World without antibiotics: how to deal with drug resistance

Posted on by

Do not include any personal opinions.

World without antibiotics: how to deal with drug resistance

I. resistance to antibiotics: Global threat to health

A. Determination and mechanisms of resistance to antibiotics

  1. Determining resistance to antibiotics (amr): Resistance to antibiotics occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to drugs. This makes infections more difficult to treat and increases the risk of the spread of diseases, serious illness and death. Antibiotics are drugs used to prevent and treat bacterial infections. Resistance to antibiotics occurs when bacteria mutate or acquire stability genes that allow them to survive when exposed to antibiotics.

  2. Mechanisms for the development of resistance to antibiotics: Bacteria use various mechanisms for the development of resistance to antibiotics. These include:

    a. Inactivation of antibiotics: Bacteria can produce enzymes that destroy or modify the antibiotic, making it ineffective. For example, beta-lactamases produced by many bacteria hydrolyzing the beta-lactam ring in the antibiotics of the penicillin row, inactivating them.

    b. Changing target antibiotics: Bacteria can change the antibiotic target molecule, so that the medicine can no longer contact it and have its effect. For example, resistance to rifampicin often occurs due to mutations in genes rpoBencoding the subunit of the RNA polymerase, the target of rifampicin.

    c. Antibiotic release from the cell: Bacteria can use the efflux pumps to active pumping an antibiotic from the cell, reducing the concentration of the drug inside the cell and preventing its effect on the target. These outflow pumps often have wide specificity and can ensure resistance to several classes of antibiotics.

    d. Reducing the permeability of the cell wall: Bacteria can change their cell wall to reduce the penetration of the antibiotic into the cell. This can be achieved by changing the structure or amount of porin proteins, which allow antibiotics to penetrate through the cell wall.

    e. Circle of the metabolic path: Bacteria can develop alternative metabolic tracks bypassing the target of antibiotics. For example, bacteria resistant to sulfonamides can absorb folic acid from the environment, instead of synthesizing its de novo, which is a tarphanyamide target.

  3. Transfer of stability genes: Sustainability genes can be transmitted between bacteria in several ways:

    a. Vertical transmission: Sustainability can be transmitted to the offspring of bacteria during cell division. If the bacterium acquires a mutation that ensures stability, this mutation will be transferred to all its descendants.

    b. Horizontal transfer of genes (HGT): HGT is the transfer of a genetic material between bacteria, not related to reproduction. The main HGT mechanisms include:

    i.  **Трансформация:** Бактерии могут поглощать ДНК из окружающей среды, например, ДНК, высвобождающуюся при гибели других бактерий. Если эта ДНК содержит гены устойчивости, бактерия-реципиент может стать устойчивой.

ii. **Трансдукция:** Бактериофаги (вирусы, инфицирующие бактерии) могут переносить ДНК между бактериями. Если бактериофаг заражает бактерию, содержащую гены устойчивости, он может включить эти гены в свою ДНК и передать их другой бактерии при последующем заражении.

iii. **Конъюгация:** Бактерии могут обмениваться ДНК напрямую через плазмиды. Плазмиды – это небольшие, кольцевые молекулы ДНК, которые могут реплицироваться независимо от хромосомы бактерии. Они часто содержат гены устойчивости и могут быстро распространяться между бактериями.

B. The prevalence and trends of Amr in the world

  1. Global prevalence: Resistance to antibiotics is common all over the world, but its level varies depending on the region, the type of bacteria and antibiotics. WHO considers Amr one of the 10 main global threats to human health.

  2. Trends: The prevalence of Amr has grown steadily in recent decades. This is due to many factors, including excessive and improper use of antibiotics in medicine, agriculture and aquaculture, as well as poor prevention and control of infections.

  3. Specific examples of stable pathogens:

    a. Methycillin-resisted golden staphylococcus (MRSA): MRSA is a bacterium that is resistant to beta-lactam antibiotics, such as methicillin and penicillin. This is a common cause of skin and soft tissue infections, as well as more serious infections, such as pneumonia and blood flow infections.

    b. Vancicomicin-resistant Enterococcus (Vre): Vre is a bacterium that is resistant to vanc -breeding, an antibiotic that is often used to treat serious infections caused by other stable bacteria. Vre can cause blood flow infections, urinary tract infection and wound infection.

    c. Carbapenem-resistant enterobacteria (Cre): Cre is bacteria resistant to carbapenems, a class of antibiotics, which are often used as “last hope” drugs for the treatment of serious infections. Cre cause serious concern, because they are often resistant to many other antibiotics, which complicates their treatment.

