Many bacteria (an example in green here) have become resistant to common antibiotics (an example as the yellow circle here), which could mean that we will soon run out of medicines to treat even simple infections. — dpa
We have probably all heard that antimicrobial resistance (AMR) is a growing problem, but what exactly does it mean?
AMR refers to the ability of microbes to resist the effects of antimicrobials.
Antimicrobials are chemical substances that kill microbes – primarily bacteria – that can infect and potentially kill us.
Antibiotics are the most important class of antimicrobials.
Broadly defined, antibiotics are chemicals produced by bacteria to kill other bacteria, as well as artificial versions of these substances.
Throughout our lives, we often use and misuse various antibiotics to treat conditions such as persistent colds, urinary infections, infected scratches and wounds, and even serious bloodstream infections.
However, if the bacteria we aim to eliminate become resistant to our antibiotics, we could face more severe health issues and a higher risk of succumbing to infections.
This scenario could resemble the period before antibiotics were available.
Historical records from the United Kingdom indicate that infections caused by microbes were the leading cause of death for both males and females across most age groups from 1915 to 1945.
By 2015, infections were no longer the leading cause of death in any age group.
In the Asean region, Thailand is currently well-known for its frequency of AMR bacteria.
While the situation in Malaysia is not as severe, it remains concerning.
We conducted a survey on the frequency of antibiotic-resistant bacteria in a typical community in Segamat, Johor, with assistance from the South-East Asian Community Observatory (Seaco).
Our survey included over 240 individual households.
We discovered that more than one quarter of the participants carried bacteria resistant to the antibiotics tested.
Although we did not identify any bacteria resistant to multiple antibiotics within the community, we found such bacteria in a hospital in the area.
These findings are quite alarming.
How it occurs
The simple reason as to why we have an AMR problem today is the overuse and misuse of antibiotics.
Imagine a scenario in which someone has a lung infection.
Different types of bacteria compete to take over the lungs, replicating and vying for resources.
When we use an antibiotic to treat the infection, most bacteria are eliminated after the first dose, but a few more resistant to the antibiotic remain.
As the person starts to feel better, they stop taking the medication.
This allows the surviving bacteria – those that are more resilient – to multiply rapidly.
Some of these bacteria may also acquire additional mutations that increase their hardiness.
When the infection recurs, the individual retakes antibiotics.
After two doses this time, most of the bacteria die, and they may feel better and stop treatment once more.
Yet again, some of the more resistant bacteria survive, leading to a population that is increasingly resistant to that particular antibiotic.
If these bacteria become resistant to multiple antibiotics, they can pose a serious, life-threatening risk.
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The undeniable fact is that the widespread use of antibiotics in the poultry, cattle and aquaculture industries is a major contributor to antibiotic resistance.
Innovative solutions
So, what can we do about the impending crisis of AMR bacteria?
One clear action is to complete the entire course of antibiotic treatment prescribed, rather than stopping once we start to feel better.
Another approach is to seek potential sources of new antibiotics, including in our very own rainforests.
In fact, my colleague Dr Joash Tan has discovered a new strain of bacteria that produces several types of antibiotics from this ecosystem, including one that is very rarely found.
This particular antibiotic could potentially be effective against problematic bacteria that we currently face.
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An alternative approach to tackling antibiotic resistance involves the development of entirely new types of drugs known as aptamers.
Aptamers are unique molecules that can form distinct shapes, allowing them to bind to critical components of bacterial cells, thereby killing or weakening the bacteria.
If the bacteria mutate and modify the target component to become resistant to an aptamer, the aptamer can be re-engineered to remain effective.
One promising strategy is to combine aptamers with traditional antibiotics.
Another colleague Dr Patrick Tan has discovered that bacteria that were previously resistant to a specific antibiotic can become sensitive to it when attacked simultaneously with an aptamer and the antibiotic.
He is collaborating with Indah Water to monitor the prevalence of antibiotic-resistant genes in the community.
Another approach to combating bacterial infections is to use viruses that specifically target the bacteria.
By harnessing these natural enemies, we may be able to manage infections without relying on antibiotics.
This therapy has been used for many years in parts of Eastern Europe, and it may be possible to identify and develop viruses from Malaysia that can target bacteria, potentially leading to new treatment options.
As we confront the growing challenge of AMR, we must take proactive measures to combat this issue.
AMR poses a serious threat to public health, making it essential for all of us to play an active role in addressing it.
Consumers are encouraged to use antibiotics only when necessary and to follow their healthcare provider's guidance meticulously to prevent misuse.
Meanwhile, scientists and researchers must intensify their efforts to discover and develop innovative treatment strategies that can effectively tackle these resilient bacteria.
By working together and taking responsibility at every level, we can make significant strides in the fight against AMR and protect future generations from its consequences. —
Professor Dr Sadequr Rahman is the director of Monash University Malaysia's Tropical Medicine and Biology Multidisciplinary Platform. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
