Examine the Growing Problem of Antibiotic Resistance and its impact on Public Health

When bacteria or other microorganisms develop defenses against antimicrobials (drugs used to treat illnesses), this phenomenon is known as antimicrobial resistance (AMR). There is the potential for drug-resistant strains to emerge across all microbial groups. Antifungal resistance develops in fungi. Viral drug resistance develops over time. Antiprotozoal resistance in protozoa is analogous to antibiotic resistance in bacteria. All of these problems may be grouped together under the heading of antibiotic resistance. Superbug is another name for bacteria that has developed resistance to numerous antibiotics, or multidrug resistant (MDR) bacteria. Although antimicrobial resistance occurs naturally, it is often caused by inappropriate medication use and inadequate care for illnesses. Specific bacteria that have developed resistance to antibiotics constitute a significant component of AMR known as antibiotic resistance. Bacterial resistance may occur spontaneously via genetic mutation or by the horizontal transfer of resistance across species. Resistance may emerge both naturally, as a result of random mutations, and artificially, via the horizontal transfer of resistant genes. However, there is evidence that shows that prolonged use of antibiotics promotes selection for mutations that might eventually make antibiotics useless. Fungi that have developed resistance to antifungals are an example of antimicrobial resistance (AMR). Natural mechanisms for the development of antifungal resistance include mutation and aneuploidy. When antifungals are used repeatedly, resistant strains of the fungi eventually emerge. Millions of people every year lose their lives to diseases brought on by bacteria that carry AMR. About 1.27 million people throughout the world lost their lives this year due to antibiotic-resistant germs. Resistance in microorganisms makes it more difficult to treat infections caused by them, sometimes necessitating treatment with either stronger antimicrobial treatments, more costly antibiotics, or even potentially more toxic alternatives. These methods could be more expensive as well. Taking antibiotics exclusively as directed by a doctor is one way to avoid the overuse of these drugs and

spectrum antibiotics are favored over broad-spectrum antibiotics when applicable. Home users of these drugs need to be taught how to use them safely. Proper sanitation and hygiene, such as handwashing and disinfection between patients, may reduce the transmission of resistant illnesses, and healthcare personnel should urge their patients, visitors, and families to do the same. Use of antimicrobials in people and other animals, and the subsequent dissemination of resistant strains amongst them, is largely to blame for the alarming rise in antibiotic resistance. Inadequately treated effluents from the pharmaceutical sector, particularly in nations where bulk medicines are generated, have been related to the spread of resistance.