    d. Tuberculosis resistant to drugs (MDR-TB) and tuberculosis with wide medicinal stability (XDR-TB): MDR-TB is stable at least to isoniazida and rifampicin, the two most effective antibiotics used to treat tuberculosis. XDR-TB is resistant to isoniazida and rifampicin, as well as to any fluoroquinol and at least one of the three injection antibiotics of the second row (amikacin, kapreomitsin or Cana Mitsin).

    e. Neisseria gonorrhoeae with drug stability: Horror with medicinal stability is a growing problem around the world. Some gonorrhea strains are resistant to all the recommended antibiotics, which complicates the treatment of infection.

C. Factors contributing to the development of AMR

  1. Excessive and improper use of antibiotics in people: Excessive use of antibiotics, when they are not needed (for example, with viral infections), and the improper use of antibiotics (for example, passing doses or cessation of treatment too early) contribute to the development of AMR. When antibiotics are used in an unnecessary way, they kill sensitive bacteria, leaving stable bacteria for propagation and distribution.

  2. The use of antibiotics in agriculture and aquaculture: Antibiotics are widely used in agriculture and aquaculture to promote the growth and prevention of diseases. This contributes to the development of AMR in bacteria that can be transmitted to people through food products or the environment.

  3. Poor prevention and control of infections in healthcare: The poor practice of preventing and controlling infections in medical institutions can lead to the spread of bacteria resistant to drugs. To measures such as proper hand hygiene, insulation of infected patients and cleaning and disinfection of surfaces, can help prevent the distribution of AMR.

  4. Insufficient sanitation and hygiene: Poor sanitation and hygiene can contribute to the spread of bacteria resistant to drugs. A proper sanitation, such as access to pure water and sanitary conditions, as well as good hygienic habits, such as frequent hand washing, can help prevent the distribution of Amr.

  5. Globalization and movement: Globalization and movement of people and goods can contribute to the spread of bacteria resistant to drugs in different countries and regions.

D. The consequences of AMR for human health, economics and society

  1. Increased incidence and mortality: Infections caused by bacteria resistant to drugs can be treated and can lead to longer hospitalization, an increase in medical care costs and increasing the risk of death.

  2. Healthy healthcare costs: Treatment of infections caused by bacteria resistant to drugs is more expensive than the treatment of infections caused by sensitive bacteria. This is due to the fact that the treatment of infections caused by stable bacteria requires more expensive antibiotics, longer hospitalization and additional diagnostic tests.

  3. Economic losses: AMR can have a significant impact on the economy. An increase in incidence and mortality can lead to a decrease in labor productivity. In addition, additional healthcare costs associated with AMR can lie in a burden on the economy.

  4. The threat to modern medicine: Amr threatens the achievements of modern medicine. Many medical procedures, such as surgery, organs transplantation and chemotherapy, depend on the availability of effective antibiotics to prevent and treat infections. AMR undermines the effectiveness of these procedures.

  5. Disproportionate impact on vulnerable groups of the population: AMR disproportionately affects vulnerable groups of the population, such as small children, elderly people and people with a weakened immune system. These groups of the population are more susceptible to infections, and they are more likely to encounter serious consequences of infections caused by bacteria resistant to drugs.

II. Strategies for the fight against resistance to antibiotics

A. National Action Plans and Global Initiatives

  1. National Action Plans (NAP): Many countries have developed a NAP to combat AMR. These plans usually include strategies in:

    a. Improving the awareness and understanding of AMR among the population, medical workers and politicians. B. Strengthening the epidemic for AMR and the use of antibiotics. C. Reducing the frequency of infections by improving sanitary conditions, hygiene and prevention of infections. D. Optimization of the use of antibiotics in medicine and agriculture. E. Development of new antibiotics, diagnostic agents and other therapeutic agents.

  2. Global initiatives: Several global initiatives are aimed at combating AMR, including:

    a. AMR global plan of Action: The global AMR action plan, adopted in 2015, is the basis for the fight against AMR around the world. He calls on the countries to develop and implement NAP, improve the epidemic for AMR, optimize the use of antibiotics and stimulate research and development.

    b. Global System of the Epidemino for Amr (Glass): Glass is a global epidemic system for AMR, controlled WHO. It is aimed at collecting and analyzing AMR data in different countries for informing about politics and programs.

    c. Global partnership of antibiotic research and development (Gardp): Gardp is a joint initiative of WHO and Drugs for Neglected Diseases Initiative (DNDI). It is aimed at developing and delivering new and affordable methods of treating infections resistant to drugs, especially in countries with low and average income.

    d. Initiative “One Planet of Health”: The initiative “One Planet of Health” recognizes the relationship of human health, animal health and environmental health. It promotes a multi -sectral approach to solving problems associated with AMR, including the use of antibiotics in agriculture and the spread of bacteria resistant to drugs in the environment.

