Antimicrobial Resistance and innovations shaping our future

Antimicrobials in common practice are used to reduce the duration of illness and the chance of death from infections. They also prevent infections in people who are at high risk, such as patients undergoing surgery and those with weakened immune systems. They are a rare class of medication where the treatment of one patient can potentially affect the outcome of other patients and communities through the transmission of antimicrobial-resistant microbes. 

Antimicrobial Resistance (AMR) occurs when microbes like bacteria, viruses, fungi, and parasites evolve to develop mechanisms to evade the effects of drugs designed to kill them by mutating or acquiring mutated genes from other microbes. When resistance to commonly used first-line antibiotics occurs, we often need to take alternate or reserve drugs for effective treatments. The more often antibiotics are used or taken incorrectly, the more likely it is that resistant bacteria will survive, grow, and multiply. This can make future bacterial infections much harder to treat and increase the risk of disease spread in the body and the community.

AMR isn’t just a scientific challenge; it’s a growing threat to public health and has a severe economic impact. The World Health Organization (WHO) considers AMR one of the top ten global health threats, highlighting its potential to send us back to a pre-antibiotic era. We may soon be returning to the pre-antibiotic era because antibiotics are losing their power. According to a World Bank estimate, resistant infections could kill 10 million people and shave off 3.8 per cent of the world’s annual GDP by 2050, with an annual shortfall of $3.4 trillion by 2030 unless new antibiotics are developed. In 2019 alone, there were around 3 lakh deaths directly linked to AMR and over a million deaths associated with AMR in India.

AMR can cripple healthcare systems and endanger lives in the following ways:

• High treatment costs: As bacteria become resistant to common antibiotics, doctors are forced to prescribe stronger, more expensive medications. This puts a significant strain on healthcare budgets, making it harder to provide affordable treatment for all.
• Extended hospital stays:  When infections become resistant to antibiotics, they take longer to treat. This translates to longer hospital stays for patients, further burdening healthcare systems and delaying recovery for individuals.
• Increased morbidity and mortality:  The most concerning consequence of AMR is the potential for untreatable infections. If bacteria become resistant to all available antibiotics, even minor infections could become life-threatening, leading to a rise in mortality rates and jeopardising public health.

The key factors contributing to the burgeoning issue of AMR include overuse and misuse of antibiotics, lack of public awareness led to unnecessary antibiotic use, poor infection control practices in healthcare facilities, unregulated antibiotic use in livestock as growth promoters, poor sanitation and hygiene in our environment and drive antibiotic use and increase AMR. Weak surveillance and regulations further make it difficult to track the actual burden and impact of AMR.

The battle against AMR is a marathon, not a sprint. It requires sustained investment in research, development, and global collaboration. But just like climate change, tackling AMR necessitates innovative and multiprong approaches and collective action to combat AMR. Innovations can play a major role in addressing the issue of AMR in future as follows:

Technological innovations:

• Harnessing AI: Artificial intelligence (AI) is revolutionising the fight against AMR. By sifting through vast datasets, AI can identify patterns in resistance, predict the emergence of new strains, and even aid in the design of targeted therapies.
• The next generation of antibiotics: Scientists are actively exploring novel antimicrobials with unique mechanisms of action. This includes investigating phage therapy (viruses that target specific bacteria), antimicrobial peptides derived from natural sources, and even reviving discarded antibiotics with renewed effectiveness.
• Rapid diagnostics for smarter treatment: Faster and more accurate diagnostic tools like MALDI-TOF are crucial for targeted antibiotic use. These tools can rapidly identify bacteria and their resistance profiles, ensuring the right treatment is administered.
• Alternative therapies: Researchers are venturing beyond traditional antibiotics. Promising areas include bacteriophages, antimicrobial nanoparticles, gene therapy, and immunotherapy to bolster the body’s natural defences.
• Rethinking the past, embracing the future: Scientists are re-examining discarded antibiotics and exploring ways to overcome existing resistance mechanisms. Additionally, revolutionary tools like CRISPR gene editing hold the potential to make bacteria susceptible to existing drugs.

System and process innovations

Combatting AMR requires more than just scientific advancements; it demands a shift in mindsets and behaviours. Here’s how we can build a future resilient to AMR:

• Antimicrobial stewardship programmes: Promoting responsible antibiotic use in human and veterinary medicine is paramount. These programs champion responsible prescribing practices, track resistance patterns, and advocate for rapid diagnostics.
• The one health approach: AMR is a multifaceted issue that requires a collaborative effort across human, animal, and environmental health sectors. This “One Health” approach fosters coordinated surveillance, research, and interventions for effective AMR control.
• Global surveillance networks: Establishing robust surveillance networks to monitor AMR trends across different regions is essential. This data will guide targeted interventions and inform research priorities.
• Investing in innovation: Increased investment in R&D for new antimicrobials, diagnostics, and alternative therapies is crucial. Public-private partnerships can accelerate innovation and ensure a steady stream of solutions.
• Dedicated funding for innovation: Creating a dedicated “AMR and Innovation Fund” can incentivise continued research and development.
• Vaccinations as a preventive measure: Investing in vaccines can prevent diseases in the first place, ultimately reducing reliance on antibiotics.
• Improved hygiene practices: Implementing stricter hygiene protocols in healthcare facilities, communities, farms and animal husbandry can minimise the spread of infections, lowering the need for antibiotics.

Innovations in raising AMR awareness 

Public awareness and engagement are critical weapons in the fight against AMR. Here’s how individuals can be empowered to make informed choices:

• Educational campaigns: Public health agencies can launch campaigns to educate people about AMR, its causes, and the importance of responsible antibiotic use. 
• AMR awareness week: Events like the WHO’s AMR Awareness Week can be leveraged to raise awareness and spark discussions on responsible antibiotic use and the importance of research.
• Empowering patients: Patients can be empowered to ask questions about the necessity of antibiotics prescribed by doctors. Understanding the diagnosis and the rationale behind antibiotic use can promote informed decision-making.
• Combating misinformation: The internet is rife with misinformation surrounding antibiotics and AMR. Public health agencies and reputable science organisations can provide reliable information and counter myths related to antibiotics and resistance.

By fostering innovation, promoting responsible practices, and raising public awareness, we can create a united front against AMR. This long-term battle necessitates a collaborative effort from scientists, policymakers, healthcare professionals, and individuals alike. Only through such a collective effort can we secure a future where antibiotics remain effective guardians of human health and continue to save lives.