Antimicrobial resistance: A looming public health crisis

Almost 100,000 tonnes of veterinary antimicrobials were used worldwide last year, and that’s expected to surge by 8% within a decade, according to a recent study published in the journal PLOS Global Public Health. Asia’s the hotspot for antibiotic use, accounting for 67%, while Africa barely registers with less than 1%. India is among the top 5 consumers along with China, Brazil, USA, and Australia and estimates say that by 2030 this will go up by another 5%. With antimicrobial resistance (AMR) rapidly spreading and the global response lacking coordination, the threat of untreatable infections looms large. Without action, we’re headed for a public health crisis of epic proportions. 

What is AMR?

Antimicrobial resistance (AMR) is a growing public health concern that is threatening to reverse the progress made in medicine over the past century. It is a phenomenon in which microorganisms such as bacteria, viruses, fungi, and parasites become resistant to antimicrobial agents, rendering them ineffective in treating infections. The widespread misuse and overuse of antibiotics, both in human medicine and agriculture, are the leading contributors to AMR.

Antimicrobial resistance occurs when microorganisms such as bacteria, viruses, fungi, and parasites develop the ability to resist antimicrobial agents such as antibiotics, antivirals, antifungals, and antiparasitics, making them ineffective in treating infections. This phenomenon is caused by genetic mutations or the transfer of resistance genes between microorganisms. The more frequently antimicrobial agents are used, the more likely it is that microorganisms will develop resistance to them.

What leads to AMR?

The overuse and misuse of antimicrobial agents is the leading contributor to AMR. The inappropriate use of antibiotics, such as taking antibiotics for viral infections, not completing the full course of treatment, or using antibiotics for growth promotion in livestock, can contribute to the development of resistance. The use of antibiotics in farming is a significant contributor to the development of AMR. Antibiotics are used to promote growth and prevent infections in livestock, but this practice can lead to the development of antibiotic-resistant bacteria that can spread to humans through food or the environment. Additionally, poor infection control practices in healthcare settings and inadequate sanitation and hygiene in the community can also contribute to the spread of resistant organisms.

What leads to AMR?

The overuse and misuse of antimicrobial agents is the leading contributor to AMR. The inappropriate use of antibiotics, such as taking antibiotics for viral infections, not completing the full course of treatment, or using antibiotics for growth promotion in livestock, can contribute to the development of resistance. The use of antibiotics in farming is a significant contributor to the development of AMR. Antibiotics are used to promote growth and prevent infections in livestock, but this practice can lead to the development of antibiotic-resistant bacteria that can spread to humans through food or the environment. Additionally, poor infection control practices in healthcare settings and inadequate sanitation and hygiene in the community can also contribute to the spread of resistant organisms.

Implications

AMR is a ticking time bomb with serious implications. It poses a significant threat to public health as well as for global food security and the economy, as it can lead to the emergence of untreatable infections. According to the World Health Organization (WHO), an estimated 700,000 deaths occur each year due to AMR globally, and this number is projected to increase to 10 million by 2050 if no action is taken. Here are some of the key implications of AMR:

• It can increase mortality and morbidity rates, leading to higher healthcare costs and a burden on patients and families.

• Overuse of antibiotics can decrease their effectiveness, making them less useful against bacterial infections.

• AMR can increase the risk of infections spreading, affecting public health and food safety.

• The agricultural sector can suffer from reduced productivity, leading to more resources being required to treat sick animals.

• The economic costs of AMR are staggering, from healthcare to reduced food security.

• Developing new antibiotics is costly, and there is no guarantee that they will be effective against resistant bacteria.

Overall, AMR is a significant public health issue that requires a coordinated global response.

Alternatives and Solutions

AMR requires a multifaceted approach that involves implementing infection prevention measures and promoting appropriate use of antimicrobial agents. This includes implementing infection prevention and control measures in healthcare settings, promoting appropriate use of antimicrobial agents, and strengthening surveillance and monitoring of AMR. In the agricultural sector, the use of antibiotics for growth promotion and prophylaxis should be phased out, and alternatives such as bacteriophages, probiotics, essential oils, antimicrobial peptides, vaccines and immunotherapy should be explored. However, these alternatives are not widely available or fully developed, and more research is needed to determine their safety and effectiveness. In the meantime, it’s crucial to use antibiotics responsibly and support the development of new antibiotics.

