Antibiotics 2015). The residual bacteria remaining from the

Antibiotics
are a class of drug used to treat many bacterial infections. There are
bactericidal antibiotics, such as penicillin; that function to unreservedly
kill the bacteria cells. There also exists a type of antibiotic called a
bacteriostatic, such as streptomycin or tetracycline; that prevent the growth
and reproduction of bacteria. “The first true antibiotic was discovered by
accident by Alexander Fleming, a Professor of Bacteriology at St Mary’s
Hospital London” (American Chemical Society, 2015). Antibiotics are usually
chemicals produced by bacteria or fungi that can inhibit the growth and
reproduction of bacteria, consequently killing the infection, or killing the
bacteria outright as discussed above. Bacteria on the other hand are classed as
either gram positive or gram negative. Gram positive refers to for example,
Clostridium species and Bacillus species, which when saturated with Gram stain
retain crystal violet within their cells and thus appear blue or purple under
the microscope. Gram negative bacteria, for example, Pseudomonas species do not
retain the crystal violet stain. The difference between the two groups is due
to their different cell wall compositions (Griffin, 2018).

Each year in the United States alone, at least 2 million people become infected
with bacteria that are resistant to antibiotics and at least 23,000 people die
each year as a direct result of these infections (Cdc.gov, 2018). Antibiotic
resistance means that researchers must engage in “an infectious arms race”
(Hede, 2014), to develop new antibiotics to treat new, resistant, bacterial
infections as quickly as they arise in hospitals all over the world. The
consequence of antibiotic resistant bacteria can be catastrophic (Frieden,
2013), in the short term leading to increased morbidity in patients, increased
mortality, longer patient hospital stays, increased cost of healthcare, and the
subsequent spread of the multi-drug resistant bacteria (N. Naegeli and J. Roup,
2016).

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Literary Review:

Antibiotics are used habitually, and over use is widespread. This has caused an
abundance of different types of bacteria to become resistant (unresponsive) to
antibiotics. Because resistance has become more common, many diseases cannot be
treated as well as they could in the past (PubMed Health, 2013), as agreed with
by (Lee Ventola, 2018) on this paper discussing antibiotic resistance. A common
cause contributing to the antibiotic resistance crisis is people feeling their
symptoms alleviate after 3 or 4 days of antibiotic use and not finishing the
full course as prescribed (Duong, 2015). The residual bacteria remaining from
the infection reproduce and multiply to a strain resistant to the antibiotics
used to treat the infection. This is intrinsic resistance. Acquired resistance
is the process of a bacterium changing in the way it protects itself from an
antibiotic via a genetic change or the transfer of a gene coding for resistance
from another bacterium cell in the process of horizontal gene transfer.

According to the Duke Global Health Institute (Boyce, 2017), the main factors
precipitating the threat of antibiotic resistance is the abuse of antibiotics
and lack of viable drug alternatives, culminating in an acceleration of
bacteria developing resistance. Antibiotic resistance is directly responsible
for 25,000 deaths in Europe per year, most of which are avoidable by using
antibiotics properly (Health and Food Safety, 2016). Moreover, pharmaceutical
companies are often reluctant to inject money into the research and development
of new antibiotics due to unfavourable returns on investment (Kanapaux, 2004).
People will typically use antibiotics only for a week or two at most, hence
they generate less of a profit than other drugs. For example, chemotherapy
drugs to treat cancer, or long-term pain medications (BNF 74, 2017). The World
Health Organisation has developed a list of 3 main bacteria strains that fall
under their critical priority class for the development of new antibiotics:
acinetobacter baumannii, pseudomonas aeruginosa and enterobacteriaceae. These
bacteria are most commonly contracted from contaminated food, water or hospital
equipment (Manchanda, Sinha and Singh, 2010). The resulting infections can
cause severe, life-threatening illnesses, including pneumonia and
gastrointestinal illness, for which there are no effective treatments (Boyce,
2017).

