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Fighting the tide of antibiotic resistance – Kate Scheer W&H UK

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  Posted by: The Probe      7th April 2019

Antibiotic resistance may be the single greatest threat to people’s health over the coming decades. All healthcare providers, including dental, must take steps to minimise and slow the development and spread of antimicrobial resistance, or we all stand to lose a cornerstone of modern medicine.

For most of human history, people have largely been at the mercy of harmful bacteria. While there have been some historical uses of what are now understood as antimicrobials, it was the discovery and pursuit of penicillin by Alexander Fleming that led to the modern antibiotic era. In many ways, modern medicine relies heavily on the efficacy of antimicrobials. A bacterial infection could have had dire consequences a century ago, but since World War 2, they have been largely relegated to a minor inconvenience – thanks to antibiotics. Procedures that would be incredibly risky without the ability to reliably fight infections – such as chemotherapy, Caesarean sections and organ transplants – are now commonplace.

However, life is remarkably adaptable. Bacteria has had to overcome chemical threats for billions of years. Humans have been actively developing antibiotics for less than a century, with an early boom between 1940 and 1962 yielding twenty distinct classes, followed by a long drop off which has seen only two new classes reaching the health care market since then. While penicillin was a true game changer, Fleming himself was amongst the first to recognise and caution that an insufficient course of treatment could lead to resistance.[1],[2]

Part of what enables bacteria to accomplish such rapid adaptation is the existence of plasmids, which are tiny circular DNA strands that inhabit bacteria.

Plasmids allow genes to transfer horizontally across bacterial populations through contact. This ability allows a few scraps of genetic code to be freely shared and replicated, even by very different species of bacteria. When one of these plasmids proves useful – such as by conferring antibacterial resistance – it can spread very quickly. Inappropriate use of antibiotics can provide a selection pressure that actively encourages the evolution and proliferation of such plasmids.[3]

A small world

Our increasingly connected world can frustrate national level efforts to combat this problem. Air travel allows illness and bacterial mutations to spread to almost any part of the globe, potentially within days.

Not only can our systems facilitate the movement of contagion, but where these systems break down, antibiotic resistance can develop more freely. For example, present health care in Gaza is thoroughly overwhelmed, with a system that was already in crisis being pushed to the brink by recent events. Without adequate supplies, laboratories are unable to take cultures, and patients are frequently given inappropriate and insufficient courses of antibiotics. Such circumstances have and continue to fuel antibiotic resistance in the region.[4]

In many places around the world, it is possible for members of the public with no medical training to acquire antibiotics. In some countries, people can purchase drugs without prescription freely, but even where regulated, motivated members of the public are able to acquire them. Some Americans unable to afford health care, for instance, have reputedly resorted to buying antibiotics intended for fish online.[5],[6],[7]Industrial pollution from pharmaceutical manufacturers and irresponsible agricultural usage have also driven antibacterial resistance.[8]  

Already an emergency

Antibiotic-resistant bacteria are already a major strain on health care systems and a life-threatening possibility for those receiving care.

Bacteria that are resistant to particular antibiotics are now common, while multidrug-resistant (MDR) infections are no longer rare. Moreover, some pathogens have emerged in recent years that are resistant to nearly all existing antibiotics. A recent conservative estimate of deaths attributable to antibiotic-resistant bacteria within the European Economic Area found that over 33,000 people lost their lives to five types of infection in 2015 alone, and that these numbers were increasingly trending upward over time.[9]

Prior to penicillin, staphylococcus aureusinfections of the blood had a mortality rate in excess of 80%, with the vast majority of people developing metastatic infections. While initially successful, over 90% of staphylococcal isolates have now become resistant to penicillin.[10]Even conditions like cellulitis and erysipelas were fatal in more than 1 in 10 cases prior to antibiotics becoming widely available.[11]Left unchecked, antibiotic resistance could see many of the gains in medicine of the last few decades undone.

