Why don't the medicines given for some diseases work? (Antimicrobial Resistance) Let's talk about it!

Do you sometimes wonder, 'Why doesn't the medicine I'm giving you for this disease work?'? Some disease-causing germs develop resistance to the medicines we give them. That's what we call antimicrobial resistance, or ( It's called Antimicrobial Resistance . This is a bit of a serious story, but let's keep it simple.

What is this (Antimicrobial Resistance)?

Simply put, this (Antimicrobial Resistance) means that there are certain types of germs (microbes), for example, bacteria, fungi, viruses, or parasites, and the drugs given against them do not work. We usually call these little ones 'germs'. So, this is a situation where these germs have 'adapted' to the drugs, and the drugs are useless to them. Then it becomes difficult for doctors to cure some diseases.

Think of it this way. When a germ is exposed to the same drug over and over again, it recognizes it and says, "Oh, this is coming." Then it finds ways to escape the drug. That is, it makes small changes (mutations) inside its body. These changes are made in a way that makes it resistant to drugs that were previously used to kill it or stop it from spreading. That is what is called "resistance." There are some germs that are resistant to not just one drug, but to many drugs. Those are the ones we call "superbugs."

There's something important to understand here. Antimicrobial resistance is caused by germs, not by your body becoming resistant to the medication .

What are these 'antimicrobials'?

Now let's look at what these 'antimicrobials' are. These are the types of medicines we use to fight germs that cause disease. There are several main types:

• Antibiotics: These are given for bacterial infections.
• Antifungals ( Antifungals : For fungal infections.
• Antiparasitics: For diseases caused by parasites.
• Antivirals: For viral infections.

This antimicrobial Different types of medicine kill germs in different ways, or they stop them from spreading. Some medicines go inside the germ's cells and inactivate the things they use to make you sick, or the things they use to spread more.

Imagine this. You're in the kitchen trying to cook. I want to stop you. What do I do? I come into your kitchen and destroy something you're using to cook, or I stop you from using the stove. That's how this medicine works.

So, when germs develop resistance to these drugs, they can do things like:

• "I (meaning the medicine) is not allowed to enter the kitchen (the germ cell)."
• "If I enter the kitchen, I will be thrown out."
• "I will destroy my weapons (the active ingredients of the medicine) that I use to stop them from cooking ."
• "I change the things they target (for example, changing some of the cooking utensils, or changing the stove so I can't stop it)."
• "They're changing the way they cook. That means using different ingredients, or making food that doesn't require an oven or baking."

How does this (Antimicrobial Resistance) work?

Okay , so how exactly does this antimicrobial resistance work? Here are some ways in which a germ becomes resistant to a drug:

• The medicine prevents the germ from entering the cell.
• Somehow, the medicine that got inside is pushed out.
• The chemical nature of the medicine is changed, or it is destroyed.
• They change part of the germ itself, so the drug can't target it.
• They are developing a new way to live and reproduce without having to deal with medicine.

What are the main types of Antimicrobial Resistance?

There are two main types of antimicrobial resistance. One is intrinsic resistance , and the other is extrinsic or acquired resistance . When we usually talk about resistance to these drugs, we mean the latter, acquired resistance.

• Intrinsic resistance is a natural characteristic of some germs that prevents them from being treated with certain drugs. For example, there are some types of bacteria that have very strong cell walls. So some antibiotics can't get through that cell wall. It's something that's innate to them.
• Acquired resistance (extrinsic resistance) is when a drug that previously worked on a certain germ changes in the germ and makes it ineffective. When the germs are infected, these changes are passed on to their offspring. Also, things like bacteria can pass these changes on to other bacteria that are already there. This is called (horizontal gene transfer) .

Some examples of drug-resistant germs

Here are some examples of germs that are resistant to these drugs:

• Bacteria that are resistant to antibiotics: Examples include MRSA (methicillin-resistant Staphylococcus aureus), CREs (carbapinem-resistant Enterobacteriaceae), and Pseudomonas aeruginosa .
• Fungi that are resistant to antifungals: Examples include (Candida auris) and (Aspergillus fumigatus) .
• Some viruses are resistant to antivirals: For example , some resistant strains of HIV , influenza , and Hepatitis C viruses.
• Some parasites are resistant to antiparasitics: For example, resistant strains of parasites that cause diseases such as malaria , leishmaniasis, and trypanosomiasis .

