Despite his chance extraction of penicillin, Fleming has

been known to have foreseen the potential of antibiotic

misuse. “The ignorant man may easily underdose

himself and by exposing his microbes to non-lethal

quantities of the drug, makes them resistant”.

Antimicrobial resistance reduces the options and

effectiveness of anti-infective therapy; the emergence of

resistance is a natural phenomenon which can be

promoted by the use of anti-infective medicines in

certain circumstances. The evolution of antimicrobial

resistance is greatly accelerated when anti-infective

agents are used inappropriately.

Antibiotics have long been considered the “magic bullet”

that would end infectious diseases. Although they have

improved the health of countless numbers of humans

and animals, many antimicrobials have also been losing

their effectiveness since the beginning of the

antimicrobial era. Microorganisms have adapted

defences against these antibiotics and continue to

develop new resistances, even as new antimicrobials

are developed. In recent years, much attention has been

given to the increase in antibiotic resistance. As more

microbial species and strains become resistant, many

diseases have become difficult to treat, a phenomenon

frequently ascribed to both indiscriminate and

inappropriate use of antibiotics in human medicine.

However, the use of antibiotics and antimicrobials in

raising food animals has also contributed significantly to

the pool of antimicrobial resistant organisms globally

and resistant bacteria are now found in large numbers in

virtually every ecosystem on earth.

There is no doubt that the use of antibiotics provides

selective pressure that results in antimicrobial resistant

bacteria and resistance genes. While some resistant

bacteria are found naturally in the environment,

pathogens and non-pathogens are released into the

environment in several ways, contributing to a web of

resistance that includes humans, animals, and the

environment, essentially the biosphere.

The interest in antimicrobial therapy dates back to the

times when it was known that microorganisms are

responsible for diseases.

Egyptians and Greeks

used plant extracts successfully to treat diseases.

Malaria was treated with extract of cinchona bark

(quinine) and amoebic dysentery with “ipecacuanha”

root (emetine).

2,3

The discovery of penicillin in 1928 by Alexander

Fleming,

laid the foundation of modern antimicrobial

therapy, but it is interesting to note that Fleming

overlooked the resistance mechanism of the organisms

he tested. Microorganisms isolated before penicillin era

had the ability to produce beta lactamase.

Since the discovery of penicillin, a number of new

antibiotics were discovered and modified in the labs to

introduce new antimicrobial agents, but it is interesting

to note that no sooner newer antimicrobials were

introduced, microorganism acquired mechanisms to

counteract these products. The resistant genes can

spread far wider than once believed and a pool of

resistance develops in the non-pathogens which may

act as a source for pathogens to acquire resistant

genes.

Antimicrobial usage in human, animal and agriculture

leads to resistance in the environment via discharge

of domestic sewage, hospital waste water, and in

dustrial pollution. Much more antimicrobials are used in

animals as compared to human beings. In Denmark in

1994, a total of only 24 kgs of vancomycin was used to

treat infections in humans versus 24,000 kgs for

animals.

Once resistant organisms are into the environment,

they pose a health risk if they colonize or spread

resistance genes to bacteria that colonize humans.

We are not very far from the era in which antimicro-

bials will become ineffective if we do not control the

usage of antimicrobials in industry, agriculture, poultry,

improve the water and sewerage system, and make

judicious use of antimicrobials in community and

hospitals.

REFERENCES

1. Brian James Gangle, Master of Science, 2005. Sources and

occurrence of antibiotic resistance in the environment.

2. Garrod, LP, O'Grady F. Antibiotic and Chemotherapy, Third ed.

E. & S.

Livingstone, 1971. Edinburgh.

Journal of the College of Physicians and Surgeons Pakistan 2016, Vol. 26 (4): 243-244 243

EDITORIAL

Antimicrobial Resistance – A Global Threat

Saleem Hafiz and Sana Jamil

Department of Microbiology, Sindh Institute of Urology and

Transplantation (SIUT), Karachi.

Correspondence: Prof. Saleem Hafiz, Department of Microbiology,

Sindh Institute of Urology and Transplantation (SIUT),

Karachi.

E-mail: drshafiz@gmail.com

Received: March 22, 2016; Accepted: March 26, 2016.