A Global Threat to Humanity: Anti-Microbial Resistance

the Oxford Scientist

A Global Threat to Humanity: Antimicrobial resistance (AMR) is spreading at an alarming rate, yet the antibiotic industry is only shrinking—could a pre-antibiotic era return as our future? Anti-Microbial Resistance

antibiotic, resistance can arise. Moreover, resistant bacteria have existed long before humans used an‐tibiotics, even being found in Egyptian mummies from 9000 years ago.

But now, resistance has become a threat com‐parable to climate change due to the overuse of an‐timicrobials. It is reported that 700,000 people die every year due to resistant microbes. At this rate, resistance could kill up to 10 million people each year by 2050, which translates to a devastating one person every three seconds. The more we use anti‐microbials, the more resistance: by exposing pathogens to antibiotics, selective pressure is ap‐plied so that only resistant strains will survive and multiply, leading to greater numbers of resistant bacteria.

A prominent example of overuse is overpre‐scription. In 2016, the Centres of Disease Control and Prevention (CDC) reported that at least 30% of antibiotics prescribed to outpatients in the US were unnecessary, with more than 60% of respirat‐ory disease patients given antibiotics when not re‐quired. Antibiotics only work against bacterial infections, so taking them for a viral infection such as the common cold will not do anything but drive resistance in the individual’s microbiome. A ntimicrobials revolutionised medicine. Before antibiotics, the average life expect‐ancy was 47 years. Infections such as pneumonia could easily be fatal, and to put it bluntly, a scratch could kill. There is no better ex‐ample than the First World War, where at least one-third of soldiers were killed by infections and diseases.

But now, the rise of antimicrobial resistance (AMR) makes it possible for the horrors of the preantibiotic era to return. AMR includes antibiotic resistance, which is when bacteria survive expos‐ure to antibiotics that usually kill or slow their growth. Resistance is present naturally in some bacteria and can arise due to random mutation, while microbes can also acquire resistance from others through gene transfer. Antimicrobials are targeted at infections caused by bacteria, viruses, and fungi, enabling us to treat life- threatening illnesses from tuberculosis to HIV, and malaria. Resistance not only paves the path for a future without such treatments, but it also means that common surgical procedures such as organ transplants and C-sections will become infeasible due to the high risk of infection. This risk is even larger for those with compromised im‐mune systems, such as cancer patients undergoing chemotherapy.

Yet resistance is not new. Sir Alexander Flem‐ing—the discoverer of the first antibiotic penicillin, warned us of this danger more than 50 years ago in his Nobel lecture. Fleming noted that if bacteria were exposed to non-lethal concentrations of the “Resistance is present naturally in some bacteria and can arise due to random mutation”

Perspective ing closer. At this rate, there would be no pharmaceutical companies develop‐ing antibiotics by 2025. As Jim O’Neill the former-chief economist of Goldman Sachs puts it, we are ‘facing a growing enemy with a largely depleted ar‐moury’.

This paradoxical situation results from decades of under-investment by companies and the government in anti‐microbial R&D.

Drug development is time-con‐suming and costly, a single drug takes at least 10 years and 1 billion pounds to reach the patient. If it finally makes it to the market, new antibiotics are often re‐served as a last-line defence. With cheap, existing generic drugs still effect‐ive enough, competitive pressure means that newly patented drugs are not sold much. In other words, resistance is a problem, but with our present market system, its occurrence is not high enough to yield a sufficient market to sustain the development of new drugs. So it is unsurprising that no one wants to develop antibiotics despite the urgent and increasing need for them. Between 2003 and 2013, less than 5% of venture capital investments in pharma‐ceuticals were for antimicrobial devel‐opment. With too little money and market interest, too little time and nat‐ural resources, and the increasing threat of AMR and unpredictable occurrence, we need to focus on antimicrobial drug discovery with renewed vigour and sense of emergency. agriculture and aquaculture. Although they are needed to treat animal or plant infections, most of these including lastline antibiotics, are instead used to pro‐mote organism growth or prevent po‐tential infections.

As AMR becomes increasingly deadly, it is critical that we reduce our unnecessary demand for antimicrobials. But even if antimicrobials were used completely appropriately, resistance as a natural process can only be slowed down, not eradicated. Therefore, not only do we need to make existing drugs stay effective longer by reducing use, the development of new drugs is essen‐tial. The Antibiotic market: a commercial failure T hat being said, no new classes of antibiotics have been introduced since the 1980s. R&D in antimicrobials is shrinking faster than ever, while the global threat of resistance is only loom‐General practitioners still rely on the patient’s symptoms and slow dia‐gnostic tools such as a blood or culture tests to distinguish between viral and bacterial infections. Better diagnostics such as the point-of-care C-reactive protein (CRP) testing have been trialled in the UK. The test only requires a fin‐ger prick, a few extra minutes, and a cost of approximately £4, but it has not proven effective in reducing unneeded prescriptions.

However, such tests are yet to be‐come routine as it is still far cheaper and faster to prescribe antibiotics ‘just in case’. Therefore, not only do rapid dia‐gnostics need to be made available and affordable to doctors, policies must be put in place to make such testing com‐pulsory.

But reducing antibiotic use in hu‐mans is simply not enough to tackle res‐istance. The FDA reports that 70% of the antibiotics (by-weight), critical in treating human infections, are used in “...its occurrence is not high enough to yield a sufficient market to sustain the development of new drugs.” Maria Kostylew