Despite all of its advances and developments, modern medicine still struggels with its over-reliance on antibiotics. In fact, if there’s one aspect of medicine that we tend to take for granted, it’s definitely antibiotics. From simple ear or throat infections to STIs, we got used to treating all kinds of bacterial infections with antibiotics. And it’s not without good reason – bacterial infections are very common, wide-ranging and can affect more or less any part of our organism. What’s more, when left untreated, they can cause serious harm.

But, in the developed world, most of these health conditions are viewed as nothing more than just nuisances, small annoying problems that can be easily solved by a week or two of tablets. But is it really all that simple and easy?

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What is antibiotic resistance?

Antibiotic resistance is an ever-growing problem of modern medicine, although a relatively underestimated one. This term is used to denote an unwanted side effect of our constantly increasing reliance on antibiotics – the development of immunity to antibiotics in common bacteria.

This isn’t something that wasn’t expected to a certain extent. To put it in a different perspective – evolution of any population is determined by random mutations and selection factors, as described by classical theory of evolution. A certain characteristic can randomly appear in certain individual and if it gives that individual an advantage, it is likely that the mutated gene will be passed on to the next generation of organisms.

In terms of bacteria, our use of antibiotics presents the factor of selection and the ability of bacteria to withstand treatment is often the difference between reproducing and dying out. And the same is true for more than 80 years at this point. Infections that were thought to be potentially fatal before 1930s are today viewed as trivial. But at the same time, unwillingly, we have been forcing bacteria to adapt and evolve in order to survive, and the biggest advantage they can get in the modern world is resistance to antibiotics.

Some might conclude that 80 years is just too little time for evolution to occur. Even if we said that bacteria are under constant threat from antibiotics for a whole century (which is certainly stretching the truth a bit), it still seems like too little time. But, is it?

With proper conditions such as temperature and presence of nutrients, some bacterial species can reproduce roughly every 20 minutes by dividing into two identical daughter cells. What this means is that in ideal conditions, one bacterium can generate as much as 2 million of bacteria with the same genetic properties in as little as 7 hours! This rate of multiplication is something that could never be achieved by more complex organisms. And it is exactly this that gives single-cell organisms “an edge” – they reproduce quicker, so they are also able to evolve quicker than any other more complex organism on the planet, making antibiotic resistance a real and present threat, like the recent emergence of so-called super gonorrhoea proves.

What exactly causes antibiotic resistance?

It is biologically inevitable for any organism to evolve and mutate in order to survive – this is the very basis of life on Earth as we know it. With this in mind, it is not surprising that whenever a new antibiotic is developed and put into use, it will remain effective for a very limited period of time after which the bacteria it is supposed to be combating will become immune to it.

It is only natural for infectious bacteria to develop defences against treatments used to combat it and this tendency is pushed to the extreme by our over-reliance on antibiotics which reached such proportions that in many cases, the use and prescription of this type of medicines is considered to be even inappropriate.

In some cases, the use of antibiotics is justified and necessary – for example, complex surgeries or cancer treatments would be virtually impossible without antibiotics. Likewise, many infections can be very successfully mitigated by prescribing this type of medicine. But, in all these examples, it is of uttermost importance that antibiotics are properly prescribed and properly used, thus sharing the blame for inadequate use between doctors and patients.

What is inappropriate prescribing?

When it comes to doctor’s responsibility for contributing to the ever-growing antibiotic resistance, we can mention several harmful practices such as prescribing antibiotics when they aren’t really necessary (like in cases of mild infections that can be easily defeated by immune system alone), selecting the wrong type of antibiotic, prescribing the wrong dose or issuing the treatment for the incorrect duration.

Any of these practices can simply serve as additional stress factors that will force the bacteria to evolve more quickly. At the same time, they can be ineffective in fighting the type of bacterial infection that is at hand (like in the case of prescribing the wrong type of antibiotics), thus increasing the chances that the mutated bacteria will spread further.

The issue of patient responsibility

However, it’s not just the doctors that might cause this problem – the decisions of patients also play a very important role. Inappropriate use of antibiotics include practices such as requesting antibiotic treatment when it isn’t necessary, skipping doses, not completing the course of the treatment, saving some for later use or sharing medicines with others.

In order to decrease the prevalence of antibiotic resistance among infectious bacteria, the patient themselves need to play a more active role, too. It is important to use antibiotics only when really needed – this will not only help with the antibiotic resistance issue, but will also keep your immune system in shape. At the same time, prescription of antibiotics is strictly controlled and directed by decades of medical knowledge – one should never assume that the course of the treatment can be modified or changed at will.