Spices as an Alternative

Spices might hold the key to unlocking a tasty solution to the issue of antimicrobial resistance (AMR). Several studies have shown that certain spices, such as turmeric, cinnamon, garlic, ginger, and oregano, possess antimicrobial properties, making them an alternative to antibiotics. Recently an excellent review has been published in MDPI compiling such vast information carried out across the globe. A study published in Microbial Pathogenesis found that curcumin, the active ingredient in turmeric, was able to inhibit the growth of antibiotic-resistant bacteria. Another study, published in PLoS ONE, found that cinnamon essential oils could inhibit the growth of bacteria resistant to multiple antibiotics. Spice-based treatments are still in the early stages of research, but the results are promising. A study in the Journal of Nutrition showed that a combination of cinnamon, garlic, and ginger supplements was just as effective as antibiotics in treating urinary tract infections (UTIs). Meanwhile, adding black pepper and turmeric powder to the diet of broiler chickens reduced the incidence of pathogenic bacteria in their gut, as per a study in the International Journal of Veterinary Science and Medicine. Spices might just be the delicious answer to AMR.

The One Health approach recognizes that the health of people, animals, and the environment are interconnected, and that solutions to complex health problems require a collaborative and integrated approach across multiple sectors. AMR is one such complex health problem that requires a One Health approach for effective management. By adopting a One Health approach, policymakers, healthcare professionals, veterinarians, environmentalists, and other stakeholders can work together to promote responsible and sustainable use of antibiotics, reduce the spread of resistant infections, and preserve the effectiveness of existing antibiotics. Some of the action points are:

1. Promoting responsible use of antibiotics: Reduce unnecessary and inappropriate use of antibiotics and adopt alternative therapies where possible through awareness campaigns, guidelines for healthcare professionals and veterinarians, and regulations that limit the use of antibiotics in animal feed and agriculture.

2. Surveillance and monitoring: Facilitate the monitoring and surveillance of antibiotic use and resistance in humans, animals, and the environment to identify emerging resistance patterns, assess the impact of interventions, and guide the development of policies and guidelines.

3. Research and development: Promote research and development of new antibiotics, vaccines, and alternative therapies by involving collaborations between human and veterinary medicine and basic and applied research across different sectors.

4. Environmental stewardship: Promote environmental stewardship to prevent the spread of antibiotic-resistant bacteria in the environment through proper disposal of pharmaceuticals and other products, managing waste from agriculture and livestock, and reducing pollution and contamination of water sources.

5. Education and outreach: Promote education and outreach to raise awareness about the AMR issue and the importance of responsible antibiotic use by organising campaigns targeted at healthcare professionals, veterinarians, farmers, and the general public.

Conclusion

In conclusion, antimicrobial resistance is a ticking time bomb that threatens to undermine decades of progress in modern medicine. It’s a problem that affects us all, from the farmer to the consumer, from the doctor to the patient. We need to take action now to address the issue of AMR, through implementing infection control measures, promoting responsible use of antibiotics, and exploring alternatives to antibiotics. The clock is ticking, but we have the power to defuse this crisis. The choice is ours – to act or to suffer the consequences.

Additional Reading

• Khatri P, Rani A, Hameed S, Chandra S, Chang C-M, Pandey RP (2023). Current Understanding of the Molecular Basis of Spices for the Development of Potential Antimicrobial Medicine. Antibiotics 12(2):270. https://doi.org/10.3390/antibiotics12020270

• McKernan C, Benson T, Farrell S, Dean M (2021). Antimicrobial use in agriculture: critical review of the factors influencing behaviour. JAC Antimicrobial Resistance 3(4):dlab178. https://doi.org/10.1093/jacamr/dlab178. 

• Mulchandani R, Wang Y, Gilbert M, Van Boeckel TP (2023). Global trends in antimicrobial use in food-producing animals: 2020 to 2030. PLOS Global Public Health 3(2): e0001305. https://doi.org/10.1371/journal.pgph.0001305

• Velazquez-Meza ME, Galarde-López M, Carrillo-Quiróz B, Alpuche-Aranda CM (2022). Antimicrobial resistance: One Health approach. Veterinary World 15(3):743-749. https://doi.org/10.14202/vetworld.2022.743-749. 

(Published in Spice India 36(2): 21-24 – February 2023 issue)