The Economic and Clinical Implications of Antibiotic Resistance

Abstract

T he E conomic and C linical I mplications of A ntibiotic R esistance Rohini Behl T T he P roblem The dilemma of antibiotic resistance has evolved to become a multifaceted issue exacerbated by a series of molecular, operational, psychological, and economic factors. On the molecular level, antibiotic resistance is the result of bacteria changing in ways that lead to the reduced effectiveness of antibiotics to cure or prevent infections. There are three main mechanisms through which resistance is acquired in bacteria: 1) Natural selection, or the gradual scientific process by which biological traits such as resistance to antibiotics become common in a population (i.e. bacteria); 2) plasmids, or independent circular pieces of DNA that may carry genes for antibiotic resistance that can be conferred between bacteria; and 3) mutations, or permanent changes in the DNA sequence of a gene that can lead to the formation of new traits such as resistance (Ramanan, 2012). Furthermore, cross- resistance, or the possession of a resistance mechanism by a bacterial strain that enables it to survive the effects of several antibacterial molecules, may continue even after halting or reducing antibiotic use. As such, antimicrobial resistant bacteria may emerge under the selective pressure of antibiotics and become the dominant flora. There are a series of operational factors, such as the role of setting, modes of transmission, and lack of regulation enforcement, that appear to be rather simple to remediate, but in practice this has not been the case. An increasing number of cases of antibiotic resistance occur within hospital and institutional settings; in these situations, antibiotic resistant flora may live within the institution and be transferred to the patient (Sipahi, 2008). Transmission may occur when coming into contact with soiled hands of staff as well as contaminated surfaces and equipment, in addition to passing from patient to patient, which is why effective infection control and hygiene are essential to inhibit their spread. The severity of the disease being treated, length of current hospital duration, exposure to other ill patients, invasive surgical procedures, intensity of clinical therapy, and advanced age further increase the odds of susceptibility to antibiotic resistant bacterial strains. Over-prescription of antibiotics by physicians further increases the likelihood that particular strains will develop resistance and can be simplified into two main causes: 1) consumer insistence that antibiotics are a magic cure-all for flu, infections, and unrecognizable conditions and 2) doctors’ fear of malpractice lawsuits that impels them to err on the side of over-prescription. For example, contracting the flu comes from a virus, rather than a particular bacterial strain; therefore there is no reason to take an antibiotic as treatment for the flu. Taking antibiotics more frequntly than necessary results in natural selection in the body for the most resistant bacteria and contributes to higher levels of resistance; consumers incorrectly believe “better safe than sorry” and thus err on the side of overconsumption of antibiotics when in reality, by doing so, they are increasing their odds of susceptibility to antibiotic resistant bacteria. For this reason, associations have provided and implemented regulations that restrict the supply of antibiotics created in the first place. However, these appear to be mainly ignored by antibiotic manufacturers in order to promote antibiotic sales and resulting profits. B erkeley S cientific J ournal • D eath and D ying • S pring 2013 • V olume 17 • I ssue 2 • 1 B S J here is no doubt that antibiotic resistance is a growing phenomenon. As Nobel Prize Winner and famed molecular biologist Joshua Lederberg put it, “We are running out of bullets for dealing with a number of bacterial infections. Patients are dying because we no longer in many cases have antibiotics that work (2007).” This issue can be attributed to over-prescription of available antibiotics, their currently limited diversity, as well as lack of incentives to encourage investment in development of new classes of antibiotics. Antibiotic resistance is a problem that afflicts both affluent and impoverished countries, and the outlook it generates appears to be bleak due to rapidly rising costs of treatment, the threat of cross-resistance, as well as increased morbidity.