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Toolbox

Understand

The UNDERSTAND focus area of the toolbox provides information and tools for increased knowledge about bacteria, antibiotics and antibiotic resistance, and aims to explain why antibiotic resistance has become one of the major health challenges of our time. The focus area further discusses why it is important to take action against this negative development and gives an introduction to possible ways to do so.

The narrative text is accompanied by “Selected resources” for more in-depth information. Browse through then pick and choose what material is most helpful for you!

Setting the scene

The discovery and introduction of antibiotics to treat bacterial infections is one of the single most important advancements in human medicine. From treatment of pneumonia and gonorrhea to prevention and treatment of infections that can arise after major surgery or chemotherapy, antibiotics have become indispensable. Overall, antibiotics have greatly improved human health and animal welfare. They are really the cornerstones of modern medicine.

Antibiotic pills depicted as essential pillars to support basic medicine (treating bacterial diseases such as pneumonia) and modern medicinal procedures (such as cancer treatment and surgeries), shown here as building blocks in a pyramid that rest upon the antibiotics.
Figure 1. Antibiotics – The cornerstones of basic and modern medicine. Treatment of infections as well as most modern medicinal procedures relies on functioning antibiotics. Idea B. Holloway and Prof. O. Cars, Photo: M. Pränting.

Unfortunately, the growing phenomenon of antibiotic resistance now threatens to leave us without effective treatment of bacterial infections. Over time, some bacteria have evolved the means to avoid and survive the action of antibiotics, for example by producing molecules that destroy the antibiotic. As resistance increases, antibiotics that were once effective stop working. Use and misuse of antibiotics in health care, agriculture and aquaculture to counteract infections and promote growth of livestock, has lead to the selection and proliferation of antibiotic resistant bacteria. These resistant bacteria then spread to other people, animals and in the environment, facilitated by poor hygiene and sanitation practices, human travel and trade. At the same time, very few new antibiotics are under development.

Resistance levels alarmingly high

Resistance has already reached a critical point for some major infections and the consequences can be seen worldwide. Data on the actual health and economic burden of antibiotic resistance is scarce. Some of the more reliable estimates on the number of deaths caused by antibiotic resistant bacteria each year and the costs for society are discouraging:

Country and number of deaths Societal costs
Thailand: More than 38,000 ~85-200 million US Dollars direct (>1.3 billion indirect).
USA: 23,000 Up to 20 billion US Dollars direct (up to 35 billion indirect).
European Union: 25,000 ~1.5 billion Euros.

And this is only the top of the iceberg as only a few selected bacteria were included in these estimates. Antibiotic resistance has an especially devastating impact on people living in low- and middle-income countries, where for example treatment failure in pneumonia or blood stream infections among children results in large number of deaths. Studies from South Asia (India, Pakistan, Afghanistan, Nepal, Bangladesh) indicate that blood stream infections with resistant bacteria alone kill 98,000 newborns each year. This means that one child looses its life every five minutes because the available antibiotics are useless due to resistance! Many more have suffered from resistant infections but recovered.

The World Health Organization (WHO) has stated that bacterial resistance to antibiotics is a major global threat to public health, and warned that we are heading toward a post-antibiotic era where common bacterial infections that have been treatable will once again be associated with high mortality rates.

In this short movie, M.D. Otto Cars, founder of ReAct and Professor of infectious diseases at Uppsala university in Sweden shares his concern about the antibiotic resistance problem and briefly discusses what we should do to counteract this negative development.

A complex issue

The issue of antibiotic resistance is complex, and so are possible solutions to manage the situation. To halt the spread of resistance and reach sustainable solutions, multiple interventions are needed on many levels in society all around the globe. The only true way forward must involve global collective action applying a holistic perspective. This means that both the human and animal sector as well as environmental and financial consequences must be taken into consideration. All efforts are important, from decisions and actions by individuals to large-scale initiatives by governments.

Selected Resources

Resource Description
Lecture: Bacteria, antibiotics and antibiotic resistance (PDF, 5MB) A basic introductory lecture to antibiotics and antibiotic resistance from ReAct (PowerPoint slides, pdf version).
What do we do when antibiotics don’t work any more? TED talk by Maryn McKenna on the consequences of antibiotic resistance and what may happen if we don’t start acting now (17 min).
The drugs don’t work TEDx talk by Sally Davies on the reason why drugs don’t work and how to fight against it (10 min).
The coming crisis in antibiotics TED talk by Ramanan Laxminarayan about the coming antibiotic resistance crisis (15 min).
What causes antibiotic resistance? This TED-Ed animated video gives an overview of how antibiotics function, how bacteria evolve to resist their action and how selection of resistant bacteria works (5 min). Also available in Spanish.
Antibiotic Resistance: An Ecological Perspective on an Old Problem This report highlights the need of co-existence with resistance instead of fighting it. To be able to do this and save life, strategies can be developed to prevent new resistance from spreading, identify strains we need to protect against, manage reservoirs of antibiotic resistant strains in the environment and find effective treatment in patients infected with resistant bacteria. Also available in French.