The role of one health education in combatting antibiotics resistance

This article was exclusively written for The European Sting by Ms. SNDJON LIND, a sixth year medical student at the Faculty of Medicine and Pharmaceutical Science of the University of Douala (FMPD-UD). She is affiliated with 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.

The  term “antibiotics” was ever coined by the American microbiologist Selman Waksman and his team in 1942, who successfully isolated chemical substances from microorganisms capable of inhibiting the growth of other microbes [1]. To appreciate the life-saving importance of antibiotics today, we must remember the pre-antibiotic era, when common skin infections (like cellulitis and erysipelas) frequently led to death. The “golden era” of antibiotic discovery following World War II identified numerous classes of antibiotics still used today which earlier reduced death rate drastically [1]. Penicillin’s 1928 discovery by Sir Alexander Fleming launched a highly productive period of antibiotic discovery that peaked by the mid-1950s. Resistance to Penicillin was first noted in early 1940, when Escherichia coli inactivated the drug using the enzyme penicillinase. This allowed the pathogen to survive or multiply despite antibiotic treatment, a condition known as antibiotics resistance. [2]. 

Currently, antibiotic resistance has emerged as a major, worldwide crisis, it seems living that era without antibiotics. We have heard of 1st to 5th generations cephalosporins, an example of how an antibiotic has evolved from simple to complex forms and the higher the generation, the worst the side effect. Having to treat cellulitis with a 5th generation cephalosporins instead of a 2nd or 3rd as we do is a real problem [3]

 This silent crisis stems primarily from inappropriate human antibiotic use (misprescription, non-adherence, prophylaxis) to the past use of antibiotics as livestock growth promoters and the  environment (water and soil) acting as a “mixing vessel” for resistant gene exchange, spread through manufacturing and sewage runoff [2,3]. 

All these phenomena lead to a closed and continuous cycle, highlighting the need for urgent action  to reduce the impact and spread of antibiotic resistance. Tackling antibiotics resistance at the intersection of human and environmental health demands the One Health approach, a collaborative, multisectoral, and transdisciplinary framework that recognizes the inextricable linkages between human, animal, and environmental health. Within this strategy, education plays a central role.  A recent study carried by Hurley et al on about 3000 veterinary students showed gaps in knowledge and practices concerning antibiotic resistance. Given the interconnected nature of this crisis, a siloed educational approach is insufficient [3,4]. The One Health model directly addresses these shortcomings by implementing specific, goal-oriented teaching methods aimed at curbing the spread of antibiotic resistance. Maintaining the efficacy of antibiotics requires significant contributions from human and animal health professions. Major  objectives of this approach include creating comprehensive curricula focusing on mandatory modules on environmental transmission pathways, the principles of antimicrobial stewardship in both clinical and agricultural settings, and the sociology of antibiotic prescribing behavior  as well as introducing interdisciplinary case studies between medical, veterinary, and public health students collaborating on  cases about multi-drug resistant infections traced from a farm to a hospital [4]. 

In conclusion, it’s essential to adopt a One Health approach to revise medical, veterinary and public health education and standardize all providers’ competency in microbial resistance for a better world.

REFERENCES

[1] Muteeb G, Rehman MT, Shahwan M, Aatif M. Origin of Antibiotics and Antibiotic Resistance, and Their Impacts on Drug Development: A Narrative Review. Pharmaceuticals 2023;16(11):1615. 

[2] Hutchings MI, Truman AW, Wilkinson B. Antibiotics: past, present and future. Curr Opin Microbiol 2019;51(1):72–80. 

[3] Shlaes DM, Bradford PA. Antibiotics—From There to Where?: How the antibiotic miracle is threatened by resistance and a broken market and what we can do about it. Pathog Immun 2018;3(1):19. 

[4] Marvasi M, Casillas L, Vassallo A, Purchase D. Educational Activities for Students and Citizens Supporting the One-Health Approach on Antimicrobial Resistance. Antibiotics 2021;10(12):1519. 

About the author

SNDJON LINDA is a sixth year medical student at the Faculty of Medicine and Pharmaceutical Science of the University of Douala (FMPD-UD). She currently serves as the Vice President for external affaires’ Liaison Officer to IFMSA and National Member Organizations (NMOs) in the Cameroon Medical Students’ Association. She is a passionate aspiring neuroscience actor, a global health and medical research enthusiast.  Her love for leadership motivated her to serve as the Director of the Standing Committee for Medical Students Social Security where she coordinated a couple of activities for the past two years in the aforementioned association.