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Isabelle Stull
Dr. Freymiller
CAS 138
11 April 2017
The Resistance Epidemic
In 2009, the Swine Flu was a massive influenza pandemic that took the world by surprise
and sent everyone into a panic. The H1N1 virus was such a big deal because it was an entirely
new strain which most people had little to no immunity for. Furthermore, in the past, influenza
pandemics have resulted in the death of millions. Imagine if every day diseases like strep throat
and bacterial pneumonia caused the same kind of panic as the Swine Flu. If we don’t place more
emphasis on fighting antibiotic resistance and provide more funding for research, we may not
have to imagine that scenario much longer because it will become reality.
According to the Alliance for the Prudent Use of Antibiotics (APUA) at Tufts, “antibiotic
resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial
growth” (“What is Antibiotic…”). Some bacteria have a natural resistance to specific kinds of
antibiotics. This natural resistance is also called intrinsic resistance and clinician awareness of
such resistance is important so that ineffective treatments are not prescribed which would further
promote unnecessary antibiotic use. Our greater concern is with the bacterial ability to become
resistant either through a genetic mutation of their own or via a transmission from another
bacterium. This ability is often called acquired resistance. Genetic mutations can occur randomly
and can be effective against antibiotics by giving bacteria the ability to produce an enzyme that
inactivates the antibiotic or by sealing the region through which an antibiotic enters the cell.
While the random genetic mutations can’t be prevented, they present an issue because the non-
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resistant bacteria are killed off while the resistant ones remain and thrive in the environment.
Their survival allows them to pass on the resistance through reproduction or conjugation which
is the transfer of genes from one bacteria to another (“Antimicrobial Resistance Learning…”).
Antibiotic resistance is perpetuated by misuse and overuse in both humans and animals.
As mentioned earlier, bacterial intrinsic resistance can lead to misuse of antibiotics if a clinician
isn’t properly educated on which antibiotics are effective and which aren’t. Overuse occurs when
antibiotics are overprescribed or prescribed when they aren’t actually necessary. According to
estimates by the CDC, up to 50% of antibiotics are unnecessary or not appropriate for the
bacteria they’re trying to cure. Due to their nature of being viewed as a cure-all, patients often
push providers to prescribe antibiotics for viral illnesses. Another patient fault is stopping the
drug regimen before it’s complete because the symptoms have resided. This results in the death
of most of the bacteria but not all and so the remaining bacteria develop resistance (Chin).
Antibiotics are used in livestock to prevent disease as well as promote growth and health and
ensure survival in the poor conditions. Small doses are given regularly and for the most part,
their goal isn’t to fight illness. This leads to the development of resistant bacteria in the guts of
livestock such as chickens and cows. Veterinarians will also often give antibiotics in a
preventative manner such as right after a surgery when the risk of infection is high
(“Prophylactic or Metaphylactic…”).
Understandably, antibiotic resistance poses a major threat in the healthcare world and
there are a multitude of diseases that are resistant to one or more kinds of antibiotics. In fact, in
January of 2017, a woman died after being infected with a bacterium that was resistant to all 26
different antibiotics that are available in the United States (Brink). This bacterium, and others
like it, have been nicknamed superbugs. The Center for Disease Control has compiled a report
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that discusses the major drug-resistant bacteria and categorized them based on the danger they
pose. Urgent threat antibiotic resistant bacteria offer the most extreme risks and include
Clostridium Difficile, Carbapenem-Resistant Enterobacteriaceae, and Neisseria gonorrhoeae. C.
difficile is a common nosocomial infection, or an infection that was contracted in a hospital or
health care facility, threatening both patients and providers alike. CRE is another nosocomial
infection that infects the bloodstream and nearly half the number of patients who acquire these
bacteria die from the infection. Neisseria gonorrhoaea causes gonorrhea and is on the verge of
becoming resistant to the only two antibiotics that remain able to cure it. Methicillin-resistant
Staphylococcus aureus or MRSA is categorized as a serious threat bacteria but is one of the more
common bacteria that is contracted in a hospital setting. Fortunately, cases of MRSA seem to be
declining (“Biggest Threats”).
Perhaps, the most important problem with antibiotic resistance is the fact that it doesn’t
seem to be going away or finding any sort of resolution in the near future. The CDC identified 18
major bacteria that are behind antibiotic resistant diseases and the report in which the species
were named was from 4 years ago. Our current medicines are ineffective against these diseases
and we’re doing nothing to develop medicines that are effective. If we can’t get the resistance
rate under control, some experts say we’ll find out what it’s like to live in a world without
antibiotics. Furthermore, antibiotic resistance poses a financial burden, adding $20 billion in
excess health care costs according to the CDC. Betsey McCaughy, a health policy expert,
estimated $30.5 billion was spent in relation to hospital-acquired infection costs in 2014. Dr. S.
Cosgrove et al. determined that patients with antibiotic resistance cost anywhere from $6,000 to
$30,000 more than their counterparts infected with treatable bacteria (“The Cost of Resistance.”).
