Introductory Chapter: The Antibiotic Resistance Epidemic

1. Introduction

Antibiotic resistance is a global problem that has triggered a global human and animal health crisis worldwide. Antibiotics have changed the face of medicine and saved millions of lives, but resistant bacteria are threatening their usefulness.

The pharmaceutical industry is experiencing a shortage of new drug development due to declining economic incentives and demanding regulatory requirements. Governing agencies worldwide have identified several “super-bugs,” bacteria resistant to all antibiotics known by man.

A more comprehensive approach to bacterial infection is required, including alternatives to conventional antibacterial agents.

Several antibiotics were discovered from the 1950s to the 1970s to cure previously incurable diseases, including tuberculosis and syphilis [1]. Since then, no new antibiotic classes have been discovered, which is concerning given the bacterial resiliency [2] and the continuous abuse and misuse of antibiotics [3].

Alexander Fleming recognized the phenomena of resistance to antimicrobial agents, by the misuse of antibiotics, in 1945 when he stated, “The time may come when anyone in the shops can buy penicillin. Then there is the danger that the ignorant man may easily under-dose himself and by exposing his microbes to nonlethal quantities of the drug make them resistant” [4].

In the absence of novel and more potent drugs, we risk a future where minor injuries and illnesses can be fatal and essential operations like surgery and chemotherapy become unmanageable. Antimicrobial resistance poses a serious threat to our way of life and could lead to a global pandemic if we don’t act to combat it. Longer hospital stays and higher medical costs are now the results of antimicrobial resistance [5].

Antibiotic resistance is eroding our ability to treat bacterial illnesses. Infections resistant to most, if not all, current medicines are becoming common. The nature of significant acute bacterial infections and the economic realities of this field makes developing novel antibacterial medication difficult.

Because of the induction, amplification, and transmission of aspects of antimicrobial resistance among microbes, adequate management of a novel antibacterial agent is required for both the patient and the community when a new antibacterial agent is introduced. Furthermore, most antibiotic treatment regimens are brief (sometimes lasting only a week or two), and antimicrobial management aims to reduce the use of broader spectrum agents whenever possible to retain their usefulness, lowering the need for newer agents to enter the market.

In contrast, in many other treatment areas, such as diabetes, hypertension, and hyperlipidemia, long-term daily usage by patients does not add to the agent’s loss of efficacy, and there is no medical reason to delay administration. While antimicrobial stewardship is critical, it will almost certainly diminish the economic benefits for a medication developer. Financial pressures associated with the development of antimicrobial medicines are not new [6].

There aren't enough reasons to invest in developing new antimicrobials under the current intellectual property innovation system. Since 1980, pharmaceutical corporations have made investments in cancer and chronic disease treatments for three reasons:

1. There is a better possibility of financial success than ever before.

2. They have realized that this is a lost war. The time and money invested in developing a new antimicrobial drug are not justified because profit will not be as attractive as other cancer or chronic disease treatments. Pharmaceutical corporations know that the improper use and abuse of the new drug will lead to the development of resistance by bacteria.

3. Those corporations are very well aware that bacteria are equipped with more advanced and sophisticated intelligent mechanisms to mute resistant clones than we humans have to make new drugs.

It is as simple as that. Where is the profit in a lost war?

Like eukaryotes, prokaryotes, including bacteria and other microorganisms, have membranes surrounding a droplet of cytoplasm. Prokaryotes acquire nutrients, communicate, excrete, and even process information in a “neurological” way [7, 8]. They can detect the presence of nutrients, toxins, and predators and adopt powerful escape techniques to preserve their viability [9]. From the evolutionary standpoint, bacteria have millions of years in advance against eukaryotes.

2. Novel alternatives to combat super-bugs

In 1908 Eli Metchnikoff obtained the Nobel Prize and was regarded as the originator of innate immunity, offering the breakthrough idea of consuming live bacterial cultures (yogurt) to improve the health and longevity of people more than a century ago [6, 10]. This principle is more appropriate than ever, as many antibiotic-resistant microorganisms threaten animal and human health [11].

In some countries around the world, pressures from society have resulted in establishing guidelines on antibiotic use in the feedstock industries. In other countries, like in the USA, it has become a commercial strategy for poultry companies and fast-food restaurants to label their products with no antibiotics ever (NAE). A similar commercial approach is observed in Brazil, which has dominated the chicken meat export market for over a decade, simply listening to the demands of countries in Europe, Asia and the middle east. Food animal production systems such as the poultry industry have been using alternative antibiotics to enhance disease resistance and productivity. According to new studies, nutritional treatments for stress, disease, and chronic inflammation may be more effective than antibiotics in some cases [12, 13, 14].

Disease resistance improvement in non-antibiotic raised animals has been shown to benefit animal products’ health, welfare, production, and food safety. Alternative feed additives are being researched and developed in response to rising customer demand to remove growth-promoting antibiotics. Some of those alternatives include nutraceuticals such as probiotics [15, 16]; prebiotics [17]; organic acids [18, 19]; Phytochemicals [20, 21, 22]; enzymes [23, 24]; Vaccines and immunoglobulins [25, 26]. Innovative methodologies and cutting-edge technologies, like quorum sensing and quantum mechanics approaches, have the potential to shift the balance and help to minimize the epidemic problem in the future.

Conflict of interest

The author declares no conflict of interest.