Antibiotic Resistance as a Global Health Problem
Antibiotics are clinically important drugs used in the treatment and prophylaxis of infectious diseases caused by microorganisms. The discovery of antibiotics has been an important milestone in human health and the mortality and morbidity rates associated with infectious diseases have dramatically decreased following the clinical use of these drugs. However, almost simultaneously with the discovery of antibiotics, it was predicted that microorganisms could gain resistance to these drugs, and if the necessary precautions were not taken, the existing antibiotics would lose their effect on the treatment of infectious diseases, and thus humanity would be able to re-encounter the pre-antibiotic period.
One of the attempts to prevent the clinical reflection of antibiotic resistance to the feared dimensions has been considered as the discovery of new antibiotic drugs and after the discovery of penicillin, great progress has been achieved in this area in a short time. But at that time, as long as resistance development was not prevented, the prophecy that mankind was ultimately doomed to lose the war against pathogenic microorganisms continued to cause concern. As a matter of fact, while new antibiotic discoveries have slowed down considerably in the last decade, the incidence of multiple antibiotic resistance microorganisms has increased significantly and a future in which antibiotics have lost their effect has begun to emerge.
Recognizing the importance of global initiatives to prevent antibiotic resistance is not new. In 1998, the General Assembly of the World Health Organization decided to take action against antibiotic resistance of the member states; In 2001, the WHO Global Strategy for limiting antibiotic resistance was published. The 2005 decision of the World Health Organization's General Assembly called on providers and consumers to make reasonable use of antibiotics, highlighting the slow progress in progress towards limiting antibiotic resistance. In order to draw attention to the importance of the threat to public health, WHO has identified the theme of World Health Day 2011 as antibiotic resistance and urged the whole world to think about it, take action and take responsibility in order to stop the development of resistance.
Antibiotic resistance is a very important health problem that concerns the whole world and not only today but also the future. As a result of the increase in the frequency of international travel with the help of today's technological and economic conditions, the problem of antibiotic resistance that arises in any part of the world reaches a dimension that covers the whole world in a very short time. Therefore, national regulations and studies play a key role in controlling antibiotic resistance worldwide, but all national programs must achieve the same level of success in order to succeed. Because the problem in any part of the world is the problem of the whole world.
The World Health Organization's program for combating the development of resistance to antibiotics includes the preparation of national programs on the subject, compliance with the program, and encouragement of civil society participation; increasing audit and laboratory capacities; ensuring uninterrupted access to essential and proven drugs; regulating the rational use of antibiotics (including their use in veterinary, agricultural and animal husbandry, the textile sector, etc.) with appropriate patient care; It includes an action plan that requires coordination and cooperation of many national and international institutions, organizations and civil society, including R & D activities to make development and control of infectious diseases more effective and development of new drugs.
Antibiotic Resistance Definition and Perception
It is defined as the development of resistance to the drug effect when the effect of the drugs at a certain dose decreases after repeated use at the same dose or the need to use the same dose at higher doses to produce the same effect. Drug-resistant pathogens are mentioned when the same applies to drugs (antibiotics, antineoplastics) whose mechanism of action is to kill or suppress pathogens that cause disease in the body.
Genes responsible for the development of resistance to antibiotics in bacteria are acquired by spontaneous or induced mutations or by transfer of resistance genes from other bacteria. In the case of exposure to antibiotics, these resistance genes are naturally selected because the bacteria carrying these genes are more likely to survive, and the space occupied by the bacteria carrying these genes increases in the ecosystem.
The development of resistance to antibiotics is known from the earliest stages of the discovery process of antibiotics. Alexander Fleming, who discovered penicillin, in his speech when he received the Nobel Prize in 1945, said that if the microorganisms were exposed to penicillin in a dose not sufficient to kill themselves in the laboratory, they would gain penicillin resistance and the same was true in the body.
Studies to examine the origin of the presence of antibiotic resistance genes in nature show that these genes, and therefore the antibiotic resistance observed in bacteria, are a natural phenomenon long before people start using antibiotics for treatment. Considering that the presence of antibiotics in nature exists long before the discovery of antibiotics, it can be assumed that this is expected.
Today, antibiotic resistance mechanisms are considered as part of the evolutionary process of bacteria. Accordingly, it is foreseen that antibiotic resistance will always exist as it has always existed and that there is and will not be an antibiotic that is not resistant to its effect, and it is accepted that the plan to combat antibiotic resistance should be realized on this assumption. It is also thought that clinically important resistance mechanisms and resistant bacterial species may change over time. These causes include the production of new antibiotics at regular intervals; these antibiotics should be specific to specific resistance mechanisms and their use should be limited to these situations.
Recent studies have included the concept of a resistance pool called “resistoma oluş, which consists of the sum of the resistance factors in all bacteria as well as the multidrug resistance in a particular bacterium. Bacteria in this pool include not only pathogenic bacteria but also non-pathogenic bacteria. The reason behind this approach change is that bacteria can transfer their resistance genes horizontally to different bacterial species. It is hoped that a better understanding of resistor can provide important benefits in the discovery process of new drugs by providing insight not only to the clinically important resistance mechanisms at the present time, but also to new resistance mechanisms that may become important in the future.
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