Before knowing about the Antimicrobial resistance, lets know about the antimicrobials. Antibiotics are those substances that are used as medicines to prevent and treat infections in individuals, plants, and animals. They include antibiotics, antivirals, antifungals. In the same way, antimicrobial resistance, or AMR, is the result of bacteria, viruses, fungi, and parasites losing their capacity to respond to antimicrobial drugs. Drug resistance causes antimicrobial medications, along with antibiotics, to be ineffective and makes treating infections difficult or impossible. It increases the risk of infection spread, severe illness, disability, and death. Furthermore, one of the major threats to global development and public health is antimicrobial resistance, or AMR. Bacterial AMR is thought to have been responsible for 4.95 million deaths globally in 2019. A comprehensive analysis that was published in 2019 alone estimated that antimicrobial resistance had been directly accountable over 1.3 million deaths, with the majority happening in Asia and sub-Saharan Africa.
Antibiotic resistance is a natural phenomenon that occurs when microorganisms are exposed to antibiotic drugs. Under the selective pressure of antibiotics, susceptible bacteria are killed or inhibited, while bacteria that are naturally (or intrinsically) resistant or that have acquired antibiotic-resistant traits have a greater chance to survive and multiply. The rapid unroll of superbugs, or multi- and pan-resistant bacteria, whose infections cannot be treated with the antibiotics of today, is even more worrying. Nevertheless, as AMR expands, the advancement and development of new antibiotics is still falling for short. Furthermore, it develops naturally over time, typically as a result of genetic modifications. People, animals, food, plants, and the environment all contain microorganisms that are resistant to antibiotics. They can spread from one person to another or between humans and animals, especially through eating animal-based food. Similarly, excessive use and misuse of antibiotics—found in contaminated food, water, affordable medications, vaccines, and diagnostics—are the leading causes of antimicrobial resistance. Chemical and biological pollution from intensive crop production, poor sanitation and inadequate sewage systems, pharmaceutical manufacturing, and hospitals is another significant. The major threat of today is drug resistance in viruses, HIV, malaria parasites, mycobacterium and others bacteria too. Not only the overuse of antibiotics but also the inappropriate use (inappropriate choices, inadequate dosing, poor adherence to treatment guidelines) contribute to the increase of antibiotic resistance. A key contributor to the improper use of antibiotics in the community of wealthy nations is general practitioners’ overprescribing, even in the lack of suitable indications. Excessive prescribing is frequently encouraged by diagnostic confusion, particularly in cases where the clinical presentation of bacterial or viral etiology is similar.
Drug resistance in bacteria
•For common bacterial infections, including UTI, sepsis, STIs, and some forms of diarrhea, high rates of resistance against antibiotics frequently used to treat these infections have been observed world-wide, indicating that we are running out of effective antibiotics. The 2022 Global Antimicrobial Resistance and Use Surveillance System (GLASS) report highlights alarming resistance rates among prevalent bacterial pathogens. Median reported rates in 76 countries of 42% for third-generation cephalosporin-resistant E. coli and 35% for methicillin-resistant Staphylococcus aureus are a major concern. In Europe each year, the number of infections and deaths due to the most frequent multidrug-resistant bacteria (S. aureus, Escherichia coli, Enterococcus faecium, Streptococcus pneumonia, Klebsiella pneumoniae and Pseudomonas aeruginosa) was estimated at ∼400 000 and 25 000, respectively, in 2007.
N. gonorrhoeae has compromised the management and control of gonorrhea because of rapid emergence of its resistance towards sulphonamides, penicillins, tetracyclines, macrolides, fluoroquinolones, and early generation cephalosporin’s
K. pneumoniae are common intestinal bacteria that can cause life-threatening infections. Its resistance towards antibiotics has too has been reported recently
Antibiotic resistant Mycobacterium tuberculosis strains are the also the major threats to today’s world. WHO estimates that, in 2018, there were about half a million new cases of RR-TB identified globally, of which the vast majority have MDR-TB. In 2018, an estimated 3.4% of new TB cases and 18% of previously treated cases had MDR-TB.
Drug resistance in virus
• Similarly, antiviral drug resistance is an increasing concern immunocompromised patient populations, which is because of the ongoing viral replication and prolonged drug exposure. Resistance has developed to most antivirals including antiretroviral (ARV) drugs. Increasing levels of resistance have important economic implications since second- and third-line regimens are much more expensive than first-line drugs. WHO’s HIV drug resistance programme is monitoring the transmission and emergence of resistance to older and newer HIV drugs around the globe.
Drug resistance in malaria parasites
•The emergence of drug-resistant parasites is the major threat to malaria control and results in increased malaria morbidity and mortality. Artemisinin-based combination therapies (ACTs) are the recommended first-line treatment for uncomplicated P. falciparum malaria and are used by most malaria endemic countries. Similarly, in the WHO Eastern Mediterranean Region, P. falciparum resistance to major drugs failures in some countries, necessitating a change to another ACT. Not only that in Africa too evidence has recently been published showing emergence of mutations linked to partial artemisinin resistance in Rwanda.
Drug Resistance in Nepal
According to the IHME report 2019, there were 6,400 deaths attributable to AMR and 23,200 deaths associated with AMR. Similarly, Nepal has the 153rd highest age-standardized mortality rate per 100,000 population associated with AMR across 204 countries. Furthermore, the number of AMR deaths in Nepal is higher than deaths from neoplasms, respiratory infections and tuberculosis, digestive diseases, maternal and neonatal disorders, and diabetes and kidney diseases. There are five pathogens to be aware of in Nepal (number of deaths associated with AMR in parenthesis): Klebsiella pneumoniae (3,700), Staphylococcus aureus (3,600), Escherichia coli (3,400), Pseudomonas aeruginosa (2,300), and Streptococcus pneumoniae (2,100).
AMR has been listed among the top 10 global health threats by the WHO. The environment, food and nutrition security and safety, human and animal welfare, economic development, and equitable society are all at risk to antimicrobial resistance. Our ability to treat common infections—infections that are intractable with present antimicrobial medicines like antibiotics—continues to be feared by the emergence and spread of drug-resistant pathogens that have created new resistance mechanisms, leading to antimicrobial resistance. Drug resistance is increasing all over the world, causing antibiotics to be less and less effective, which makes infections more difficult to treat and raises death. New antimicrobials are currently a need of time. However, if people do not change the way antibiotics are used now, these new antibiotics will suffer the same fate as the current ones and become ineffective.
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