Research—Marvel

Let’s Resist Resistance

Current hygiene practices increase our contraction of infectious disease. We have all seen the signs on the bathroom door or next to the sink that reads “employees must wash hands.” This signifies that OSHA (Occupational Safety and Health Administration) recognizes the importance of washing our hands after using the restroom. If this sign is abided by, customers are put at ease when eating at their favorite restaurant or buying muffins from their local baker. Customers can be rest assured that they are not going to contract some vile food borne illness that will knock them out of commission for days. We forget about the dish rag that has been used all day to wipe the counters, or the bench seats at the diner that haven’t been cleaned properly. There is a growing need to address the way we clean and the products we use to clean. This extends to the antibiotics we take to “clean” our bodies and the antibiotics we use to treat the animals we eat.

The invention of penicillin awarded Alexander Fleming the Nobel Prize in 1945. Fleming warned during his acceptance speech that the overuse of antibiotics would lead to a decline in their effectiveness. This overuse happens when bacteria evolve to have stronger defenses against certain antibiotics. The overuse is dangerous because as we take more antibiotics, bacteria are getting stronger and more likely to have a defense against the very thing meant to kill them. Today we are seeing an increased awareness to antibiotic resistant strains of bacteria. Immuno-compromised persons are at an increased risk due to their susceptibility to bacterial infection. This population consists of elderly and children as well as any persons with an existing condition that would weaken their bodies ability to fight infection. Compounding these issues is improper hygiene amongst people that service these immuno-compromised people.

According to The American Journal of Infection Control we should be taking a “risk-based approach” to hygiene. Knowing which cleaning products to use and when to use them is crucial to appropriate hygiene. Author, Sally F. Bloomfield says in an article titled, “A Risk Assessment Approach to use of Antimicrobials in the Home to Prevent Spread of Infection” that “detergent-based cleaning can be used to break the chain of infection, in some cases an antimicrobial agent is required.” At one time, using an antimicrobial agent in the home was unnecessary but with a growing immune-compromised population that is receiving similar care in home as they once saw in a hospital it is becoming more crucial. This crucial step breaks the chain of the bacteria and allows for the person in contact with a once contaminated surface to now be safe from any bacterial infection. In addition to this step being crucial for the reduction of an infection, it also limits the use of antibiotics to treat an infection. By limiting the use of the antibiotics, we see a reduction in the risk for antibiotic resistant strains of bacteria.

Along with direct use of antibiotics in humans for treatment, the United States meat industry began using antibiotics both as a tool to keep animals from getting sick and as a tool to aid in weight gain. This practice is adding to the inappropriate hygiene practices. Maryn Mckenna writes in an article titled “Drugs: gut response?,“ that “By saturating the environment with antibiotic residues, Blaser argues, we have effectively recreated that weight-gain programme in humans — and the result has been the seemingly unstoppable increase in obesity, especially in children.” This article is from the International Journal of Science. Mckenna is reviewing an article written by Martin J. Blaser on how the overuse of antibiotics is “Fueling our modern plagues”. Essentially, we are contaminating our food now with a product that was meant to treat infection. In doing so we are seeing a similar response in humans that these farmers see in their animals such as weight gain. Weight gain has many health repercussions on its own and now add to that the use of the antibiotics affecting efficiency when a person is ill. On top of the now sometimes inefficient antibiotics, Blaser discusses the idea that the overuse of antibiotics is destroying healthy benign bacteria that are necessary for normal, healthy, human function.

It appears that we are at a boiling point. With things like resistant bacteria and a growing immune-compromised population it is crucial that we begin to make strides in practicing appropriate hygiene. We can’t let that sign in the bathroom fool us. Just washing our hands is not enough. Appropriate hygiene goes beyond hand-washing.

Overuse and misuse of antibiotics leads to an increased occurrence of antibiotic resistant bacteria. We have an infestation of some mutant bug, a spider-cockroach hybrid that isn’t afraid to charge at us when we try to kill it. So, we call a professional to exterminate the hybrid monster bugs. The exterminator uses a substance that kills 95% of the spider-cockroach mutants but leaves 5% not killed. Now imagine, not only are these hybrid bugs not dead but they are now stronger. They have been exposed to the substance that killed the other 95% and have evolved to defend against that lethal substance. In addition, they are multiplying and passing their enhanced defense against the killing substance to their young. Antibiotics are designed to treat bacterial infection. Not unlike the substance used by the exterminator. They attack bacteria within the body by either killing the bacteria or stopping the bacteria from multiplying. Antibiotics are meant to be used as a last line of defense. The human body can usually stop an excess of harmful bacteria from multiplying without the use of antibiotic; however, there are instances when the bacteria becomes too great for a healthy immune system. This is when antibiotics are effective.

Antibiotics are only effective when prescriptions are followed through. A doctor will prescribe a specific number of pills to rid the body of the infection. If we fail to follow though and take all the pills, then the above analogy proves true. We will have exposed some bacteria to the drug meant to destroy them but not enough to kill them. Now exposed, those bacteria grow stronger. They will no longer be killed by the antibiotic first prescribed. Thus, this misuse of antibiotics increases the likelihood of an antibiotic resistant bacteria.

The use of antibiotics in animal agriculture is also contributing to resistant bacteria. Most of the meat found at the local grocer is contaminated with antibiotics. The farmers we buy our meat from are using these antibiotics to increase their profits. Antibiotics contribute to weight gain of their livestock, giving them more inventory, and keep their livestock healthier, giving them more inventory. The situation: animals take antibiotics, whether needed or not, increasing the likelihood of developing resistant bacteria, we eat the animals containing resistant bacteria resulting in the introduction of that resistant bacteria to our system. The microbial ecosystem of the animals we eat is interwoven in such a way that it is unable to be separated from our own. This makes this passing of resistant bacteria impossible to negate unless we were to not feed livestock antibiotics.

