Abstract
The ability to fight bacterial infections with antibiotics has been a longstanding cornerstone of modern medicine. However, wide-spread overuse and misuse of antibiotics has led to unintended consequences, which in turn require large-scale changes of policy for mitigation. In this review, we address two broad classes of corollaries of antibiotics overuse and misuse. Firstly, we discuss the spread of antibiotic resistance from hotspots of resistance evolution to the environment, with special concerns given to potential vectors of resistance transmission. Secondly, we outline the effects of antibiotic pollution independent of resistance evolution on natural microbial populations, as well as invertebrates and vertebrates. We close with an overview of current regional policies tasked with curbing the effects of antibiotics pollution and outline areas in which such policies are still under development.
Highlights
The discovery of penicillin by Alexander Fleming, in 1929, is often described as one of the most important medical discoveries of the twentieth century [1]
One of the most noted consequences of antibiotic misuse and antibiotic pollution is the increased frequency of bacteria harboring antibiotic resistance genes (ARGs) in different environments
Independent of their application in human health, antibiotics are extensively used in the production of livestock in animal feeding operations (AFOs), and large scale concentrated animal feeding operations (CAFOs), as well as aquacultures
Summary
The discovery of penicillin by Alexander Fleming, in 1929, is often described as one of the most important medical discoveries of the twentieth century [1]. The rate of antibiotic discovery has declined over the past decades due to technical and economic challenges, leading up to an “antibiotic crisis” [12]. This prognostic directed world leaders to call for an immediate reduction in antibiotic use [8,13,14]. Antibiotic use is rising in aquaculture, the fastest-growing food sector worldwide due to intensive farming [17] For this reason, antibiotics of pharmaceutical origin are found in large quantities in human-made environments such as sewage and waste water treatment plants (WWTPs) [18]. We close this review with a section outlining international policy approaches aiming to mitigate the spread of antibiotics and antibiotic resistance in the environment and highlight gaps in current policies
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