Antibiotic Resistance Article Final Submission

Causes, Consequences, and Potential Solutions to the Rise of Antibiotic Resistance
Paige M. Breedon and Austin A. Mardon

The first antibiotic drug was discovered by Alexander Fleming in 1928 when a cultured plate of bacteria was accidentally contaminated by a mold spore which secreted a substance that had antibacterial activity [1] It was not until around 1940 that Ernst Chain and Howard Florey realized the therapeutic potential of penicillin [1] Although antibiotics have saved many lives, an unfortunate and inevitable consequence of all such therapies is resistance to antibiotics which is often accelerated due to misuse of antibiotics in medicine, commercially, and in the agricultural industry. 

Driving Factors in the Rise of Antibiotic Resistance
Antibiotic resistance is an inevitable consequence of evolution. Resistant strains arise from mutations in genes, and natural selection results in the bacteria that possess these resistant strains having a selective advantage and surviving under the conditions of antibiotic therapy. Especially given the short generation time, these bacteria replicate and soon, the remaining bacterial population is all resistant [3]. 
Furthermore, antibiotic resistance is a crucial example of an evolutionary arms race between bacteria and antibiotics [2]. Specifically, every time a physician prescribes a particular antibiotic, the only bacteria that can survive have antibiotic-resistant genes, and thus, a new antibiotic that targets a different process in bacteria must be instituted; this process continues until the entire medicine cabinet of antibiotics has been utilized, it is at this point that superbugs often win.
Although antibiotic resistance is a naturally occurring phenomenon, the misuse of antibiotics in medicine and agriculture has led to a substantial rise in antibiotic resistance. Through high rates of antibiotic use in medicine, communities, and agriculture, humans have selected for resistant strains of bacteria [3]. Examples of misuse of antibiotics include blinded use, use of broad-spectrum antibiotics, use of antibiotics for viral infections, patients not finishing their course of treatment, and use of antibiotics in animals. All of these misuses have ultimately led to the rise of antibiotic resistance. 
To elaborate, misuse of antibiotics could be due to a physician not knowing what kind of infection a patient has and therefore blindly prescribing a broad-spectrum agent with the intention that they will recover [3]. Also, antibiotics have been severely misused in the agricultural and factory farming industry to maintain productivity through growth promotion and disease prevention; however, such practices' impact on human health must be considered [3]. Also, even if one is prescribed antibiotic therapy and gets better, it is of the utmost importance that the patient finishes the entirety of their course of treatment because if any antibiotic-resistant bacteria survive, they will replicate. Then the antibiotics will not be effective against the remaining bacteria [3].
Furthermore, a challenge associated with developing new antibiotics is the lack of motivation in pharmaceutical industries. There is a seemingly paradoxical nature to antibiotic drug development, partly due to the inevitability of drug resistance [4] Specifically, putting so much money and time into getting a new antibiotic drug approved and, on the market, only for it to become obsolete quickly makes it less appealing from a business perspective [4]. Therefore, the lack of interest of drug development companies contributes to the burden of superbugs in today's society.

Consequences of Antibiotic Resistance
Antibiotic resistance has led to countless deaths and significant economic effects. For example, excess costs associated with antibiotic-resistant bacteria include the need to follow up with more expensive antibiotics, longer hospital stays, higher mortality, delayed appropriate antibiotic therapy and increased frequency of surgical interventions required to control infection [5]. However, there are substantial consequences to the rise of antibiotic resistance.

Potential Solutions to Minimizing the Impact of Superbugs
Antibiotic resistance can be minimized by optimizing existing antibiotics, developing new antibiotics, using alternative treatments, reducing the need for antimicrobials by increasing immunity through vaccination and improved nutrition, educating health professionals, patients and policymakers, and restricting commercial access to antibiotics [5]. In general, considering the constant flow of resistance genes between humans, animals, and environments, any approaches to minimizing the impact of antibiotic resistance require collaboration across these facets [6]. 

Overall, superbugs pose a significant threat to fighting bacterial infections; thus, collaboration, education, and caution must be exercised in fighting the rise of antibiotic resistance for the better of public health and the economy.

REFERENCES
[1]    Alexander Fleming. Science History Institute. (2021, September 21). Retrieved April 13, 2022, from  sciencehistory.org/historical-profile/alexander-fleming.
[2] Antibiotic development: an “evolutionary arms race.” (2013). Veterinary Record, 172(16), 411–411.  doi.org/10.1136/vr.f2332
[3] Laxminarayan, R., Duse, A., Wattal, C., Zaidi, A. K. M., Wertheim, H. F. L., Sumpradit, N., … Cars, O. (2013). Antibiotic resistance—the need for global solutions. The Lancet Infectious Diseases, 13(12), 1057–1098.  doi.org/10.1016/S1473-3099(13)70318-9
[4] McKenna, M. (2020). The antibiotic paradox: why companies can’t afford to create life-saving drugs. Nature (London), 584(7821), 338–341. doi.org/10.1038/d41586-020-02418-x
[5] Sipahi, O. R. (2008). Economics of antibiotic resistance. Expert Review of Anti-Infective Therapy, 6(4), 523–539. 
 doi.org/10.1586/14787210.6.4.523
[6] Tracing the origins of antibiotic resistance. (2022). Nature Medicine.  doi.org/10.1038/s41591-022-01752-z
About the Authors
Paige Breedon is a second-year medical sciences undergraduate student at the University of Western Ontario with an interest in epidemiology, public health, and the biological sciences.
Dr. Austin Mardon is a geographer, author, researcher, assistant adjunct professor at the University of Alberta and the founder and director of the Antarctic Institute of Canada.