mechanisms other than natural selection. In hospitals, broad spectrum antibiotics are used to treat nosocomial infections; nevertheless, this practice develops resistance 16. Most bacteria in a colony can usually be eradicated by antibiotics. However, a separate population of bacteria with a genetic mutation might exist, and this could result in resistance 23. There was a substantial correlation observed between the prevalence of antibiotic-resistant illnesses and the quantity of antibiotics taken 24. Failure to complete the entire course of antibiotic therapy given by a doctor may also increase the likelihood of resistance developing. The bacteria then continue unaffected, growing more resilient to the antibiotics 20. Over time, bacteria have the potential to accumulate resistance characteristics and develop resistance to several antibiotic classes 25. For instance, chromosomal changes, inefficient aminoglycoside transport within the bacteria, and enzyme alteration have all been linked to resistance in Staphylococci 16. Not only can resistance to a single medication be selected by a single antibiotic. Resistance is possible. Along with additional structurally similar compounds from the same class. For instance, oxytetracycline, chlortetracycline, doxycycline, and minocycline resistance may result from tetracycline resistance 26. In order to protect their antimicrobial products, antibiotics have resistance genes, and these genes evolved long before the antibiotics were used for therapeutic purposes 27.
Consequence of antibiotic resistance:
Superbugs are defined as microbes resistant to antibiotics. These are becoming a global issue that is causing high fatality rates and potentially fatal infections, not just a problem in laboratories 28. The aftereffects of these illnesses worsen significantly in unstable environments like starvation, natural disasters, civil instability, and violence 29. In the event that we do not take action to combat antibiotic resistance, the World Health Organization (WHO) 29 has warned that a post-antibiotic age will bring about a high frequency of diseases and that minor injuries may become fatal. More deaths globally are being caused by multidrug-resistant microorganisms. Hospital-acquired bacterial infections cause over 63,000 deaths annually in the United States of America (USA) 30. In Europe, bacterial infections resistant to multiple drugs (MDR) cause an estimated 25,000 deaths annually 31. Nosocomial Staphylococcus aureus (S. Aureus) infections are a major problem in many nations due to clonal dissemination waves. Globally, strains of Methicillin-resistant Staphylococcus aureus (MRSA) are proliferating quickly 16. The distribution of antibiotics that may no longer be effective or lack regulatory permission has been common procedure for the majority of pharmaceutical corporations 1. Data indicates that Higher prevalence of resistant bacteria may be positively correlated with increasing antibiotic use, whereas lower rates of resistance were associated with decreased antibiotic use. Patients who have previously had antibiotic treatment have a higher likelihood of developing antibiotic resistance, according to unambiguous data 22. Readministration of antibiotics from the first cycle also quickens the development of resistance mechanisms 32. When used frequently or inappropriately, antibiotics promote the selective pressure that leads to bacterial evolution. Antibiotic resistance is a product of both nations and individuals 22. In contrast to other nations, Japan saw a fourfold growth in both the consumption and resistance to clarithromycin between 1993 and 2000 33.
Regulatory issues related to antibiotic resistance:
As of yet, there are no globally accepted management guidelines that align with routine antibiotic usage. As such, national regulations differ from one another. While other governments have not yet moved, some, like the United Kingdom, have moved quickly to offer assistance in regard to interventions. According to recommendations made by the World Health Organization, children in underdeveloped nations should only receive antibiotics for the treatment of severe bloody diarrhea and cholera 34,35. We have poured more biological and inorganic poisons into rivers, streams, seas, the land, and the atmosphere since the start of the industrial revolution. Due to the high concentration of antibacterial chemicals in personal care products, there are inadequate rules for monitoring the home hygiene goods in the business, which increases the risk of resistance [22]. There is no way to dismiss the widespread antibiotic resistance that exists today. Wherever there is a larger reported intake of antibiotics, antibiotic resistance may be more common. Antibiotic use is widely unregulated and uncontrolled, and this needs to be aimed at a worldwide audience. The most vulnerable countries are developing ones. In poor nations, the overuse, accessibility, and low cost of antibiotics are contributing to increased burdens [1]. Countries without universal health coverage for their residents tend to have somewhat unregulated antibiotic use 36.
CONCLUSIONS:
The global level of antibiotic resistance is at an all-time high. Antibiotic usage in agriculture, humans, and animals is rising despite efforts by some WHO members. A pressing concern in the healthcare industry is the significant financial load brought on by prolonged hospital stays, isolation units, strict procedures to prevent infections, and unsuccessful treatments. The heads of public health should create a system of required reporting for antibiotic resistance, continuous analysis, and a pan-surveillance system that is coordinated at both the national and international levels. To prevent the overuse and abuse of antibiotics, standard national and international policies must be followed.
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Received on 11.09.2024 Revised on 03.10.2024 Accepted on 18.10.2024 Published on 14.12.2024 Available online on December 05, 2024 Research J. Science and Tech. 2024; 16(4):313-316. DOI: 10.52711/2349-2988.2024.00045 ©A and V Publications All right reserved
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