ANTIOBIOTIC RESISTANCE

TOPIC: ANTIBIOTIC RESISTANCE Student Name ID: 00000000

Public Health 1 Winter 2016

Dr. Zuzana Bic

2 Public Health Problem Antibiotics are drugs composed of bacteria and are used to treat bacterial infections. Once an antibiotic is developed for a disease, it seems as though that disease has been controlled; however, some bacteria becomes resistant to the antibiotic and the patient treatment gets interrupted. Antibiotic resistance exits today because antibiotics are treating the bacteria and that bacteria are living organisms, and just like all living organisms, they will change over time and adapt to the new environment. When the bacteria adapts to the new environment, the antibiotics are no longer effective due to the developed resistance to them (Antibiotic Resistance and the Threat to Public Health, 2010, p. 2). Antibiotic resistance is likely to happen if the antibiotic is used incorrectly. The antibiotic is used incorrectly when a patient underuses it or overuses it. When a patient does either of these two things while on antibiotics, the bacteria will become resistance to the antibiotic (Choffnes, Relman, & Mack, 2010, p. 32). When a patient that’s being treated with antibiotics starts to feel better, they tend to stop taking the pill, this causes for the existing bacteria to survive further, multiple, and take over (Schneider, 2014, p. 162). On the other hand, some patients will overuse the antibiotics thinking if they stop the usage, the disease will reoccur. However, further usage of the antibiotic than needed is also harmful because the bacteria will adapt to the antibiotic, causing for the antibiotic to have no effect and for the bacteria to multiply. (Porter & Grills, 2015, p. 3). Once a patient becomes resistant to an antibiotic, the resistant bacteria remains in the body. This can now spread around the community just through that patients germs (Antibiotic Resistance Threats in the United States, 2013, p. 14). It is also possible for the antibiotic resistance to spread through animals; if animals get antibiotics and become resistant to the antibiotic, they will obtain the resistant bacteria as well. This bacteria can now get spread on the animals meat and becomes possible for that bacteria to spread to the consumers (Antibiotic Resistance Threats in the United States, 2013, p. 14). Some individuals tend to be more prone to develop antibiotic resistance than other individuals. Jeffery Taylor and Lucina Suarez (2000) conducted a study on developing antibiotic resistance from antibiotics used to treat tuberculosis and the risk factors associated with it. The study found that those who had no previous experience of tuberculosis, females were more likely to develop antibiotic resistance than males were. Those who were aged 20 to 39 years were more likely to develop the resistance. They also found that those who are foreign born have double the risk of developing antibiotic resistance compared to those who are born in the United States. Among those who have had a previous history of tuberculosis, males at the age of 20 to 59 years and being born outside the United States had the risk of developing antibiotic resistance (Taylor & Suarez, 2000, p. 272). How to Solve the Public Health Problem Antibiotic resistance is of big concern to public health agencies. Public health agencies are designed to promote and advance the health of the people. The Centers for Disease Control and Prevention (CDC) monitors antibiotic use and antibiotic resistant infections, in other words, it is conducting surveillance. CDC’s goal for antibiotic resistance is to limit the spread of it, this is why the CDC tracks down the antibiotic resistant infections (Antibiotic Resistance: Data Gaps will Remain Despite HHS Taking Steps to Improve Monitoring, 2011, p. 9). To further reach this goal, CDC has implemented plans such as having educational programs on antibiotic resistance

3 and teaching how the antibiotic resistant infections can spread. It has also implemented the plan to monitor antibiotic prescriptions given to patients that way they can verify whether or not the prescription is acceptable and if it will help the patient with the illness/disease (Antibiotic Resistance: Data Gaps will Remain Despite HHS Taking Steps to Improve Monitoring, 2011, p. 9). The Food and Drug Administration (FDA) has the big responsibility of ensuring that human drugs are safe to use. The FDA looks over antibiotic labels and has the say on whether it is approved or not. In addition, the FDA provides information regarding appropriate antibiotic use to the patients and healthcare providers. It also lets the patients and healthcare providers beware of the risk of developing antibiotic resistance if the antibiotics are used incorrectly. FDA also licenses vaccines to give against bacterial infections; further, the FDA is able to conduct tests to find bacterial infections (Antibiotic Resistance: Data Gaps will Remain Despite HHS Taking Steps to Improve Monitoring, 2011, p. 10). The National Institute of Health (NIH) conducts research to improve the health of individuals. Regarding antibiotic resistance, NIH completes research on the antibiotic resistance aspects, such as how the resistance is developed by the bacteria. NIH also develops the tests that check upon certain bacterial infections that will become resistant to an antibiotic. Further, it has trials to determine how long the antibiotics for a certain bacterial infection should be taken for (Antibiotic Resistance: Data Gaps will Remain Despite HHS Taking Steps to Improve Monitoring, 2011, p. 10). By keeping surveillance, Europe has been able to track down antibiotic resistance infections and are able to see current treads. Europe not only tracks down where antibiotic resistance is occurring, but tracks down what antibiotics are being consumed as well. Once public health agencies realize there has been a trend of certain antibiotic resistance from the same antibiotic on more than 10-20% of the individuals, then that information from surveillance can possibly lead for that antibiotic to no longer be prescribed (Cornaglia et al., 2004). Europe also has public health agencies establish the appropriate usage of the antibiotics as well as the full therapy. In addition, it is aware that resistance may develop for certain antibiotics (Cornaglia et al., 2004). Public Health in Future According to Eileen Choffnes, David Relman, and Alison Mack (2010), in order to prevent antibiotic resistance from developing and the then the antibiotic resistance infection from spreading, three steps can be taken. The three steps involve: 1) limiting the use of antibiotics, 2) discouraging the misuse of antibiotics, and 3) decreasing the infectious disease by keeping good hygiene and good infection control (Choffnes, Relman, & Mack, 2010, p. 32). Prescribing antibiotics takes a lot of judgment of the disease and the patient in order to know if the bacteria will become resistant to the antibiotic. However, if the antibiotics prescribed are limited, then the development of antibiotic resistance is reduced; that is why it is highly important that physicians are trained well in prescribing antibiotics. Misuse of antibiotics increases the chance of antibiotic resistance to develop. By having public education campaigns and letting the public beware the importance of using antibiotics appropriately, antibiotic resistance would decrease (Choffnes, Relman, and Mack, 2010, p. 32). Infection controls in the community and hospitals such as having access to sanitation, having a safe environment, having clean and disinfected equipment, and much more are important to reduce spread of infectious diseases.