B. Improving the use of antibiotics.

  1. Definition and principles: Improving the use of antibiotics is consistent efforts to improve the use of antibiotics to ensure their use only when necessary, and to be used correctly. The basic principles of improving the use of antibiotics include:

    a. Using antibiotics only when it is necessary: Antibiotics should be used only for the treatment of bacterial infections. They are ineffective against viral infections, such as colds and flu. B. Choosing the right antibiotic: The antibiotic, which is used, should be effective against a bacterium that causes an infection. Tests should be carried out for sensitivity to determine which antibiotics with the greatest probability will be effective. C. Using the correct dose: The antibiotic should be used in the correct dose and for the correct duration. Too low dose or too short treatment may not kill bacteria and contribute to the development of resistance. An too high dose or too long treatment can increase the risk of side effects. D. The introduction of antibiotics correctly: The antibiotic should be administered correctly. Some antibiotics are best taken inside, while others must be administered intravenously.

  2. Strategies for improving the use of antibiotics in healthcare:

    a. Development and implementation of guidelines for the use of antibiotics: Guidelines for the use of antibiotics can help medical workers make reasonable decisions on the use of antibiotics. These manuals should be based on actual data and updated as new information appears. B. Training of medical workers using antibiotics: Medical workers must be trained in the proper use of antibiotics. This training should include information about AMR, the principles of antibiotic management and infections treatment guides. C. Audit and feedback: A audit and feedback can be used to monitor the use of antibiotics and identify areas for improvement. The audit includes viewing the medical history and recipes to determine whether antibiotics are used properly. Feedback is provided to medical workers based on the results of the audit. D. Restriction of antibiotic prescription: Some medical institutions have implemented restrictions on the appointment of certain antibiotics. This can help reduce the use of these antibiotics and slow down the development of resistance. E. Implementation of deferred recipes: The deferred recipe is the recipe that the doctor gives the patient, but tells him to fill it out only if his symptoms do not improve in a few days. This can help reduce the use of antibiotics for viral infections.

  3. Strategies for improving the use of antibiotics in agriculture:

    a. Reducing the use of antibiotics to promote growth: Antibiotics should not be used to promote livestock growth. Instead, farmers should focus on improving the health and well -being of animals due to proper nutrition, sanitary conditions and the prevention of diseases. B. Limiting the use of antibiotics for the prevention of diseases: Antibiotics should not be used to prevent diseases, with the exception of cases when there is a high risk of the disease. Instead, farmers should focus on improving herd management methods in order to prevent diseases. C. Using antibiotics under the supervision of a veterinarian: Antibiotics should be used only under the supervision of a veterinarian. Veterinarians can help farmers determine the proper antibiotic and dose, as well as monitor the reaction of the animals to treatment. D. Improving Biosopounts: Bios safety measures, such as proper hygiene and vaccination, can help prevent the spread of diseases in livestock farms. This can reduce the need for antibiotics.

C. Prevention and control of infections

  1. The importance of preventing and control of infections (IPC): IPC is crucial to prevent the spread of infections, including infection resistant to drugs. IPC measures are aimed at breaking the infection chain, reducing the number of microorganisms, the likelihood of their transmission and susceptibility of the owner.

  2. The main measures of IPC in healthcare:

    a. Hand hygiene: Hand hygiene is the most important IPC measure. Medical workers should wash their hands with soap water or use an alcohol -based disinfectant before and after contact with patients, as well as after touching the surfaces in the environment of the patient. B. Using personal protective equipment (PPE): PPEs, such as gloves, robes and masks, should be used to protect medical workers from exposure to infectious agents. C. Cleaning and disinfection of the environment: The surfaces in the environment of the patient should be regularly cleaned and disinfected. D. Isolation of patients: Patients with infectious diseases should be isolated to prevent the spread of infection to other patients and medical workers. E. Respiratory hygiene and cough etiquette: Patients and medical workers should observe respiratory hygiene and cough etiquette to prevent the spread of respiratory infections. This includes covering the mouth and nose with coughing or sneezing, as well as washing hands after that. f. Safe injection practice: Safe injection practice should be observed to prevent infections through injections. This includes the use of sterile equipment for each injection and proper utilization of needles and syringes.

