An alternative to the future of antimicrobial therapy

This article was exclusively written for The European Sting by Mr .Henrique de Castro Veiga, a 19 year old first-year medical student at the Centro Universitário do Planalto Central Apparecido dos Santos (UNICEPLAC), Brasília. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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Nowadays, one of the most damaging attitudes to public health that a doctor can take is to prescribe antibiotic therapy against microbial infections disregarding the defense systems of invasive bacteria and the acquisition of resistance to prescribed therapy due to an incorrect or controversal perscription. Unfortunately, this practice is common among doctors due to inattention, misinformation and/or irresponsibility when recommending a drug. The risks posed by this practice are: ineffectiveness of the antibiotic due to the selection of resistant strain of bacteria, the prolongation of bacterial infection, the increased risk of transmission to close people and the increased number of deaths from transmissible and curable bacterial pathologies. Furthermore, data released by World Health Organization (WHO) – a branch of the United Nations (UN) – in April, 2019 show that unresponsive drug infections already represents 700,000 deaths worldwide, 230,000 of which are caused by antibiotic-resistant tuberculosis. If nothing is done, an average of 10 million people are likely to die each year from resistant bacterial infections by 2050. Some of the bacteria on the UN’s top priority list for the development of new antibiotics are Ancinetobacter baumannii, Pseudomonas aeruginosa, Enterobacteriacea and Staphylococcus aureus. The aquisition of bacterial resistance is an evolutionary strategy for survival that involves programmatic rearrangement of the resistance-coding genes expression. This rearrangement may occur through bacterial reproduction mechanisms or induction of favorable mutations. An example of bacterial mutagenic factor is benzopyrene, an substance present in cigarette smoke and car exhaust smoke. Benzopyrene promotes genetic modifications that may lead to positive mutations for the bacterium by causing the exclusion of nitrogenous bases from DNA. As for the reproduction mechanisms, bacteria can be mutated to gain resistance in three ways: transformation, transduction and conjugation. Bacterial reproduction is based on the exchange genetic material between a donor bacteria and a recipient bacteria or the acquisition of plasmids or DNA fragments that will eventually be adhered to the genetic material of the recipient bacteria and used to form resistance mechanisms. Although the increase in resistant microbes is mostly caused by inappropriate antibiotic use, the work to combat antimicrobial resistance can be divided among all areas of health professionals. The proposal would be to create comprehensive and multiprofessional health networks with established communication ways in three main focuses: (1) set guidelines for treatment of infections using antibiotics as last resort against low and medium severity infections; (2) establish rules for the appropriate use and availability of antibiotics for healthcare and pharmacy professionals; (3) promote information and education programs for the population to inhibit the indiscriminate use of antibiotics and their consequences. The expected challenges for such an approach are related with the formation of an health network and the consensus among healthcare and pharmacy professionals. The desired results are: to strengthen patients’ immune systems using non-pharmacological methods, to prevent easy and indiscriminate access and use of antibiotics when there in no need for them, and to educate the population about the proper use of antimicrobial drugs and how to help preventing the progressive antimicrobial resistance. References

• World Health Organization (WHO), Report on Surveillance of Antibiotic Consumption. 2016–2018, Early Implementation [Data files]. Retrived November 20, 2019 from https://www.who.int/medicines/areas/rational_use/oms-amr-amc-report-2016-2018/en/
• World Health Organization (WHO), No Time to Wait: Securing the future from drug-resistant infections. April, 2019. Retrieved November 18, 2019 from https://www.who.int/antimicrobial-resistance/interagency-coordination-group/final-report/en/
• CÁRDENAS, Lorena L., MERCHÁN, Maritza A., LÓPEZ, Diana P. New antibiotics against bacterial resistance. Revista de La Associación Colombiana de Infectologia INFECTIO, Vol. 23 (4), 2019.
• ERRECABORDE K. M.; RIST. C.; TRAVIS. D.A.; et al. Evaluating One Health: the role of team science in multisectoral collaboration. Revue Scientifique et Technique, Vol 38 (1). 2019.

• MIYAHARA E.; NISHIE M.; TAKUMI S.; et al. Environmental mutagens may be implicated in the emergence of drug-resistant microorganisms. FEMS Microbiol Lett. 2011 Apr; 317(2):109-16.

About the author Henrique de Castro Veiga is a 19 years old first-year medical student at the Centro Universitário do Planalto Central Apparecido dos Santos (UNICEPLAC), Brasília, and a active local coordinator for IFMSA-Brazil. Hobbies are piano and reading. Currently thinking about a carrer in the study of medical genetics. He is participating on various academics and extracurricular activities related to genetics and microbiology.