Why do medicines sometimes not work? (Antimicrobial Resistance) Let's learn about it simply!

Do you sometimes think, "Oh my, this time the medicine won't make the illness go away?" Or have you ever had a case where you kept taking the medicine your doctor prescribed, but your illness didn't go away? Maybe the reason for this is a little more complicated than you think. Today we're going to talk about one such very important topic. That is the condition known as Antimicrobial Resistance .

What is Antimicrobial Resistance?

Simply put, antibiotic resistance is the inability of a drug to work against a microbe . These microorganisms are very small, invisible organisms. We usually call them "germs." These include bacteria, fungi, viruses, and parasites . These germs cause various diseases. So, when this antibiotic resistance develops, it becomes very difficult for doctors to cure some diseases.

Think of it this way. When a germ is repeatedly exposed to the same drug, it becomes "resistant" to it. Just like us, they find ways to protect themselves. They mutate their bodies, making them better able to escape the drugs that were previously used to kill them or stop them from multiplying. This is what we call "resistance." There are germs that are resistant to not just one drug, but to multiple drugs. We call them "superbugs."

The important thing is that this antibiotic resistance occurs in the germs, not in your body. It's not your body that becomes resistant to the drugs, it's the germs that cause the disease that become resistant to the drugs.

What are these antimicrobials?

Antibiotics are medicines that fight diseases that cause infections. There are several main types of them:

• Antibiotics: These are given for bacterial infections.
• Antifungals: Medicines given for fungal infections.
• Antiparasitics: Medicines given for diseases caused by parasites (e.g., medicine given for malaria).
• Antivirals: Medicines given for viral infections (e.g., for illnesses like influenza).

These antibiotics work in different ways to kill germs or stop them from spreading. Sometimes they go inside the germ's cells and attack the parts that help the germ make you sick, or they attack the parts that help the germ make more copies of itself.

Imagine this example. You're in the kitchen cooking. I want to stop you. Then I can enter your kitchen and destroy an ingredient you're using to cook the food, or stop you from using the stove.

So, once they develop antimicrobial resistance, they can do things like:

• I can prevent (that is, the medicine) from entering the kitchen (that is, the germ cell).
• You can throw me out of the kitchen.
• I can destroy the weapons (active ingredients in the medicine) that I use to stop their garden.
• I can change the things I'm targeting (the parts of the germ) so that my weapons (potions) don't work. For example, they change the ingredients they use a little, or they change the stove so that I can't block it.
• They change the way they prepare food, perhaps using different ingredients or making a dish without using a stove.

How does this antibiotic resistance work?

There are several main reasons why a medicine may not work due to antibiotic resistance:

• The medicine stops the germ from entering the cell, like a door closing.
• The medicine that entered the germ is pushed back out.
• Either the medicine changes or it destroys.
• They change part of the germ itself, so the drug can't target it.
• They find a way to live or reproduce in a new way that has nothing to do with medicine.

What are the types of antibiotic resistance?

Antibiotic resistance can be divided into two main types: intrinsic resistance and extrinsic/acquired resistance . When we usually talk about "drug resistance," we are referring to this acquired resistance.

• Intrinsic resistance: This means that some germs have an innate ability to resist certain drugs. It is a natural characteristic of that germ. For example, some types of bacteria have a very strong cell wall that some antibiotics cannot penetrate.
• Acquired resistance (Extrinsic resistance): This is when a bacterium later changes itself and becomes resistant to a drug that previously worked. When the bacterium infects, these changes are passed on to its offspring. Also, some bacteria can pass these changes on to other bacteria that are close to them. This is called (horizontal gene transfer) .

Some examples of antibiotic resistance

Here are some examples of antibiotic resistance:

• Bacteria that are resistant to antibiotics: Examples include bacteria such as (MRSA - Methicillin-resistant Staphylococcus aureus), (CREs - Carbapenem-resistant Enterobacterales), and (Pseudomonas aeruginosa).
• Fungi resistant to antifungals: Examples include (Candida auris) and (Aspergillus fumigatus).
• Viruses that are resistant to antiviral drugs: Examples include HIV, influenza, and some strains of the Hepatitis C virus.
• Parasites that are resistant to antiparasitic drugs: For example, some strains of parasites that cause malaria, leishmaniasis, and trypanosomiasis.