  3. IPC measures in society:

    a. Hand hygiene: Hand hygiene is important to prevent the spread of infections in society. People should wash their hands with soap water or use a disinfectant for alcohol -based hands after visiting the toilet, before meals and after touching public surfaces. B. Safe preparation and storage of food products: Food should be cooked and stored safely to prevent food diseases. This includes washing hands before cooking, cooking to safe temperature and storing food in the refrigerator. C. Safe sex: The practice of safe sex, such as the use of condoms, can help prevent the spread of sexually transmitted infections. D. Vaccination: Vaccination is an effective way to prevent many infectious diseases. People should be vaccinated in accordance with the recommendations.

D. Development of new antibiotics and alternative treatment methods

  1. The need for new antibiotics: The development of new antibiotics is crucial for the fight against AMR. There is a constant need for new antibiotics to defeat bacteria resistant to drugs and prevent the occurrence of new resistance.

  2. Antibiotics development problems: The development of antibiotics is a complex and expensive process. There are several problems, including:

    a. Scientific problems: Bacteria are becoming more resistant to antibiotics. This complicates the search for new antibiotics that are effective against stable bacteria. B. Regulatory problems: The process of approving new antibiotics is long and expensive. This can restrain pharmaceutical companies from investment in the development of antibiotics. C. Economic problems: The antibiotic market is small. This is due to the fact that antibiotics are used only within a short period of time, and their use is often limited to prevent the development of resistance. This makes it difficult for pharmaceutical companies to reimburse the costs of developing antibiotics.

  3. Approaches to the development of new antibiotics:

    a. Traditional drug development: The traditional development of drugs includes the screening of thousands of compounds to identify those that have antibacterial activity. B. Opening new goals: Another approach to the development of antibiotics is the identification of new targets in bacteria that can be attacked with drugs. C. Development of resistance inhibitors: Resistance inhibitors are drugs that block the mechanisms of bacterial resistance. These drugs can be used in combination with antibiotics to restore their effectiveness. D. Alternative treatment methods: Alternative methods of treatment, such as phagish therapy and antimicrobial peptides, are developed as potential alternatives to antibiotics.

  4. Alternative treatment methods:

    a. Phagic therapy: Phagic therapy includes the use of bacteriophages (viruses infecting bacteria) for the treatment of bacterial infections. Phagic therapy is a promising alternative method of treating infections caused by bacteria resistant to drugs. B. Antimicrobial peptides: Antimicrobial peptides are small proteins that have antibacterial activity. They are a promising alternative method of treating infections caused by bacteria resistant to drugs. C. Monoclonal antibodies: Monoclonal antibodies are antibodies that are designed to bind to certain targets on bacteria. They can be used to neutralize bacteria or to enhance the immune response to bacteria. D. Probiotics: Probiotics are living microorganisms, which, when used in sufficient quantities, bring health benefits. Some probiotics, as shown, are effective for preventing or treating some bacterial infections.

E. Epidadzor and research

  1. The importance of the epidemic for Amr: The epidemiological supervision of AMR is necessary to track the prevalence of AMR, to identify new trends in resistance and assess the impact of measures to combat AMR.

  2. The components of the epidemic system for amr: The epidemic system for AMR should include:

    a. Laboratory diagnostics: Laboratory diagnosis is necessary to identify bacteria resistant to drugs. Laboratory should be able to carry out tests for sensitivity to antibiotics in order to determine which antibiotics with the greatest probability will be effective against a particular bacteria. B. Data collection: Data on AMR should be collected from various sources, including medical institutions, agricultural enterprises and food products. C. Data analysis: Data on the AMR should be analyzed to track the prevalence of AMR, identify new trends in resistance and assess the impact of measures to combat AMR. D. Data distribution: Data on AMR should be distributed among medical workers, politicians and the population.

  3. AMR research studies: Studies are necessary for the development of new ways to prevent and treat infections caused by bacteria resistant to drugs. AMR research should be focused on the following areas:

    a. Understanding of resistance mechanisms: Understanding the mechanisms of resistance is crucial for the development of new antibiotics and other therapeutic agents. B. Development of new diagnostic tools: New diagnostic agents are necessary for the quick and accurate detection of bacteria resistant to drugs. C. Development of new antibiotics: New antibiotics are necessary to combat bacteria resistant to drugs and prevent the occurrence of new resistance. D. Development of alternative treatment methods: Alternative methods of treatment, such as phagish therapy and antimicrobial peptides, are developed as potential alternatives to antibiotics. E. Assessment of the influence of measures to combat AMR: It is necessary to assess the impact of measures to combat AMR in order to determine whether they are effective.

