Issue of the Over-Prescription of Antibiotics

TITLE: “Over-prescription of antibiotics now threatens the future health of millions”. Analyse and discuss this statement with reference to specific examples, using a range of academic sources.

INTRODUCTION

This essay is about the over-prescription of antibiotics and the way it can affect the ‘future health of millions’. It intends to give background information on the discovery of antibiotics, the different groups of antibiotics. It also briefly describes their mechanism of action and what they are used for.  It analysis the different types of bacteria, the different routes of transmission and how bacteria can become resistant to antibiotics. It will also explain how they can become a threat to public health if they become resistant to current antibiotics, with examples of Multi-drug resistant bacteria. Lastly, this essay will give suggestions of ways to prevent from antibiotic resistance.

Antibiotic resistant is a very dangerous and life-threatening matter as it is likely to happen in individuals with low immunity such as young and the elderly individuals. One of the biggest worries is the failure to create new antibiotics for bacteria that are becoming resistant. This results in the bacteria being left untreated and therefore could lead to the death of the infected patient.

Antibiotics

Antibiotics are a type of drug frequently prescribed to treat bacterial infections.

Alexander Fleming discovered the first antibiotic in 1928, Fleming found a culture plate with staphylococci being grown within it, the growth present was contaminated with a mould of genus Penicillium. (American Chemical Society, 2018). He learnt that the bacterial growth in the region of the mould was stopped. As a result, he put the mould in pure culture and established that it produced an antibacterial substance, which he named Penicillin.

According to an online source, there are over 100 antibiotics but there are 7 main classes: Sulfonamides, Penicillin’s, Cephalosporin’s, Macrolides, this includes; erythromycin, Fluoroquinolones such as levofloxacin, Tetracyclines such as tetracycline and lastly, Aminoglycosides, including gentamicin. (Shiel Jr, MD and FACP, 2018). Every antibiotic is used to treat a specific infection. The antibiotic chosen by the doctor depends on factors such as allergies, which part of the body is infected and the type of bacteria it is infected by. This lowers the chances of antibiotic resistant as the right antibiotic would be prescribed. Penicillin was used to treat many different bacterial infections, however, due to overuse, penicillin resistance became a huge clinical problem.

Antibiotics work by targeting bacteria and stopping their growth, or by killing the bacteria. Each antibiotic works differently, but they all work by influencing things that bacterial cells have, which don’t exist on human cells. Penicillin and cephalosporin work by stopping the bacteria from creating a cell wall, which results in the membrane bursting due to pressure. Other antibiotics attack different parts of the bacteria, such as the DNA while it is being replicated. Levofloxacin breaks the DNA and stops it from being repaired, which means the bacteria cannot live or reproduce. Antibiotics do not work against viral infections such as the common cold and the flu, therefore using antibiotics for these illnesses, contributes to antibiotic resistance and side effects.

The image below summarises how different antibiotics work.

(Figure 1: an illustration showing the mechanism of action for different antibiotics. (Garima Kapoor, 2017).

Bacteria

A bacterium can be defined as a “member of a large group of unicellular microorganisms, which can cause disease” (Google Dictionary). There are different types of bacteria, however they can usually be categorised as being either Gram-positive or Gram-negative. The structure of the cell and the thickness of the cell wall defines whether it can be stained with Gram’s stain. Gram-positive bacteria have a simple cell wall structure. It contains peptidoglycan, acidic polymer, protein and polysaccharides (Rang et al. Pharmacology, 2016). Whereas Gram-negative is more complex. It contains enzymes, peptidoglycan, lipid bilayer, proteins and complex polysaccharides. This makes it difficult for some antibiotics to pierce the complex outer layer. The image below shows a side by side comparison of Gram-positive and Gram-negative.

(Figure 2: An illustration comparing the cell walls of Gram-positive bacteria to Gram-negative bacteria (Deena T Kochunni, 2018).

Infectious diseases can be transmitted through a variety of ways the following is just a few examples, such as from direct or indirect contact with an infected person. This can be through the droplets in the air from sneezing and coughing e.g. Meningitis, skin/mucous membrane e.g. Staphylococcus aureus infection, blood or bodily fluids through sexual contact e.g. Gonorrhoea and lastly, through contaminated food or water e.g. Salmonella. (Higuera and Pietrangelo, 2018).
The bacteria become resistant to antibiotics by changing. The resistance occurs by the bacteria surviving and multiplying in number, which causes more harm. The bacteria develop resistance by modifying their gene immediately or through a genetic exchange with other resistant bacteria in the body. This, therefore, results in resistance as the antibiotic that once worked on the bacteria, no longer works. A bacterium becomes a ‘superbug’ when its known to be resistant to one or more antibiotics.

