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The use of antimicrobialantimicrobial
A group of medicines including antibiotics, anti-viral and anti-fungal medicines. These are used to treat infections by bacteria, viruses, fungi, and parasites.
s acts as a selection pressureselection pressure
Event(s) which affects the ability of an organism to survive in its environment.
. Only resistant microbesmicrobes
Group of organisms of microscopic size that can be found in a single cell form or forming multicellular colonies. Most microbes are found in the domains of archaea and bacteria, but there are also some eukaryotes.
can survive exposure to antimicrobialsantimicrobials
A group of medicines including antibiotics, anti-viral and anti-fungal medicines. These are used to treat infections by bacteria, viruses, fungi, and parasites.
. These resistant microbes can go on to replicate and pass their resistance on to their offspring. Resistant microorganisms consequently become more common in the population. This process occurs whenever antimicrobials are used.
The misuse of antimicrobials speeds up the spread of resistance. There are many different types of misuse. Some examples are described below.
Patients can inappropriately take antimicrobialantimicrobial
A group of medicines including antibiotics, anti-viral and anti-fungal medicines. These are used to treat infections by bacteria, viruses, fungi, and parasites.
s in various ways. Examples include:
The exposure of microbesmicrobes
Group of organisms of microscopic size that can be found in a single cell form or forming multicellular colonies. Most microbes are found in the domains of archaea and bacteria, but there are also some eukaryotes.
to a low concentrationconcentration
The amount of a substance (solute) in a solution.
of medicine (as achieved when skipping doses or not taking doses at regular time intervals) increases the spread of resistance, as there is a lower chance that microbes will be killed.
Infections often clear without the help of antimicrobialantimicrobial
A group of medicines including antibiotics, anti-viral and anti-fungal medicines. These are used to treat infections by bacteria, viruses, fungi, and parasites.
s. It is predicted that 30% of all antibioticantibiotic
Medicine that is used to treat bacterial infections and works by killing or stopping the growth and reproduction of bacteria. These can be specific to a particular bacteria or act on groups of related bacteria.
s prescribed out of hospitals are unnecessary.
In addition, inappropriate antimicrobialsantimicrobials
A group of medicines including antibiotics, anti-viral and anti-fungal medicines. These are used to treat infections by bacteria, viruses, fungi, and parasites.
are often prescribed. One potential reason for this is that there are very few diagnostic tools capable of rapidly identifying infections. Consequently, infections can be wrongly diagnosed and inappropriate antimicrobials used as treatment.
Narrow spectrum antimicrobials are medicines that target either a single species or a few species. A lack of diagnostics also stops doctors using narrow spectrum antimicrobials as often as they could.
A review published in the British Medical Journal in 2017 suggested that courses of antibiotics are too long. The authors claimed that antibiotic treatments are prescribed based on a fear of under treating a patient. The authors claimed that over use is more concerning than under treatment.
The ideas presented in this review were picked up on by the media, who claimed that this review concluded that patients did not need to finish a course of antibiotics. This is a simplification of a complicated issue.
Read the articles below:
Rule that patients must finish antibiotics course is wrong, study says, The Guardian
'Don't finish the course of antibiotics'- experts turn medical advice on its head, The Telegraph
What do you think?
In some countries around the world, antimicrobialsantimicrobials
A group of medicines including antibiotics, anti-viral and anti-fungal medicines. These are used to treat infections by bacteria, viruses, fungi, and parasites.
can be bought from a pharmacy or online without a prescription. This uncontrolled access to antimicrobials is irresponsible as there is a risk that these medicines will be used unnecessarily and inappropriately. Specific antimicrobials are prescribed for specific infections- not all antimicrobials can treat all infections.
In many countries healthcare is extremely expensive and hard to access. Unrestricted sale of antimicrobials enables individuals in these countries access to these medicines.
This poses an ethical dilemma whether to restrict antimicrobials in these countries- as even though restriction could reduce the spread of resistance it could also prevent access to these lifesaving medicines for many individuals.
What do you think?
Should access to antimicrobials be restricted?
In the UK in 2013, 44% of the total antibiotic use was in animals. Antibiotics are used in animals for three reasons: to treat infections, as prophylaxisprophylaxis
Use of medicines to prevent an infection or disease occurring.
and to promote growth.
The use of antibiotics for growth promotion is controversial. The hypothesis is that antibiotics kill the normal microbesmicrobes
Group of organisms of microscopic size that can be found in a single cell form or forming multicellular colonies. Most microbes are found in the domains of archaea and bacteria, but there are also some eukaryotes.
in the intestine, which is thought to increase the amount of nutrients available for the animal and enhance growth. This practice however drives resistance development in animals. Humans then consume these animals as meat, which causes the spread of resistance to continue. The use of antibiotics for growth promotion is illegal in many countries.
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Antibioticantibiotic
Medicine that is used to treat bacterial infections and works by killing or stopping the growth and reproduction of bacteria. These can be specific to a particular bacteria or act on groups of related bacteria.
s are used for various reasons in farm animals such as sheep, cows and chickens.
There have been reports of antimicrobialantimicrobial
A group of medicines including antibiotics, anti-viral and anti-fungal medicines. These are used to treat infections by bacteria, viruses, fungi, and parasites.
s leaking into the environment surrounding factories. This can happen as a result of substandard manufacturing conditions.
Pollution from factories can expose microorganisms in the local environment to antimicrobialsantimicrobials
A group of medicines including antibiotics, anti-viral and anti-fungal medicines. These are used to treat infections by bacteria, viruses, fungi, and parasites.
. This promotes the growth of resistant microbesmicrobes
Group of organisms of microscopic size that can be found in a single cell form or forming multicellular colonies. Most microbes are found in the domains of archaea and bacteria, but there are also some eukaryotes.
. Even though the pollution is local - due to travel, this resistance can quickly spread globally.