• Dr Emma Derbyshire

The Pending Threat of Antimicrobial Resistance - Time to Take Proactive Action Now?


Antimicrobial resistance is one of the greatest threats to healthcare today and urgent action is required to avert the antimicrobial resistance crisis.


Antimicrobial drugs include antivirals, antiparasitics, antifungals and also antibiotics - which are used to treat bacterial infections. 'Antibiotic resistance' is a term used when antibiotics are no longer effective in the treatment of bacterial infections due to bacteria changing in response to the constant use of a particular drug over time. However, the problem is much greater, and not just specific to bacterial infections. All microbes, including viruses, such as HIV-1 and SARS-CoV-2 (the virus that causes COVID-19); parasitic infections, such as malaria and toxoplasmosis; and fungal infections such as candida and ringworm are also becoming resistant to the medicines we use to treat them.


Thus, it isn't only antibiotic resistance that should be concerning us, but resistance to all antimicrobials. Drug-resistant microbes pose a serious threat to human health worldwide. Bacteria, viruses, parasites and funguses that infect humans are changing, making them harder to treat with the medicines we currently have available to us. Current medications are losing efficacy and we are now at a critical point in the fight to protect some of our most vital medicines.


It isn't simply a case that new antimicrobial drugs need to be urgently developed. The world needs to stop the misuse and overuse of our current, essential drugs used to treat infections, and establish other methods to counteract antimicrobial resistance.


In 2019 the World Health Organisation (WHO) published a report highlighting the need for a coordinated and intense effort to overcome antimicrobial resistance. The WHO believes that unless the world acts urgently, antimicrobial resistance will have a disastrous impact within a generation, causing ten million deaths each year, catastrophic damage to the economy and forcing up to 24 million people into extreme poverty. Recognising that human, animal, food and environmental health are closely interconnected, the report calls for a coordinated, multisectoral 'One Health' approach. [2]


More and more common diseases, including respiratory tract infections, sexually transmitted infections and urinary tract infections, are becoming untreatable. Furthermore, lifesaving medical procedures are becoming much riskier due to the presence of resistant microbes in hospitals, which are much more prevalent than in the community. Our food systems are also affected by antimicrobial drug resistance, and as such agricultural and farming practices need to be changed to reduce the risk of antimicrobial resistance and to promote sustainable, viable alternatives.


COVID-19 is also exacerbating the problem, as treatment is highly dependent on the administration of drugs. Patients with COVID-19 have been administered antiparasitics, antivirals, antibiotics and anti-inflammatory drugs to prevent secondary infections, which has increased the risk, evolution and spread of antimicrobial resistance. Furthermore, mutations in SARS-CoV-2 are rendering the drugs ineffective, not only in the fight against the coronavirus pandemic, but in the treatment of other bacterial and viral infections. [3]

In the UK, bacterial respiratory tract infections account for approximately half of all oral antibiotics prescribed. The misuse and overuse of antibiotics is exacerbating the antimicrobial problem, leading to the emergence of infections that are no longer treatable. Considering this, Nutritional Insight teamed up with Professor Peter Calder, head of human development and health, within medicine at the University of Southampton, to investigate the potential role of vitamin D as an intervention to help improve an individual's health prior to being exposed to bacterial respiratory tract infections, so that people are more able to cope with the subsequent infection – with the aim to reduce the need for antibiotics. [1]


Meta-analysis and clinical trials suggest that supporting the immune system in advance of exposure to infections may reduce the number and severity of infections and reduce the use of antibiotics. Vitamin D is known to have multiple roles in supporting the immune system and evidence has demonstrated that vitamin D supplements reduce the risk, duration and severity of respiratory tract infections. In light of this evidence, supplementation with vitamin D may also play a vital role in reducing the misuse and overuse of antibiotics. Further clinical trials and meta-analysis are thus required to further investigate the precise relationship between vitamin D status and the health of our immune and respiratory systems. [1]


Additional to vitamin D, research on alternative or complementary therapies to traditional antimicrobials is urgently needed. Natural products are of great scientific interest due to their unique properties, availability and vast chemical diversity with the potential to be better utilised in combination therapy or as prophylactics in the fight against microbial infections. Their joint application with traditional antibiotics could contribute to enhancing the antibiotics effect, and even reduce their use [4].


In light of the COVID-19 pandemic and our reliance of pharmaceutical interventions, antimicrobial resistance needs to be taken seriously worldwide – with policymakers, businesses, academia and civilians all working urgently to protect people and the planet in order to secure a sustainable future for our civilisation.


References:


1. Derbyshire EJ & Calder P (2021) Respiratory Tract Infections and Antibiotic Resistance: A Protective Role for Vitamin D? Frontiers in Nutrition, Nutritional Immunology. Volume 8, Article 652469. Available at: https://pubmed.ncbi.nlm.nih.gov/33842525/


2. No Time to Wait: Securing the Future from Drug-Resistant Infections. Available at:

https://www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG_final_report_EN.pdf?ua=1

3. Ebrahim Afshinnekoo et al (2021). COVID-19 drug practices risk antimicrobial resistance evolution. The Lancet Microbe. Available at:

https://doi.org/10.1016/S2666-5247(21)00039-2


4. Francisco Javier Alvarez-Martinez et al (2020). Tackling Antibiotic Resistance with Compounds of Natural Origin: A Comprehensive Review. Biomedicines Oct; 8(10): 405. Available at:

https://doi.org/10.3390/biomedicines8100405

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