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What is antimicrobial resistance (AMR) and why you should know about it

Pharmacist holding medicine box and capsule pack in pharmacy drugstore.

 

Today marks the beginning of World Antimicrobial Awareness Week, driven by the World Health Organisation to improve global knowledge of antibiotic drugs. Running from the 18th to the 24th of November, the awareness initiative is focused on uniting to preserve effective antimicrobials and reduce or prevent the spread of Antimicrobial Resistance (AMR), which is becoming an increasing concern across the world.

Before we jump deeper into the AMR and the global impact it will have if not addressed, let’s briefly cover the history of antimicrobials in medicine. 

1910, the first breakthrough in antimicrobial treatment

These life-saving drugs are rather ironically named, since the literal meaning of antibiotic is ‘anti-life’ or ‘against living’ – but in this case, the living organisms that produce the disease’. 

Selman Waksman first used the term ‘antibiotic’ during the 1940s. Until then, antibiotic drugs were simply referred to by their names. 

While there are anecdotal accounts of antimicrobial treatments being administered during ancient times, the breakthrough moment was the creation of the first synthetic antimicrobial agents by Paul Ehrlich who noted that certain dyes would color bacterial cells but not others.

Ehrlich thought that if these cells could be isolated, and that selective chemicals could be used to target and neutralize bacteria. 

Ehrlich worked with the toxic element arsenic to produce compound 606, which was introduced in ca. 1910, under the name Salvarsan. Salvarsan, now known as arsphenamine, was the ‘drug of choice’ to treat syphilis until the 1940s.

1928, Fleming discovers penicillin

Treatment of syphilis with Salvarsan was superseded by the most famous antibiotic of them all – penicillin. This antibiotic is derived from natural substances, in contrast to dyes and arsenic derivatives. Early observations of penicillin properties were made by William Roberts and Louis Pasteur during the close of the 19th century however,  it was not until 1928 that a revolutionary discovery was made by Sir Alexander Fleming, who was studying a green mold (Penicillium chrysogenum) in his laboratory. 

Fleming discovered that the mold killed and prevented the growth of bacteria. He deduced that the mold must be creating a specific substance, and he named this ‘mold juice’ penicillin. 

This first antibiotic was not isolated and purified until 1942, by two Oxford scientists Ernst Chain and Howard Florey – who shared the 1945 Noble Prize in Medicine with Fleming.

In the following decades, at least a dozen additional antibiotics entered the medical field, creating an arsenal for use against several major diseases.

2020, emerging antimicrobial resistance (AMR)

What is AMR? AMR stands for “antimicrobial resistance” – a process of pathogen adaptation, whereby bacteria, viruses, fungi, and parasites develop defenses that make antimicrobials less and less effective. Ultimately, treatment times are prolonged,  increases the risk of spreading disease, and developing complications. 

When a tried and proven medicine is no longer effective at fighting its targeted disease, an alternative is needed, which might take years to develop. A “worst-case scenario”  will result, in which pathogens ‘outsmart’ humans, and we are left without drugs needed to cure even the most common bacterial infections.

Why is this happening? The misuse and overuse of antimicrobials, including instances of viral diseases (where they are ineffective) have allowed pathogens to be exposed to more and more medicine, encouraging the selection of strains that have lost their susceptibility to these compounds. 

Issues such as poor water quality, lack of sanitation, and substandard hygiene have also hastened the spread of antibiotic-resistant infections. 

It is up to us all to recognize AMR as an emerging global health threat, act to prevent and treat the infection using properly targeted drugs at the proper dosage and duration of therapy.

 

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