There are numerous patients that go through regular treatments such as organ transplantation, cancer treatments, hip and knee replacements which are frequently prescribed antibiotics. This helps to prevent from infections throughout their treatments. However, the problem of antibiotic resistance is increasing, this results in more deaths from bacteria that are resistant to common antibiotics prescribed. This creates a big problem for routine surgical procedures as it makes it harder to prevent from bacterial infections and the procedures could become hazardous. A reliable source mentioned that “Sepsis is a common cause of death in the UK with over 44,000 deaths every year”. These deaths are due to untreatable antibiotic resistance infections and this high number is more than the deaths from lung cancer (35,000) and bowel cancer (16,000). (Antibiotic Research UK, 2018).

Examples of multi-drug resistant Bacteria

It is undeniable that antibiotic resistance is life-threatening in the same way as cancer and other dangerous diseases. World Health Organisation believes that antibiotic resistance is one of the biggest threats to human and animal health worldwide. WHO created a rank of bacteria names which need new antibiotics urgently. This list has the names of bacteria in order of priority depending on how much they threaten human life. The first bacteria on the list is, Acinetobacter baumannii. This superbug can cause different diseases such as meningitis and pneumonia, which are life-threatening if left untreated. Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae are all dangerous bacteria that have become resistant to many strong antibiotics such as Carbapenem. These bacteria can be very threatening, which is the reason they are number one on the list (Lawe Davies, 2017). Another superbug that is multidrug-resistant is Salmonella typhi. This bacterium is extremely transmittable and it causes infections such as typhoid fever, salmonellosis in the intestinal tract and many other acute diseases that could potentially lead to death. Its stated that, about 1% of those infected will die (Christine McCaughey, 2018). This strain of salmonella typhi has become extensively resistant to many antibiotics such as chloramphenicol, ampicillin and trimethoprim. (Rowe B, Ward LR and Threlfall EJ, 1997).

In addition, other examples of bacteria that have become resistant to almost all the easily accessible antibiotics are: Methicillin-resistant Staphylococcus, Multi-drug-resistant Mycobacterium tuberculosis, Vancomycin-resistant Enterococcus and Carbapenem-resistant Enterobacteriaceae. Bacteria such as MRSA and Neisseria gonorrhoea were both controlled by penicillin, and now they are almost always resistant to benzyl penicillin. (Betterhealth.vic.gov.au, 2018)

Prevention

There are ways to prevent antibiotic resistance, Firstly, doctors need to minimise the prescription of antibiotics especially in developing countries. Secondly, it is advised to finish the entire course of antibiotics prescribed by the doctor. This way the antibiotic can be fully effective and kill the bacteria instead of allowing it to develop resistance. Thirdly, being sanitary such as washing hands and contamination control procedures need to be practised, this way the risk of transmitting infection is reduced especially in places like hospitals and GP’s, where bacteria can easily be transmitted. Moreover, always make sure the food is cooked before its eaten and stay up to date with vaccination. (Betterhealth.vic.gov.au, 2018). Furthermore, another method to help with antibiotic resistant is to create new antibiotics to fight against the resistant bacteria, but in the recent years, only a few options have become available, with under fifty potential new antibiotics being tested. This is a very small number because most of the drugs are unsuccessful. (Patient Research Exchange, 2018).

CONCLUSION

In conclusion, I believe antibiotics have played a vital role in medicine and saving lives. However, in recent years there has been an increase in the unnecessary prescription of antibiotics. The NHS stated that a fifth of prescriptions provided throughout GP surgeries were to patients who do not need them. From this, a study was conducted which investigated the number of antibiotic prescriptions that were not required in GPs from 2013-15. They found “8.8% and 23.1% of all antibiotics prescribed to be known as inappropriate” (NHS.uk, 2018). This may be due to patients asking for antibiotics without considering the type of organism that caused their infection, which could result in the inappropriate prescription of antibiotics. If all bacteria become resistant, then a simple infection could become life-threatening and routine surgeries would become much more difficult and dangerous. I think more people need to be educated about the causes and the risks of antibiotic resistance. This could result in patients being more responsible with the use of antibiotics and in prevention from infections.