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Currently, there are some things that are being done to fight this epidemic but it’s not
nearly enough. Some hospitals have instituted a policy meant to guide and review the use of
antibiotics to make sure the use is necessary and doesn’t advance this resistance. A handful of
governments have placed restrictions on the antibiotics that are given to livestock. The World
Health Organization created a document called the “Global Strategy for Containment of
Antimicrobial Resistance,” which urged policy-makers and governments to step up and play a
role in this fight (“General Background…”). According to the funding report by the National
Institute of Health, the United States is only putting about $400 dollars of funding towards
researching antimicrobial resistance. To compare, about $3,000 is used for research on the
human genome (“Estimates of Funding”). The Food and Drug Administration is also taking steps
to fight antibiotic resistance, acknowledging that it’s a serious problem. According to their
website, they are ensuring that labels are regulated and properly address how to appropriately use
antibiotics. Also, they’re connecting with the CDC to create a campaign that aims to inform the
public about how to prevent antibiotic-resistant infections. Furthermore, they’re taking an active
role in the process of developing new antibiotics (“Combating Antibiotic Resistance”).
The biggest problem in combatting antibiotic resistance is the lack of funding which
severely inhibits any action. The first step should be to slow down the rate of resistance in order
to create time for other things to occur, such as research. Decreasing this rate is majorly
dependent on the education of the public, as the FDA seems to have determined as well. As
previously stated, one of the big factors behind resistance is misuse and overuse. If patients were
educated on not only the fact that antibiotic resistance is an issue but how they’re perpetuating it,
they might be more inclined to want to take action themselves. It’s important to place emphasis
on the fact that even the smallest of actions offer a contribution and are helpful. Preventative
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measures can be as simple as making sure to take the entire regimen of antibiotics, washing
one’s hands frequently, choosing to wash one’s hands over using a hand sanitizer, washing
produce properly and thoroughly, and cooking meat completely. It’s also important to place
focus on an antibiotic’s inability to affect a viral infection and distinguish which common
diseases originate from a virus or a bacterium. The FDA and CDC pairing to create an
educational campaign is extremely beneficial to the cause because it means that money doesn’t
have to be taken away from the NIH which is devoted to research. The FDA and CDC and both
reputable sources that the public would take seriously.
Once the solid education basis is established, it’s important to focus on funding for
research. Helpful things to research might include working to discover new antibiotics or looking
for a completely new alternative to fight bacterial diseases like bacteriophages. However, before
new or extensive research can be done, money needs to be available. It’s hard to decide if money
should be taken away from one subject of research under the NIH in favor of a different subject
so perhaps it’d just be better to suggest that more money is put towards medical research by the
federal government. Former president Obama wanted to increase funding to the NIH during his
time in office whereas President Trump wants to cut the funding by 18% (Zeltner). However, all
of the research doesn’t have to be conducted by government organizations. It might be healthy to
encourage competition between pharmaceutical companies to either work towards discovering
new cures for bacterial diseases or a better alternative to antibiotics.
To conclude, antibiotic resistance is a serious issue that could launch us back into the
medical Dark Ages if not taken care of properly and efficiently. The most significant problem
and cause of resistance is due to misinformation leading to improper or inadequate use of
antibiotics. There is a large number of diseases that have already developed resistance and are
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now untreatable by current methods. Fortunately, not all hope is lost because there’s a lot that
can be done to combat this resistance. There is a small number of things that are already in place
to break down antibiotic resistance but there’s plenty more that can be done. Hopefully, you too
are encouraged to take action after realizing how monumental this epidemic actually is and
getting to take a peek at the bleak future of ultimate bacterial survival.
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Works Cited
"Antimicrobial Resistance." Antimicrobial Resistance Learning Site For Veterinary Students.
Michigan State University, 2011. Web. 10 Apr. 2017.
"Biggest Threats." Centers for Disease Control and Prevention. Centers for Disease Control and
Prevention, 08 Sept. 2016. Web. 10 Apr. 2017.
Brink, Susan. "A Superbug That Resisted 26 Antibiotics." NPR. NPR, 17 Jan. 2017. Web. 10
Apr. 2017.
Chin, Teresa. "Antibiotic Resistance." Health Policy Briefs. Health Affairs, 21 Apr. 2015. Web.
11 Apr. 2017.
"Combating Antibiotic Resistance." U S Food and Drug Administration Home Page. Office of
the Commissioner, 15 Nov. 2011. Web. 11 Apr. 2017.
"The Cost of Resistance." Alliance for the Prudent Use of Antibiotics - APUA. APUA, 2014.
Web. 11 Apr. 2017.
“Estimates of Funding for Various Research, Condition, and Disease Categories
(RCDC).” National Institutes of Health. U.S. Department of Health and Human Services,
10 Feb. 2016. Web. 11 Apr. 2017.
"General Background: What can be done about Antibiotic Resistance?" Alliance for the Prudent
Use of Antibiotics - APUA. APUA, 2014. Web. 10 Apr. 2017.
"Prophylactic or Metaphylactic Use." Antimicrobial Resistance Learning Site For Veterinary
Students. Michigan State University, 2011. Web. 11 Apr. 2017.
"What Is Antibiotic Resistance and Why Is It a Problem?" Alliance for the Prudent Use of
Antibiotics - APUA. APUA, 2014. Web. 10 Apr. 2017.
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Zeltner, Brie. “Trump’s Budget Puts Local Public Health, Medical Research and Jobs at
Risk.” Cleveland.com. Advance Ohio, 17 Mar. 2017. Web. 22 Mar. 2017.