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Antimicrobial Resistance: A Dark Shadow on Global Public Health

Antibiotics were the one of the revolutionary discoveries of the 20th century while their resistance has turned out to be one of the grievous challenges of the 21st century. The burgeoning burden of antibiotic resistance as a whole and the sharing of these resistance traits among humans, animals and environmental reservoirs, are continuously threatening mankind with the nightmare of succumbing to even infections like the common cold. Like many emerging public health problems, the problem of antibiotic resistance reminds us that the health of humans, animals, and ecosystems are completely interconnected, and that to better understand and respond rapidly to this public health emergency at the human-animal-environment interface requires coordinated, collaborative, multidisciplinary, and crosssectoral approaches, which in a single term can be labelled as “One Health” approaches.

Antibiotics (“anti” – against; “biotic” – relating to living organisms) are molecules that can stop the growth of microbes or can kill them outright. Most of the antibiotics introduced into clinical use to treat infectious diseases have been natural products produced by one microorganism in a particular habitat and set of environmental conditions, to affect the neighboring microbes, either to regulate their growth or to trigger their elimination.

The successful survival of bacteria for approximately 3.5 billion years on earth attests to their highly adaptive nature through genome plasticity against perilous odds of innumerable hostile circumstances, and also proves that the genomes of all bacteria can be considered as a single global gene pool, into which bacteria can dip for genes necessary for their survival against any unfavourable encounter. The discovery of antibiotics started challenging bacterial survival for some period of time, but now it seems that bacteria have completely taken over the survival race against antibiotics, with the rise of more and more ‘superbugs’ that could possibly announce an end to the antibiotic era. With few alternatives in the armoury, this scenario makes human existence endangered, as per a recent report from the United Kingdom – the human cost of the antibiotic-resistance crisis has been estimated to be 300 million cumulative premature deaths by 2050, with a loss of up to $100 trillion to the global economy [1]. Taking this dreadful scenario in cognizance, in 2017 the World Health Organization published its first ever list of antibioticresistant “priority pathogens” that pose the greatest threat to human health.2

Rise of Antimicrobial Resistance

The introduction of the “magic drug”, penicillin, into human therapeutics in the 1940s with a great deal of promise to counter all infectious life-threatening diseases soon went through major blows in the following decades. The pace of resistance towards these magic drugs can be estimated by observations that penicillin was given to the first patients in 1941, and resistance towards it was detected in 1942. Similarly, the drug methicillin was introduced in 1960 and resistance to the same was reported in 1961.3 The rising concern of the problem of antimicrobial resistance (AMR) is that we have very few antibiotics in the pipeline to counter these lifethreatening ‘superbugs’, and producing new antibiotics in the 21st century has become a daunting task as the poor economic return on the investment in drug discovery has made many pharmaceutical companies halt their antibiotic research and development programmes to focus on more economically favourable arenas.