Word count: 1531

REFERENCES

Websites

• American Chemical Society. (2018). Alexander Fleming Discovery and Development of Penicillin – Landmark – American Chemical Society. [online] Available at: https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicillin.html [Accessed 9 Dec. 2018].
• Antibiotic Research UK. (2018). Antibiotic Research UK – The problem explained. [online] Available at: https://www.antibioticresearch.org.uk/about-antibiotic-resistance/ [Accessed 9 Dec. 2018].
• Shiel Jr, W., MD and FACP (2018). Antibiotic Side Effects, Types & Drug Interactions. [online] eMedicineHealth. Available at: https://www.emedicinehealth.com/antibiotics/article_em.htm#what_drugs_interact_with_antibiotics [Accessed 9 Dec. 2018].
• Antibiotic resistance and the challenges of conducting new antibiotic clinical trials – Patient Research Exchange. (2018). Antibiotic resistance and the challenges of conducting new antibiotic clinical trials – Patient Research Exchange. [online] Available at: https://www.patientresearchexchange.org/stories/detail/antibiotic-resistance-and-the-challenges-of-conducting-new-antibiotic-clini [Accessed 9 Dec. 2018].
• Betterhealth.vic.gov.au. (2018). Antibiotic resistant bacteria. [online] Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/antibiotic-resistant-bacteria [Accessed 9 Dec. 2018].
• Bennington-Castro (2018). What Is Acinetobacter Baumannii?. [online] EverydayHealth.com. Available at: https://www.everydayhealth.com/acinetobacter/guide/ [Accessed 9 Dec. 2018].
• Christine McCaughey, L. (2018). Five of the scariest antibiotic-resistant bacteria of the past five years. [online] ABC News. Available at: https://www.abc.net.au/news/2018-09-03/scariest-antibiotic-resistant-bacteria-australia-contagion/10194230 [Accessed 9 Dec. 2018].
• Lawe Davies, O. (2017). WHO publishes list of bacteria for which new antibiotics are urgently needed. [online] Who.int. Available at: https://www.who.int/news-room/detail/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed [Accessed 9 Dec. 2018].
• Labtestsonline.org. (2018). Antibiotic Resistance in Bacteria | Lab Tests Online. [online] Available at: https://labtestsonline.org/articles/antibiotic-resistance-bacteria [Accessed 9 Dec. 2018].
• Netdoctor. (2018). Medicines for bacterial infections (antibiotics). [online] Available at: https://www.netdoctor.co.uk/medicines/infection/a25910/treatments-for-bacterial-infections-antibiotics/ [Accessed 9 Dec. 2018].
• Deena T Kochunni, J. (2018). 10 Differences between Cell wall of Gram positive and Gram negative Bacteria. [online] Majordifferences.com. Available at: https://www.majordifferences.com/2018/06/difference-between-cell-wall-of-gram.html#.XBF43xP7Rdg [Accessed 9 Dec. 2018].
• nhs.uk. (2018). Up to 1 in 5 antibiotics may be prescribed inappropriately. [online] Available at: https://www.nhs.uk/news/medication/1-5-antibiotics-may-be-prescribed-inappropriately/ [Accessed 9 Dec. 2018].
• Higuera, V. and Pietrangelo, A. (2018). Disease Transmission: Direct Contact vs. Indirect Contact. [online] Healthline. Available at: https://www.healthline.com/health/disease-transmission#indirect-contact [Accessed 9 Dec. 2018].

Journals

• Rowe B, Ward LR and Threlfall EJ (1997). Multidrug-resistant Salmonella typhi: a worldwide epidemic. – PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/8994789 [Accessed 9 Dec. 2018].
• Ventola, C. (2018). The Antibiotic Resistance Crisis: Part 1: Causes and Threats. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/ [Accessed 9 Dec. 2018].
• Garima Kapoor. (2017). Action and resistance mechanisms of antibiotics: A guide for clinicians. [online] PubMed Central (PMC). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672523/ [Accessed 9 Dec. 2018].

Book

• Rang, H., Dale, M., Ritter, J., Flower, R. and Henderson, G. (2016). Rang and Dale’s pharmacology. [Amsterdam]: Elsevier, Churchill Livingstone.