The discovery and development of antibiotics improved people’s lives, providing treatments that were more effective than their predecessors. What was once a potentially deadly infection can now be treated with amazing efficacy. Arsenic, a deadly poison in a high dose, was once the only method of treating infection. In small doses arsenic would attack the unwanted bacteria, but this was a precarious scenario. Too much arsenic would have an adverse effect, potentially killing the consumer. Enter the “Age of Antibiotics,” states Gerard D. Write in his book, The Origins of Antibiotic Resistance and we see drastic improvements in the field beginning in the 1940’s. However, resistance was inevitable from the start.

We need to figure out a way to combat resistance. In the article, “What’s old is new: Reconfiguring known antibiotics to fight drug resistance,” from the journal Nature Medicine, Shraddha Chakradhar proposes that the way to do that might be by changing current antibiotics. Chakradhar states, “Turning to pre-existing drugs to make antibiotics more effective against drug-resistant strains of well-known pathogens is especially appealing given that no new class of antibiotics has been approved for nearly 30 years.” This argument does not address why no new class of antibiotics have been approved and therefore leaves us wondering, is it perhaps policy that needs to change? Moreover, she states that “drug companies and the US government have invested more than $1 billion combined toward the development of new antibiotics, just within the past decade,” which again screams at a potential flaw in how we go about approving these new antibiotics. According to the UK’s Chief Medical Officer, Sally Davies, there is a, “‘ticking time-bomb’. She says this is because of an overuse of antibiotics and the lack of new drugs coming on stream—no new class of antibiotics has been discovered since 1987,” from the Cancer Nursing Practice Journal, written by Nick Triggle.

The approach of “reconfiguring” existing antibiotics does nothing to address the problem with over-prescription. Over-prescription and misuse are negating any efforts to create stronger more effective drugs. Linda Bren quotes Stuart Levy, M.D., president of the Alliance for the Prudent Use of Antibiotics. “”The number of bacteria resistant to many different antibiotics has increased, in many cases, tenfold or more. Even new drugs that have been approved are confronting resistance, fortunately in small amounts, but we must be careful how they’re used. If used for extended periods of time, they too risk becoming ineffective early on,“” in her article, “Overprescription of Antibiotics Has Led to Resistant Bacteria,“ Dr. Levy warns us that if we continue to overprescribe, even new drugs will become ineffective.

References

Aiello, A. E., & Larson, E. (2003). Antibacterial cleaning and hygiene products as an emerging risk factor for antibiotic resistance in the community. The Lancet Infectious Diseases, 3(8), 501-506. doi:http://dx.doi.org/10.1016/S1473-3099(03)00723-0

Bloomfield, Sally F., PhD, BPharm, & Scott, Elizabeth A., PhD, MPhil. (2013). A risk assessment approach to use of antimicrobials in the home to prevent spread of infection.AJIC: American Journal of Infection Control, 41(5), S87-S93. doi:10.1016/j.ajic.2013.01.001

Bren, L. (2006). Overprescription of Antibiotics Has Led to Resistant Bacteria. In A. Hiber (Ed.), At Issue. Are Americans Overmedicated? Detroit, MI: Greenhaven Press. (Reprinted from FDA Consumer, 2003, September) Retrieved from http://link.galegroup.com/apps/doc/EJ3010471213/OVIC?u=rowan&sid=OVIC&xid=04a2ea06

Brian N Tse, Amesh A Adalja, Christopher Houchens, Joseph Larsen, Thomas V Inglesby, Richard Hatchett; Challenges and Opportunities of Nontraditional Approaches to Treating Bacterial Infections, Clinical Infectious Diseases, Volume 65, Issue 3, 1 August 2017, Pages 495–500, https://doi.org/10.1093/cid/cix320

Chakradhar, S. (2016). What’s old is new: Reconfiguring known antibiotics to fight drug resistance. Nature Medicine, 22(11), 1197-1199. doi: http://dx.doi.org/10.1038/nm1116-1197

Coates, A. R. M. (2012;2014;). Antibiotic resistance (1. Aufl. ed.). Heidelberg;New York;: Springer. https://link-springer-com.ezproxy.rowan.edu/book/10.1007%2F978-3-642-28951-4

Davies, J., & Davies, D. (2010). Origins and evolution of antibiotic resistance. Microbiology and Molecular Biology Reviews, 74(3), 417-433. doi:10.1128/MMBR.00016-10

McKenna, Maryn, (2014) Drugs:Gut Response. Nature Publishing group, a division of Macmillan Publishers Limited. All Rights Reserved. Nature volume508, pages182–183. Retrieved from https://www.nature.com/articles/508182a

Nordqvist, Christian. “Antibiotics: Uses, Resistance, and Side Effects.” Medical News Today, MediLexicon International, 25 July 2018, www.medicalnewstoday.com/articles/10278.php

Shlaes, D. M. (2010). Antibiotics: The perfect storm (1st;1; ed.). New York;Dordrecht;: Springer. doi:10.1007/978-90-481-9057-7 https://link.springer.com/book/10.1007%2F978-90-481-9057-7

Triggle, N. (2013). Overprescription of antibiotics is a ‘ticking time-bomb’: Chief medical officer points out that cancer patients are at increased risk of infections. nick triggle reports. Cancer Nursing Practice, 12(3), 6-7. doi:10.7748/cnp2013.04.12.3.6.p10926

Twomey, Carolyn (2006). Hand Hygiene. Infection Control Today. Retrieved from https://www.infectioncontroltoday.com/hand-hygiene/hand-hygiene-0?nck=1.

Witte, W. (1998). Medical consequences of antibiotic use in agriculture. Science, 279(5353), 996-997.