Hygiene and Disinfection

Antibiotic resistance has historically started within many health care settings, then spread to the wider community.[12]One crucial area that can make a real difference in slowing and halting the spread of antibacterial resistant pathogens is through following strict decontamination processes, particularly within the dental practice.[13]This involves investing in reliable decontamination solutions that can adequately support clinicians’ infection control protocols. Using the ThermoKlenz washer disinfector dryer from W&H, for instance, limits the risk of sharps injuries and reduces the risk of the dental team being exposed to potentially harmful microorganisms. W&H’s Lisa Type B vacuum sterilizer is ideal for fast but effective sterilization of instruments, ensuring a consistent, qualifiable and effective decontamination process. 

Antibiotic resistance is an ongoing problem, but by following best practice dental practitioners can help keep their patients safe.

To find out more visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com


[1]Aminov R. A brief history of the antibiotic era: lessons learned and challenges for the future. Frontiers in Microbiology. 2010; 1: 134.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109405/January 3, 2019.

[2]Coates A., Halls G., Hu Y. Novel classes of antibiotics or more of the same? British Journal of Pharmacology.2011; 163(1): 184-194. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085877/January 3, 2019.

[3]Davies J. Vicious circles: looking back on resistance plasmids. Genetics.1995; 139(4): 1465-1468. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1206476/January 3, 2019.

[4]Kanapathipillai R., Malou N., Baldwin K., Marty P., Rodaix C., Mills C., Herard P., Saim M. Antibiotic resistance in Palestine: an emerging part of a larger crisis. The British Medical Journal.2018; 363: k4273. https://www.bmj.com/content/363/bmj.k4273January 3, 2019.

[5]Mainous A., Everett C., Post R., Diaz V., Hueston W. Availability of antibiotics for purchase without a prescription on the internet. Annals of Family Medicine.2009; 7(5): 431-435. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746509/January 3, 2019.

[6]Safrany N., Monnet D. Antibiotics obtained without a prescription in Europe. The Lancet. 2012; 12(3): 182-183. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(12)70017-8/fulltextJanuary 3, 2019. 

[7]Rogers K. People are buying fish antibiotics because they can’t afford human ones. Motherboard.July 31st, 2017. https://motherboard.vice.com/en_us/article/bjxwma/people-are-buying-fish-antibiotics-because-they-cant-afford-human-onesJanuary 3, 2019. 

[8]Davies J., Davies D. Origins and evolution of antibiotic resistance. Microbiology and Molecular Biology Reviews. 2010; 74(3): 417-433. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2937522January 3, 2019.

[9]Cassini A., Högberg L., Plachouras D., Quattrocchi A., Hoxha A., Simonsen G., Colomb-Cotinat M., Kretzschmar M., Devleesschauwer B., Cecchini M., Ouakrim D., Oliveira T., Struelens M., Suetens C., Monnet D. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modeling analysis. The Lancet. 2019; 19(1): 56-66. https://doi.org/10.1016/S1473-3099(18)30605-4January 3, 2019.

[10]Lowy F. Antimicrobial resistance: the example of staphylococcus aureus. Journal of Clinical Investigation.2003; 111(9): 1265-1273. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC154455/January 3, 2019.

[11]Spellberg B., Talbot G., Boucher H., Bradley J., Gilbert D., Scheld W., Edwards J., Bartlett J. Antimicrobial agents for complicated skin and skin-structure infections: justification of noninferiority margins in the absence of placebo-controlled trials. Clinical Infectious Diseases.2009; 49(3): 383-391. https://academic.oup.com/cid/article/49/3/383/497585January 3, 2019.

[12]Chambers H., DeLeo F. Waves of resistance: staphylococcus aureus in the antibiotic era. Nature Reviews Microbiology.2010; 7(9): 629-641. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2871281/January 3, 2019.

[13]Lee C., Cho I., Jeong B., Lee S. Strategies to minimize antibiotic resistance. International Journal of Environmental Research and Public Health. 2013; 10(9): 4274-4305. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799537/January 3, 2019.


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