Effect Of Antibiotics On Antibiotic Resistance

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Introduction
Antibiotics has changed modern medicine into what we know today, saving many lives and alleviating the suffering of individuals [1]. Around the 1940s, the use of penicillin and streptomycin effectively controlled the prevalence of bacterial infections, dramatically improving life expectancy [2]. However, antibiotic resistance started to evolve and there is a constant demand for the development of new compounds as the lifespan of pre-existing antibiotics is significantly reduced [3]. Nevertheless, over the last few decades, antibiotic resistance is spreading faster than the availability of new compounds creating a worldwide crisis for the public health sector [3]. Infectious diseases that were easily treated with antibiotics has
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However, with increasing obstacles associated with the economy and regulatory barriers, pharmaceutical companies have become hesitant in developing new antibiotics, which limits the chances of overcoming antibiotic resistance [7]. Pharmaceutical companies no longer believe that it is cost effective to invest into the development of antibiotics as resistance is inevitable [1]. Once resistance occurs, profits are significantly reduced to an extent of no return on investment [7]. Moreover, regulatory approvals have become difficult to obtain due to changes in the rules of licensing, bureaucracy, and the variation of requirements of clinical trials among different countries [1]. Thus, the number of approvals for new antibiotics is substantially reduced, which further

prevents the availability of alternative compounds while resistance continues to be a problem [7].
Figure 1. Factors affecting the development of antibiotic resistance. There are numerous factors ranging from choices made by humans to the properties of antibiotics, which are shown above and below the grey arrow, respectively [6].
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Staphylococcus aureus and Escherichia coli are common examples of multidrug resistant organisms, which causes severe infections in the community including hospitals [9]. Multidrug resistance makes the treatment of bacterial infections more difficult [9], and patients in the intensive care unit are vulnerable to these types of infections as resistance is common among this group [8]. Methicillin resistant Staphylococcus aureus is the first bacteria to play a major role in antibiotic resistance and has become a global pandemic [1]. The gram positive bacteria acquired resistance through the horizontal gene transfer of mec genes resulting in the expression of penicillin binding proteins, which were modified hindering the mechanism of action of conventional beta lactams [11]. Although vancomycin, a glycopeptide, and a number of other drugs maintain its action against methicillin resistant Staphylococcus aureus, there has been reports of emerging resistance [1]. The number of available treatments is gradually decreasing while there is a likely increase in the virulence of multidrug resistant organisms

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