Antimicrobial Resistance

Antibiotic/Antimicrobial Resistance (AR/AMR) is one of the biggest threats to public health today. AMR was listed among the 13 urgent challenges for the decade by the World Health Organization (WHO) at the beginning of 2020. Globally, drug-resistant diseases kill at least 700,000 people each year. By the year 2050, deaths from ineffective antimicrobials could rise to 10 million per year if no action is taken, considering the possible acceleration of this situation in the post-COVID-19 pandemic state of the world. Yet, the pandemic has caused an increase in the usage of substandard drugs due to increased demand and drug shortages.

Considering lessons learned from the COVID-19 pandemic, the world’s understanding of an uncontrolled pandemic and its health and economic implications have deepened a lot. Also, the high vaccination rates that are aimed to end the COVID-19 pandemic in the following two years would help to limit needless drug use that drives AMR. If the governments and global/local health authorities take concrete actions, it could be possible to prevent AMR from becoming the next global public health crisis.

Antimicrobials (including antibiotics and antivirals) are drugs used to prevent and treat a wide range of infections in humans, animals, and plants. AMR occurs when the microorganism causing the disease no longer responds to the drugs, making these persistent infections harder to treat, risking more people, and making the spread more difficult to contain. These antimicrobial-resistant microorganisms can also be called superbugs.

AMR concerns not only these superbugs but also more common diseases, including respiratory tract infections, sexually transmitted infections, and urinary tract infections, making even these common diseases untreatable.

WHO reported that despite the growing need for new antibiotics, none of the current drug candidates in the development phase aims at the world’s most dangerous superbugs. There should also be sustainable investments in R&D (research and development) of new and effective antibiotics targeting common diseases since most of the new antibiotics in the market are variations of the antibiotic drug classes of the 1980s. Suppose a new range of antimicrobial drugs is not discovered in the following few decades. In that case, AMR could send modern medicine back to the pre-antibiotic era when even (now) routine medical procedures were life-threatening.

As would be expected, in the coming decades, AMR will impact the world disproportionately, mainly affecting the lower- and middle-income countries, especially the resource-constrained regions and the most vulnerable groups such as newborns and young children under 5.

The contributions of human antibiotics misuse are well-recognized. However, the trends of antimicrobial resistance in animals caused by veterinary antibiotics misuse and environmental transmission via water, soil, or food contaminations need special attention, and hopefully, they are under focus in recent studies (Nadimpalli et al., 2020; Van Boeckel et al., 2019). The regions predicted to be the most burdened by the AMR crisis are the hotspots for AMR. Each country should direct research efforts towards identifying local hotspots to prevent future possible environmental AMR transmissions, which may even become global drivers.

After the devastating effects of the COVID-19 pandemic, AMR must be regarded as a global, regional, and national priority for health organizations and governments. Solutions should be tailored to improve water and waste infrastructures. Intensive research should be carried out to understand AMR's mechanisms and to design/discover new antimicrobial drugs to prevent it.

As a responsible world citizen, it would be worthwhile to follow the actions of local and global initiatives which aim to tackle the AMR challenge. These WHO-supported initiatives are some examples: GLASS (The Global Antimicrobial Resistance Surveillance System), GARDP (Global Antibiotic Research and Development Partnership), and IACG (Interagency Coordination Group on Antimicrobial Resistance).

References

Breeding a superbug: how poor-quality medicines fuel AMR
https://qualitymatters.usp.org/breeding-superbug-how-poor-quality-medicines-fuel-amr

New report calls for urgent action to avert antimicrobial resistance crisis https://www.who.int/news/item/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis

Urgent health challenges for the next decade. https://www.who.int/news-room/photo-story/photo-story-detail/urgent-health-challenges-for-the-next-decade

Global shortage of innovative antibiotics fuels emergence and spread of drug-resistance https://www.who.int/news/item/15-04-2021-global-shortage-of-innovative-antibiotics-fuels-emergence-and-spread-of-drug-resistance

Badreldin, H. A., & Atallah, B. (2021). Global drug shortages due to COVID-19: impact on patient care and mitigation strategies. Research in Social and Administrative Pharmacy, 17(1), 1946-1949.

Martin, J. K. (2020). Drug discovery needs to change. Nature, 586(7830), S57-S57.

Nadimpalli, M. L., Marks, S. J., Montealegre, M. C., Gilman, R. H., Pajuelo, M. J., Saito, M., ... & Pickering, A. J. (2020). Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. Nature microbiology, 5(6), 787-795.

Svoboda, E. (2020). Research round-up: Antimicrobial resistance. Nature, 586(7830), S58-S59.

Van Boeckel, T. P., Pires, J., Silvester, R., Zhao, C., Song, J., Criscuolo, N. G., ... & Laxminarayan, R. (2019). Global trends in antimicrobial resistance in animals in low-and middle-income countries. Science, 365(6459).

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