In terms of the future for antibiotics, the best way to solve the antibiotic
resistance crisis is to increase infection prevention rather than treating
infections already contracted. This means more thorough handwashing, more use
of ppe and maintaining a generally high standard of hygiene in the clinical and
community settings. Moreover, developing rapid diagnostic and biomarker tests
that empower providers to withhold antibiotics from patients who don’t have
bacterial infections and shorten antibiotic courses for those who do (Spellberg,
Bartlett and Gilbert, 2013) could aid in the prevention of antibiotic
resistance in the future by effectively eliminating unnecessary prescriptions
for antibiotics. The most common tests found in GP practices today are the C
reactive protein test (CRP) and urinalysis machine; CRP testing has reduced
antibiotic prescribing for respiratory tract infections by 25% (Gov.uk, 2014).
However, this is can be a paradox, as often people do not feel that they have
received treatment from their physician if they are not prescribed medication; this
pressures doctors to prescribe antibiotics when they are not needed just to
satisfy their patients demand for drugs to cure their infection. On the same
note, many doctors are reluctant to restrict their antibiotic prescriptions, as
other doctors who do not concern themselves with the problem will continue to
over prescribe the drugs, depleting motivation for some doctors to prevent
antibiotic resistance. Furthermore, a doctor’s main responsibility is with his
or her patient, so not treating them for the sake of societal antibiotic
resistance prevention does not sit well with many physicians (Fletcher-Lartey
et al., 2016). This can account for most of antibiotic prescriptions in England
in 2014 being written by GP doctors (74%) compared to 11% for hospital
inpatients, 7% for hospital outpatients, 5% by dentists and 3% in other
community settings (Gov.uk, 2014). According to the BMJ, these days, antibiotic
prescribing is closely monitored by NHS trusts and GP practices across the UK,
with the aim of reducing overuse and inappropriate use of antibiotics, to
reduce the spread of antimicrobial resistance (Llewelyn et al., 2017). This has
been proven to be effective in the GP primary care setting with a reduction of
8.5% in prescribing of antibiotics, however NHS trust hospitals showed an
increase of 33.3% between 2010 and 2014 (Gov.uk, 2014).

A study has also reported that a treatment regimen consisting of a high initial
dose followed by an extended tapering dose of antibiotic optimises antibiotic
use and improves the success of eradicating infections (30% less antibiotic
drug required) (Paterson et al., 2016). Therefore, this method of antibiotic
dosing may be something to research further in medical research for future use
of antibiotics. On the other hand, MJ Llewelyn argue that (Llewelyn et al.,
2017) that the body’s own immune system is capable of ‘mopping up’ the
remaining live bacteria pathogen along with the debris following a course of
interrupted antibiotic treatment. The correlation between antibiotic exposure
and antibiotic resistance is positive both at the population level and in
individual patients. Reducing antibiotic abuse is therefore essential to
mitigate antibiotic resistance argues (Llewelyn et al., 2017). Moreover,
another challenging factor straining the effort to stay ahead of the antibiotic
resistance curve is the use of antibiotics in agriculture, used on farms to
prevent livestock becoming diseased from bacteria. This has obvious economic
advantages, less livestock is killed by bacterial infections, leading to higher
profits in farming (Reardon, 2014). The report on agricultural use also
outlines that only 5% of the 139 academic papers identified in a separate
literature review argued there was not a link between antibiotic consumption in
animals and resistance in humans, while 72% found evidence of a link (O’neill,
2015). The report’s authors suggest this supports a link and provides enough
justification for policy makers to aim to reduce the global use of antibiotics
in food production to a more appropriate level. Farmers will not cease
antibiotic use altogether unless there is a suitable and effective alternative,
so stricter regulation over quantity dispersed to farm animals can reduce the
rate of resistant bacteria growth.

To conclude, it would be naive for any scientist to claim that they know the
future for antibiotics and their applications for modern medicine, however,
science can conclude that it is vital to reduce the volume of antibiotics
prescribed. Especially where they are not needed and won’t alleviate an
infection. There is a resounding confidence amongst all the literature
researched for this paper that antibiotics have their place in modern medicine,
and hopefully the future of modern medicine, but it is imperative that they are
not abused. I don’t believe that there will be an apocalypse and/or an
antibiotic free era (Reardon, 2014), as the WHO is actively working to prevent
this from happening. 

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