4 From my own experience, I have suffered from antibiotic resistance. I have taken the antibiotic, Doxycycline. I was prescribed to take the drug for 3 months, twice a day, on an empty stomach, however, I failed to follow all three of these guidelines for the drug. I instead took the drug once a day, which has caused for my duration of the drug to last 6 months, in addition, I do not always take it on an empty stomach. Because of my misuse of the drug, it has caused for me to develop antibiotic resistance, and still carry the bacterial infection. If I had knowledge of antibiotic resistance and how misusing the drug can cause the resistance, I would have used the drug appropriately and taken it more seriously. That is why public educational programs that the CDC and Choffnes, Relamen, and Mack emphasize are highly important because it truly can decrease the chances of an individual developing antibiotic resistance. In my own opinion, I believe that by limiting the use of antibiotics, discouraging the misuse of antibiotics, and by keeping good infection control practices, antibiotic resistance can decline and antibiotic resistance infections will decline in spreading. If too many antibiotics are used, then the chance of antibiotic resistance to develop increases. Sometimes I tend to think that physicians prescribe antibiotics to individuals for not too serious illnesses and in my opinion, I think that prescribing antibiotics are not always necessary. I believe that sometimes there are other ways and methods of treating the illness and that is why limiting the use of antibiotics is highly important. Like I mentioned above of my own personal experience of misusing antibiotics, there are also many others who misuse their antibiotics and are not aware of antibiotic resistance. I highly believe that people tend to think that as long as they just take the drug until they feel better, they will become clear of the bacterial inflectional and no longer have to finish the dosage; once they feel better and stop taking the antibiotic, they think “the drug worked faster on me than normal”. However, that is the wrong way to go about it and that is why encouraging patients to complete their full dosage, and to not go over it too, is important; education on antibiotic resistance can truly help with this issue. And lastly, infection control practices in the community and hospitals such as having a clean environment and equipment, hand hygiene, client isolation (hospital), etc can reduce antibiotic resistance infections. Infections can spread through contact that is direct or indirect, it can also spread by being airborne. With acceptable and strong infection control practices, the risk of developing the infection can decline. By following these three prevention strategies for antibiotic resistance, cases of antibiotic resistance has the possibility of declining. The CDC, FDA, and NIH also have strategies in place to help solve the problem of antibiotic resistance. All these public health interventions are regarded in a high manner and the goal is to decline antibiotic resistance and to limit antibiotic resistance infections, and with these interventions, the goal is possible.

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References Antibiotic Resistance and the Threat to Public Health: Hearing before the Subcommittee on Health on the Committee on Energy and Commerce House of Representatives. 111 Cong. 1 (2010). Centers for Disease Control and Prevention (CDC). (2013). Antibiotic Resistance Threats in the United States. Choffnes, R. E., Mack, A., & Relman, A. D. (2010). Antibiotic Resistance: Implications for Global Health and Novel Intervention Strategies: Workshop Summary. Institute of Medicine of the National Academies. Retrieved from http://www.nap.edu/catalog.php? record_id=12925 Cornagilia, G., Hryniewicz, W. Jarlier V., Kahlmeter, G. Mittermayer H., Stratchounski, L., Baquero F. (2004). European Recommendations for Antimicrobial Resistance Surveillance. Journal of Clinical Microbiology and Infection, 10(4), 349-383. Grills, N. & Porter, G. (2015). Medication Misuse in India: A Major Public Health Issue in India. Journal of Public Health, 37(1), 1-8. doi:10.1093/pubmed/fdv072 Taylor, P. J., & Suarez, L. (2000). Prevalence and Risk Factors of Drug Resistant Tuberculosis Along the Mexico-Texas Border. Journal of Public Health, 90(2), 271-273. United States Accountability Office. (2011). Antibiotic Resistance: Data Gaps will Remain Despite HHS Taking Steps to Improve Monitoring. (DHHS Publication No. GAO 11-406). Washington, DC.