ANTIMICROBIAL RESISTANCE : ITS MEDICAL AND LEGAL VANTAGE POINT

ABSTRACT

A WHO study has identified antimicrobial resistance (AMR) as one of the top ten global public health threats to humanity. AMR jeopardizes the effective prevention and treatment of an ever-growing range of infections caused by bacteria, parasites, viruses, and fungi. Antimicrobials, including antibiotics, antivirals, antifungals, and antiparasitics, are medications used to prevent and treat infections in humans, animals, and plants. Microorganisms that develop resistance to these drugs are sometimes called "superbugs." This article aims to raise awareness about the causes and effects of AMR and provide legal guidance on this issue.

INTRODUCTION

Antimicrobial resistance (AMR) is a significant global health and development challenge that demands urgent multisectoral action to achieve the Sustainable Development Goals (SDGs). As one of the foremost public health issues of the 21st century, AMR compromises the effective prevention and treatment of a growing array of infections caused by bacteria, parasites, viruses, and fungi that have become resistant to standard treatments.

AMR develops naturally over time, typically through genetic changes. Resistant organisms can be found in humans, animals, food, plants, and the environment (water, soil, and air), spreading between individuals and animals, including via animal-derived food. Key drivers of AMR include the misuse and overuse of antimicrobials; inadequate access to clean water, sanitation, and hygiene (WASH) for both humans and animals; insufficient infection and disease prevention and control in healthcare settings and farms; limited access to quality, affordable medicines, vaccines, and diagnostics; lack of awareness and knowledge; and weak enforcement of regulations.

The urgency of addressing AMR is particularly critical with antibiotic resistance in bacteria. Over the years, bacteria causing common or severe infections have increasingly developed resistance to new antibiotics. Given this scenario, taking decisive action to prevent a global health care crisis is essential. It is important to note that antimicrobial resistance (AMR) is synonymous with antimicrobial drug resistance.

MEDICAL SCRUTINY

Antimicrobial resistance (AMR) is a major global health threat. Antimicrobials are crucial for saving lives, but resistance accelerates as microbes adapt. All types of microbes—fungi, viruses, protozoa, and bacteria—can develop resistance, not in the human body, but in the microbes themselves.

Misuse and overuse of drugs are the primary factors driving the development of drug-resistant pathogens. This includes inappropriate choices, incorrect dosages, and poor adherence to treatment guidelines, all of which gradually alter the body's normal microbiota.

Understanding how antimicrobial drugs work is essential. One key concept is selective toxicity, where the drug targets the pathogen without harming the host. Antimicrobial drugs can disrupt the cell membrane, causing cell damage or death by allowing macromolecules and ions to escape. They can also inhibit protein or nucleic acid synthesis, targeting bacterial ribosomes without affecting mammalian ribosomes.

Despite these mechanisms, resistance still develops. Microbes employ defense strategies, or resistance mechanisms, making antimicrobials ineffective and resulting in untreatable infections. Resistant microbes can transfer their resistance to other germs, even those not previously exposed to antibiotics. Microorganisms can alter their permeability to drugs, develop alternative metabolic pathways, or produce enzymes that destroy the drug, like β-lactamase in Staphylococci or carbapenemases in Klebsiella pneumoniae.

Drug targets can also be modified, preventing antibiotics from binding and working effectively. This process includes changing entryways to reduce drug access to microbial cells. Human behavior significantly contributes to AMR; incomplete courses of treatment or using antibiotics for viral infections can lead to resistance. Additionally, antibiotic use in animals can lead to cross-contamination when humans consume their meat.

The impact of antibiotic resistance is challenging to quantify but significant, affecting treatments such as chemotherapy, organ transplants, and surgeries. Multidrug-resistant infections increase mortality and healthcare costs due to more expensive treatments, specialized equipment, and longer hospital stays. When first-line drugs fail, more expensive second or third-line treatments are necessary.

Without effective antimicrobials, modern medicine is at risk. Alternative treatments, like multiple-drug therapy and monoclonal antibodies, can combat resistant microbes. Vaccines also play a crucial role in preventing infections. As former UK Prime Minister David Cameron warned, failing to act against AMR could thrust us back into a "dark age" of medicine.

LEGAL SCRUTINY

The global scope of antimicrobial resistance (AMR) highlights the need for an integrated strategy at both national and international levels. This strategy faces political and legal challenges, as harmonizing international principles for prudent antimicrobial use requires monitoring, enforcement, and assistance from developed to developing countries.

Developing an international legal strategy is challenging. The WHO's limited regulatory powers do not extend to creating drug use regulations, and it has not revised the International Health Regulations to address antimicrobial drug use. While the WHO could adopt a convention on antimicrobial use, it has yet to do so. Experiences from international environmental efforts suggest that international law must play a crucial role in setting standards for domestic implementation and in creating the conditions necessary to integrate international and national laws.

National strategies also face legal and political obstacles. In the United States, state legislatures could regulate how physicians prescribe antimicrobial drugs, but such legislation might face opposition from physicians and their associations. If formal regulation is not feasible, alternatives include self-regulation through practice guidelines and peer review processes. Managed care organizations could also help control drug misuse due to their power and economic incentives.

Addressing AMR as a public health and legal challenge requires considering three levels of interdependence: among antimicrobial drug surveillance, use, and R&D; between national and international laws; and between public health and legal strategies. Each element of the public health strategy affects and depends on the others. Since AMR is a global issue, national legal reforms in a few countries will be undermined if similar actions are not taken globally, as drug-resistant pathogens travel easily.

A comprehensive blueprint to address AMR must consider these interdependencies. Effective antimicrobial use and increased R&D rely on accurate surveillance. Therefore, combating AMR requires a scientific, public health, and legal strategy. Including legal aspects in the discussion will broaden and strengthen efforts to combat antimicrobial resistance.

CONCLUSION

It is crucial to understand that creating new international legal obligations will be ineffective if they are not implemented into national law. Therefore, any legal strategy to combat antimicrobial resistance must operate at both national and international levels. Effective change depends on us. As a wise man once said, ignorance is the root cause of many of the world's problems. Clearly, new antimicrobials are necessary, but without changes in how drugs are used, these new drugs will face the same issues as the old ones. This underscores the need to properly educate people on the appropriate use of antimicrobial drugs, which will undoubtedly reduce the risk of antimicrobial resistance significantly.

REFERENCE

[1] WHO 'Antimicrobial resistance' (World health organization, 17, November,

2021) accessed 11 May 2022

[2] PFidler David, 'Legal Issues Associated with Antimicrobial Drug Resistance' (Indiana

University School of Law, Bloomington, Indiana, USA, 2021) accessed 11

May 2022

[3] https://www.pdfdrive.com/jawetz-melnick-adelbergs-medical-microbiology-28th-edition-

e200782660.html

[4] https://www.medicalnewstoday.com/articles/283963A

[5] https://www.who.int/news-room/fact-sheets/detail/antimicrobial-

resistance#:~:text=Antimicrobial%20Resistance%20(AMR)%20occurs%20when,spread%

2C%20severe%20illness%20and%20death

[6] https://www.cdc.gov/drugresistance/about/how-resistance-happens.html

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768623/