F. Information and Education of the Public

  1. The importance of informing the public about Amr: Information of the public about AMR is necessary to increase awareness of the problem and promote the proper use of antibiotics.

  2. Key messages for the public: Key messages for the public about AMR should include:

    a. Antibiotics are ineffective against viral infections: Antibiotics are effective only against bacterial infections. They are ineffective against viral infections, such as colds and flu. B. Excessive use of antibiotics contributes to AMR: Excessive use of antibiotics contributes to the development of AMR. When antibiotics are used in an unnecessary way, they kill sensitive bacteria, leaving stable bacteria for propagation and distribution. C. Antibiotics should be used only as prescribed by a doctor: Antibiotics should be used only as prescribed by a doctor. It is important to take antibiotics exactly as prescribed, and undergo the entire course of treatment, even if you feel better. D. Good hygiene can help prevent infections: Good hygiene, such as frequent hand washing, can help prevent the spread of infections.

  3. Public informing strategies:

    a. Media campaign: The media campaigns can be used to increase the awareness of AMR and promote the proper use of antibiotics. B. Training: Training can be carried out for medical workers, the population and farmers about AMR and the proper use of antibiotics. C. Social media: Social networks can be used to disseminate information about AMR and to interact with the public. D. Partnership: Partnership with other organizations, such as medical institutions, agricultural groups and public organizations, can help increase awareness of Amr and promote the proper use of antibiotics.

III. The future of the fight against resistance to antibiotics

A. New technologies and innovations

  1. Diagnostic achievements: Fast and accurate diagnostic tests are crucial for improving the use of antibiotics. New technologies, such as molecular diagnostic methods and diagnostics at the place of medical care, promise to provide a faster and more accurate diagnosis of bacterial infections.

  2. Personalized medicine: Personalized medicine is an approach to treatment, taking into account individual characteristics of a person, such as its genetic composition, lifestyle and environment. Personalized medicine can be used to develop more purposeful and effective methods of treating infections caused by bacteria resistant to drugs.

  3. Artificial intelligence (AI): AI can be used to analyze large data arrays to identify new targets of drugs, develop new antibiotics and improve the use of antibiotics.

  4. Nanotechnology: Nanotechnologies can be used to develop new ways to deliver antibiotics to the place of infection. Nanoparticles can also be used to develop new antibacterial agents.

B. Politics and regulatory framework

  1. Strengthening the regulation of antibiotics: Governments may tighten the regulation of the use of antibiotics in medicine, agriculture and aquaculture. This may include a restriction on the use of antibiotics to promote animal growth, as well as the requirement to prescribe antibiotics by veterinarians.

  2. Stimulating the development of new antibiotics: Governments can stimulate the development of new antibiotics. This may include the provision of financial incentives, such as tax benefits and the extension of patent protection.

  3. Strengthening international cooperation: International cooperation is necessary to combat AMR. This includes the exchange of data on AMR, coordination of measures to combat AMR and investing in research and development.

  4. Politics of “Unified Health”: The policy of “unified health” recognizes the relationship of human health, animal health and environmental health. The policy of “unified health” is necessary to combat AMR.

C. Change in behavior

  1. Training of medical workers: It is necessary to train medical workers to the proper use of antibiotics. This training should include information about AMR, the principles of antibiotic management and infections treatment guides.

  2. Increased awareness of the population: It is necessary to increase the awareness of the population about AMR. This can be done using campaigns in the media, education and social networks.

  3. Encouraging proper hygienic habits: It is necessary to encourage proper hygienic habits, such as frequent hand washing.

  4. Changing the attitude to antibiotics: It is necessary to change the attitude to antibiotics. Antibiotics should be considered as a valuable resource that should be used economically.

D. Investments and financing

  1. Increasing research and development financing: Investments in research and development are needed. This includes investments in the development of new antibiotics, new diagnostic agents and alternative treatment methods.

  2. Support for antibiotics management programs: Support for antibiotic management programs is needed. These programs can help improve the use of antibiotics and slow down the development of resistance.

  3. Improving the prevention and control of infections: It is necessary to improve the prevention and control of infections. This includes investments in proper hygiene, sanitation and vaccination.

  4. Creating a global fund to combat AMR: It is necessary to create a global fund to combat AMR. This fund can be used to support measures to combat AMR in low and medium income countries.

Leave a Reply

Your email address will not be published. Required fields are marked *