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Antibiotic Resistance: Public Health Strategy

By November 16, 2020 No Comments

Public health officials and researchers agree that antibiotic resistance is an increasingly acute threat. At present, the United States sees over 2.8 million antibiotic-resistant infections yearly, resulting in 35,000 deaths per year [1]. The country’s Combating Antibiotic Resistant Bacteria (CARB) strategy outlines five broad goals for fighting this problem: slowing resistant infections to begin with, buttressing the CDC’s programs for animal and environmental health, boosting testing resources to identify resistant bacteria, research and development of new antibiotics and vaccines, and increased international collaboration to fight antibiotic resistance [2]. 

In general, prevention has two equal elements: a slowing of infection rates for potentially resistant bacteria and a reduction in superfluous antibiotic prescriptions. The causes of increased infection are manifold—for instance, between 1975 and 1990, preschool-aged children visiting doctors for ear infections increased 100%, likely because of increasing preschool attendance. Furthermore, increases in chemotherapy and other therapies causing patients to become immunocompromised have heightened the number of individuals vulnerable to infection [3].  

Researchers estimate that up to a third of antibiotic prescriptions in outpatient cases are medically unnecessary [1]. Furthermore, over 60% of outpatient antibiotic prescriptions between 2007 and 2009 were for broad-spectrum antibiotics, which contribute more to antibiotic resistance than do narrow-spectrum ones. A reduction in antibiotic prescriptions, particularly broad-spectrum ones, will play a role in reducing antibiotic resistance [4]. 

Furthermore, animal medicine and environmental factors have a substantial impact on the phenomenon of resistance, leading to CARB’s second goal. Researchers suspect that antibiotic waste, filtering into water and soil through livestock feed, may cause resistance in humans even at thresholds below their minimum inhibitory concentrations. While the use of antibiotics to promote animal growth is banned in Europe, it continues worldwide, particularly in developing nations, leading to phenomena such as antibiotic-resistant Typhimurium infections in Central Africa [5]. For this reason, CARB’s goal of international collaboration is particularly important, as it aims to address the varying causes of resistance worldwide. Bodies such as the WHO have worked to promote international solutions to this problem. In addition to the WHO’s Strategic and Technical Advisory Group on Antimicrobial Resistance, the World Organization for Animal Health has focused on a reduction of animal antibiotic use, and individual governments—such as India’s, in collaboration with scientists on the Chennai Declaration—have sought political solutions [6]. 

Finally, CARB aims to improve testing to identify antibiotic-resistant bacteria, and to support the development of new therapies that will not contribute to this problem. Paper-based tests have been developed successfully to test for both infection and antibiotic susceptibility of E. coli. [7]. Meanwhile, research into therapies focused on bacteria biofilms, which protect bacteria against antibiotics, may prove useful. A study by de la Fuente-Núñez et al. showed that interventions into signaling pathways and enzymatic reactions can disrupt the construction of biofilms [8]. 

The U.S.’s current antibiotic resistance strategy encompasses both research-based and political approaches: international collaborations focus on not only human but also livestock and environmental conditions, while research ranges from new forms of testing to biofilm-disrupting therapies. Prevention attempts, meanwhile, dually engage with reducing infections and unneeded antibiotic prescriptions. 

References 

[1] Fischer, Kristen. “Antibiotic-Resistant Infections Affect Millions: How We Can Fight Back.” Healthline, Healthline Media, 26 Oct. 2020, www.healthline.com/health-news/antibiotic-resistant-bacteria-causes-2-8-million-infections-annually-how-we-can-fight-back#Will-it-work?  

[2] “National Action Plan for Combating Antibiotic-Resistant Bacteria, 2020-2025.” ASPE, U.S. Department of Health and Human Services, 9 Oct. 2020, aspe.hhs.gov/pdf-report/carb-plan-2020-2025.  

[3] Stewart, Philip S, and J William Costerton. “Antibiotic Resistance of Bacteria in Biofilms.” The Lancet, vol. 358, no. 9276, 2001, pp. 135–138., doi:10.1016/s0140-6736(01)05321-1

[4] Fiore, David C et al. “Antibiotic overprescribing: Still a major concern.” The Journal of Family Practice, vol. 66,12 (2017): 730-736. 

[5] Van Puyvelde, Sandra, et al. “Why the Antibiotic Resistance Crisis Requires a One Health Approach.” The Lancet Infectious Diseases, vol. 18, no. 2, 2018, pp. 132–134., doi:10.1016/s1473-3099(17)30704-1. 

[6] Carlet, J., et al. “Antibiotic Resistance: a Geopolitical Issue.” Clinical Microbiology and Infection, vol. 20, no. 10, 2014, pp. 949–953., doi:10.1111/1469-0691.12767.  

[7] He, Peijun J.W., et al. “Laser-Patterned Paper-Based Sensors for Rapid Point-of-Care Detection and Antibiotic-Resistance Testing of Bacterial Infections.” Biosensors and Bioelectronics, vol. 152, 2020, p. 112008., doi:10.1016/j.bios.2020.112008.  

[8] de la Fuente-Núñez, César, et al. “Bacterial Biofilm Development as a Multicellular Adaptation: Antibiotic Resistance and New Therapeutic Strategies.” Current Opinion in Microbiology, vol. 16, no. 5, 2013, pp. 580–589., doi:10.1016/j.mib.2013.06.013.  

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