But remember this. Just because you have an illness on this list doesn't mean it's a drug-resistant infection. There are strains of these germs that are resistant to drugs, and there are normal strains that aren't.

What is the main cause of antibiotic resistance?

Germs develop resistance to drugs not for one reason, but for many reasons. Sometimes, they change naturally, allowing them to coexist with other organisms. Other times, they develop defense mechanisms to protect themselves from drugs. When germs spread, these changes that help them resist drugs are passed on to their next generation.

Often, this antibiotic resistance develops most severely in hospitals and healthcare facilities. Because there are so many different types of drugs used in those places, bacteria in particular become resistant to those drugs. This is something that is really difficult to prevent.

Also, the use of antibiotics in agriculture (e.g. spraying fungicides on crops, giving antibiotics to animals) is a major reason for the development of this resistance.

How do we prevent this antibiotic resistance?

There are specific guidelines that healthcare providers, including doctors and nurses, must follow to prevent this antibiotic resistance. Some of them include:

• Always wash your hands thoroughly.
• Disinfecting surfaces.
• Prescribing antibiotics only for bacterial infections ( antibiotics are not useful for viral infections, for example, the common cold).
• Proper sterilization of medical equipment.
• Screening patients and visitors to the hospital if there is suspicion of the spread of a resistant germ.
• Quarantining/Isolating people with resistant infections to prevent them from spreading to others.

While doctors and hospital staff do these things, there are many things you can do to help with this too.

Things you can do:

• Take all medications prescribed by your doctor, exactly as prescribed, and on time.
• Especially when taking antibiotics , be sure to finish the entire course of treatment prescribed by the doctor.Even if you feel better after two or three days, do not stop taking the medicine. If you do, the germs that are not completely dead may become stronger again and develop resistance to the medicine.
• Don't take antibiotics unless you really need them. Most respiratory illnesses, like colds and flu, are caused by viruses. Antibiotics don't cure them. So don't force your doctor to prescribe antibiotics .
• Don't use other people's medicine. A medicine given to a friend may not work for you.
• Wash your hands thoroughly with soap and water regularly. This is one of the simplest things that can help prevent many illnesses.

How do you test for antibiotic resistance?

If you have an infection that doesn't respond to medication, your doctor may think you have a resistant infection. They may then test different types of medication against the germ that's causing the infection. (This is done by taking a sample of your blood or other body fluid.) This can help them find a medication that works for your infection. But these tests can sometimes take a while.

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

Antibiotic-resistant bacteria are very dangerous because they are very difficult to treat. Doctors try to find a medicine that works against the specific bacteria that caused the infection. Sometimes you may need to take a combination of medications . For example, taking different types of antibiotics together.

Who is at higher risk of developing an antibiotic-resistant infection?

You may be at higher risk of developing a resistant infection if you:

• If you have a catheter, breathing tube, or feeding tube inserted into your body, germs can easily enter your body through these.
• If you have been taking antibiotics for a long time, or if you use them frequently. Prolonged exposure to antibiotics increases the chance that bacteria will develop resistance. This can kill off the "good" (non-harmful) bacteria in your body, allowing other germs to grow out of control and cause infections.
• If you have a weakened immune system due to an underlying medical condition. For example, if you have HIV infection, blood cancers, or diabetes mellitus, or if you have had an organ transplant or stem cell transplant. Under these conditions, your body has a harder time fighting off infections.
• If you are hospitalized for a long time or in a long-term care facility.Germs can easily develop resistance in healthcare settings.

Finally, I have to say...

Doctors and scientists are working tirelessly to find solutions to the problem of antibiotic resistance. But we can all do our part. The most important thing is to take your medications exactly as your doctor prescribes, and only when you really need them, especially antibiotics . If you are caring for someone with a weakened immune system, or someone in a hospital or long-term care facility, be extra careful. Remember, even small things like washing your hands can make a big difference. Let's all work together to fight this problem.

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