Antibiotics save lives and are critical tools for treating a number of common and more serious infections, like those that can lead to sepsis. According to the Center for Disease Control and Prevention (CDC), at least 30% of antibiotics prescribed in US outpatient settings are unnecessary.
We spoke with our experts Darin Seehafer, Senior Director of Therapeutic Expertise, Center for Vaccine Research, and PRA’s interning physician Keiko Pempho Msusa, who is completing the University of Siena’s Masters of Vaccinology and Drug Development, Vaccinology about the issues around antibiotic and antimicrobial resistance.
Each year, enough prescriptions are written in outpatient settings to give five out of every six people one antibiotic prescription. These statistics are concerning because any time antibiotics are used, they can cause side effects and contribute to the development of antibiotic resistance, one of the most urgent threats to public health.
Antimicrobial resistance happens when germs, like bacteria and fungi, develop the ability to defeat the drugs designed to kill them. Each year in the United States, there are more than 2.8 million bacterial infections that occur as a result of antibiotic resistant, and more than 35,000 people die as a direct result.
With National Antibiotic and World Antimicrobial Awareness days occurring this week, we’re highlighting the importance of these issues and emphasizing this year’s themes: "Antimicrobials: handle with care" and “United to preserve antimicrobials.” We spoke with our experts Darin Seehafer, Senior Director of Therapeutic Expertise, Center for Vaccine Research, and PRA’s interning physician Keiko Pempho Msusa, who is completing the University of Siena’s Masters of Vaccinology and Drug Development, Vaccinology.
Can you explain the difference between antibiotic and antimicrobial resistance?
K: Antibiotic resistance occurs when the bacteria change in response to the use of antibiotics, making them ineffective. Antibiotic resistance is specific to just bacteria, while antimicrobial resistance occurs when bacteria, viruses, fungi, or parasites change overtime and no longer respond to medicines, making infections harder to treat.
D: Put simply, antibacterial is bacteria-resistant and antimicrobials are microbe-resistant.
Antibiotic resistance is one of the biggest healthcare challenges faced by our society. How did this come about?
D: Over-prescribing is one of the key elements to this, but it also occurs when people don’t complete their full course for the antibiotic they’ve been prescribed. There’s also misutilization of these medicines—you don't need to use a quinolone class antibiotic against something that will respond perfectly fine to amoxicillin. Not prescribing the correct class of antibiotic or over-prescribing the class of antibiotic has exacerbated resistance.
K: In some African countries like Malawi, one is allowed to purchase antibiotics over the counter without prescriptions. Some people prefer to go straight to private pharmacies to purchase over-the-counter antibiotics as opposed to visiting their physician when they're feeling unwell. A common antibiotic that is purchased over-the-counter here is metronidazole. A lot of people don't know that it's an antibiotic—they believe that it's a treatment for acute diarrhea or just general abdominal discomfort. Likewise, with amoxicillin, people will purchase this over-the-counter as a treatment measure for an acute cough.
D: This is not unique to Malawi, either. In many countries, there are no strict regulations on antibiotic use. For example, in parts of Latin America, you also can walk into the store and buy over the counter antibiotics.
What could potentially happen should we not address the issue?
D: It’s not so much “what could potentially happen” and more what is happening. We’re running out of the number of antibiotic resistant drugs that are out there and the antimicrobial drugs that are available because of the resistance issue. Quite simply, we’re running out of options.
K: Having antibiotic resistance makes illnesses more difficult to treat. One consequence is that healthcare systems become strained due to increased hospital stays and the use of expensive second- or third-line treatments.
Antibiotic resistance poses a major global health threat. For low-resource locations like Malawi, with an already fragile healthcare system, there is urgent need for a plan of action that will provide for the rational use of antibiotics.
What can we do to combat the growing resistance?
D: We need an effective public health message that addresses how to carefully prescribe antibiotics. Patient and physician education are important elements of that. I think that more testing to diagnose before prescribing would go a long way also.
K: I agree. Another issue to address is the common practice by physicians to prescribe first and test afterwards. From working in the private sector, I noticed that if a patient comes and makes a demand for antibiotics, most physicians or nurses will prescribe them. To combat this, we need to improve antibiotic prescribing practices. We need to educate the physicians working in hospitals and put restrictions in the private pharmacies to not sell antibiotics without a doctors’ prescription.
Another way we can combat this is by preventing the infections themselves. For example, typhoid is known to be resistant to antibiotics, but if you put into place good hygiene practices, like hand washing with soap and clean water and good sanitation, you can actually prevent the infection and antibiotic-resistant infections.
D: I think COVID-19 helped the public see that just a little precaution goes a long way. Keeping your hands clean, covering your cough, and other small but effective measures make a huge difference in the transmission of disease. I think that COVID-19 helped raise awareness of what simple precautions can actually accomplish.
Who is leading this research? Is the search for new antibiotics a collaborative effort?
D: We have to think about answering this from a public-private partnership perspective, but it's complicated. First, in the US, there are agencies that are out there providing government funding for studies. These are the same agencies that are going to fund antibiotic studies from a government perspective, especially the National Institute of Health and the Department of Defense. As an approved prime vendor for government agencies, PRA is able to bid on and develop these studies.
However, these are not the only funding sources for antimicrobial and antibiotic studies. There's also the private sector where organizations like the Gates Foundation help put money into the pipeline.
We know that strategic partnerships simplify the start-up and monitoring process. We’ve partnered with the Alliance for Multispecialty Research (AMR) to bring efficiency to every step of vaccine development—from protocol to database lock, from sponsor to site.
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