Important: Just because you get sick from a germ on this list, don't assume it's a drug-resistant strain. There are strains of these germs that are resistant to drugs, as well as strains that are not resistant and can be cured with regular medications.

What is the main cause of Antimicrobial Resistance?

Well, why do these germs become resistant to drugs? There could be many reasons. Sometimes, they develop natural changes that help them coexist with other organisms. Other times, they develop defense mechanisms to escape the drugs, or to destroy them. When germs spread, they pass on the ability to resist these drugs to their offspring.

Antimicrobial resistance often becomes more severe in hospitals and other healthcare settings , where bacteria develop resistance to the drugs that doctors often use. It's really hard to prevent this.

Also, the use of antimicrobials in agriculture is a major cause of this. For example, spraying crops with antifungals and giving animals antibiotics to prevent disease also increase this resistance.

How do we prevent Antimicrobial Resistance?

To help prevent this (Antimicrobial Resistance), there are guidelines that healthcare workers should follow. They are:

• Wash your hands often.
• Disinfecting surfaces.
• Prescribing antibiotics only for bacterial infections.
• Proper sterilization of medical equipment.
• If there is suspicion that a resistant germ is spreading, testing patients and visitors to hospitals.
• Quarantining someone with a resistant infection to prevent it from spreading to others.

There are ways you can help with this too. They are:

• Taking the medication exactly as prescribed by the doctor, in the correct dosage, and at the correct time.
• Especially when given antibiotics, it is very important to take all the medicine prescribed by the doctor until it is finished, even if the illness subsides. This is very important.
• Avoid unnecessary use of antibiotics. Remember, respiratory infections like colds and flu are often caused by viruses. Taking antibiotics for them won't help.

How do you test for Antimicrobial Resistance?

Now imagine that you have an infection and the medications you are given are not helping. Your doctor may think that you have an infection caused by a drug-resistant germ. In that case, they may take a sample of your blood or other body fluid and test it for different types of drugs against the germ. This is called Antimicrobial Susceptibility Testing (AST) . This can help find out which drugs will work on that germ. However, these tests take a while.

How do you treat an infection caused by a drug-resistant germ?

Diseases caused by antimicrobial-resistant germs are especially dangerous because they are very difficult to treat. Doctors try to find a drug that works against the specific germ that caused your illness. Sometimes, they have to give you combination therapy to fight the infection. For example, they give you several different types of antibiotics together .

Who is at higher risk of developing this (Antimicrobial Resistance) infection?

Some people are at a slightly higher risk of developing infections that are resistant to these drugs. Let's see who they are.

• People who have tubes (such as a central venous line , a breathing tube , a feeding tube ) or other devices inserted into their bodies. Germs can easily enter the body through these.
• People who have used antibiotics for a long time, or who use them frequently. When you are exposed to antibiotics for a long time, there is a greater chance that bacteria will develop resistance. This can also kill off the 'good' (non-harmful) bacteria in your body. These good bacteria are what keep other germs from growing out of control and causing infections.
• People with a weakened immune system due to an underlying health condition. For example, people with HIV , blood cancers , diabetes mellitus , or people who have had an organ transplant or stem cell transplant . These conditions make it harder for the body to fight infections.
• People who have been hospitalized for a long time, or who live in long-term care facilities, are more likely to develop resistance to germs in healthcare settings.

What are the most important things we should remember from this story?

Doctors and scientists continue to work hard to find solutions to antimicrobial resistance. But there is a big thing we can do too.

The most important thing is to take medications, especially antibiotics, as prescribed by your doctor, only when needed. If you are caring for someone with a weakened immune system, or someone in a hospital or long-term care facility, you need to be extra careful. Remember , even small things like washing your hands can make a big difference .

Antimicrobial resistance is a major global health threat. Let us all work responsibly to help control it.

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