Khilnani, Gurudas & Khilnani, Ajeet Kumar. (2019). In the ancient world, microbes were already well-documented. Soil microorganisms (fungi and bacteria) have been a source of antibiotics since long before they were used in hospitals and clinics. These bioactive compounds occurred spontaneously throughout microbial evolution. Antibiotic generating and antibiotic resistant microbes have coevolved over billions of years. In 1900, Paul Ehrlich proposed the idea of "Magic Bullets" to combat germs, and in 1906, Salvarsan was used to treat syphilis for the first time Otten (1986) notes that prontosil and its metabolite sulphadiazine were used to treat infections by Domagk (1933). Penicillin was first used in therapeutic settings in 1940, although its discovery dates back to 1928. As a result, the issue of antibiotic resistance (AR) is becoming a more serious threat to human health worldwide (Petri, 2011). Resistance to antibiotics is a growing public health concern due to environmental gene mixing and the unchecked use of antibiotics in livestock and poultry farms. Overuse of antibiotics, poor hygiene practices, and a general lack of understanding about the gravity of the AR are all becoming recognized as controllable factors. Bonna, Atia & Pavel, Shahed & Ferdous, Jannatul & Khan, Sabbir & Ali, Mohammad. (2022). Bangladesh's weak healthcare system and rampant drug abuse contribute significantly to the worldwide issue of antibiotic resistance. Antibiotic self-medication seems to be widespread in poorer nations, where studies have shown that access to these medications is both simple and poorly regulated. Antimicrobial resistance (AMR) has spread in Bangladesh due to over-prescribing and improper usage of medicines. Qualitative research analyzing the factors that influence antibiotic sales and dispensing across all types of healthcare providers are few in low and middle-income settings. Antibiotics were widely misused by several sectors of the healthcare industry due to misunderstandings and a lack of knowledge. Healthcare practitioners, especially those with little or sensible use of antibiotics and how they operate, aimed at all kinds of healthcare practitioners, should be among the most specific and focused treatments to reduce AMR in Bangladesh. Nadgir, Chinmayee & Biswas, Dalia. (2023). Resistance to antibiotics is a major problem that has far-reaching consequences for disease control efforts. Antibiotic resistance has emerged as a major public health problem, and one of the main causes has been the widespread misuse of antibiotics and negligent prescribing by physicians. Overuse, antibiotic resistance genes, and widespread use of antibiotics in agriculture are only few of the major causes highlighted in this article. It also highlights the difficulties in treating illnesses including TB, COVID-19, and vancomycin-resistant enterococci infections due to drug resistance. A case study illustrating the dangers of antibiotic resistance in TB therapy is provided in the article. Antibiotic resistance has serious consequences for the management of patients with COVID-19, as this paper demonstrates. It goes on to detail strategies that may be used on both a global and personal scale to reduce antibiotic resistance. The aim of minimizing antibiotic misuse is to diminish antibiotic resistance, and new research suggests that proteins produced by the body may be changed and employed in therapies to achieve this objective. Bansal, O. (2022). ABSTRACT OF THE ARTICLE Antibiotics, a miracle medication, have helped save countless lives since they were first developed. Antibiotic resistance is a major public health concern due to the widespread overuse of antibiotics in human and animal medicine, agriculture, aquaculture, and other non-medical settings. Groundwater, sea water, crops, and food animals all contain antibiotic residues, which disrupts ecological equilibrium and has direct and indirect effects on human health. This overview explains how antibiotics may get into the environment and what can be done to lessen the spread of bacteria that are resistant to antibiotics. Ferri, Maurizio & Ranucci, Elena & Romagnoli, Paola & Giaccone, Valerio. (2015) In the past two decades, antimicrobial resistance (AMR) has emerged as a major problem for the world's health care systems. Antimicrobial resistance (AMR) has been a rising global concern since the dawn of the antibiotic era, with the discovery of the first drugs that consistently improved human treatment. This study provides a comprehensive review of the epidemiology of antimicrobial resistance (AMR), concentrating on the connection between food-producing animals and people, as well as the legislative framework and policies being applied at the European Union (EU) level and internationally. Strategies for addressing the problems associated

the ecology of resistant bacteria and resistant genes; and educating stakeholders on the responsible use of antibiotics in animal productions and clinical settings. Given the widespread nature of AMR and the fact that bacterial resistance may spread across geographic and societal boundaries, the essay concludes with concrete suggestions organized around a holistic approach and directed at various stakeholders.

The research method was a cross-sectional analytic approach. Participants were undergraduates from King Faisal University (KFU). EpiInfo® version 7 was used to determine the sample size, which was based on the 2018-2019 KFU student population of 37,607 bachelor students, the reported prevalence of antibiotic misuse from the study and a confidence limit of 5% The schools and students who would take part in the research were selected using a two-stage stratified cluster selection strategy. This allowed for an adequate sample size of 748. All undergraduates at King Faisal University who were enrolled in a bachelor's degree program were deemed eligible. Online students were also disqualified, as were those in preparatory years, diploma programs, graduate programs, and postgraduate degrees. Medical, allied health, and pharmacy students, as well as those from schools of education, business, and computer and information science, made up the bulk of the 825 respondents. All student replies were kept anonymous and private, and students were given the option to participate in the research. Ethical permission was acquired by the study Ethics Committee of the Deanship of Research at King Faisal University in Al-Ahsa, KSA (KFU - REC/2019 - 11 - 03) after the study proposal was approved by the Department of Public Health. Information was gathered via responses to self-administered surveys. Information was entered into Microsoft Excel and checked for inconsistencies before being processed statistically using EpiInfo® version 7. The demographic data was subjected to a descriptive analysis. Students' levels of knowledge on antibiotic resistance as a public health issue were also estimated. Estimation of proportion was also used to calculate the percentage of kids that inappropriately utilize antibiotics. Finally, logistic regression was used to analyze the correlation between antibiotic usage and knowledge of antibiotic resistance and knowledge of antibiotic resistance as a public health concern. The data was gathered between November 4, 2019, and November 21, 2019, at King Faisal University's main campus in Hofuf, Al Ahsa, Kingdom of Saudi Arabia. Reports indicate that bacterial resistance is on the rise in Saudi Arabia Antibiotics are the third most often given drug in Saudi Arabia. There is growing worry that the distribution of antibiotics without a doctor's prescription contributes to the spread and elevation of antimicrobial-resistant bacteria and antimicrobial resistance The infection and colonization rates of HA methicillin-resistant S.= aureus (MRSA) in Saudi Arabia rose from 2.17 to 3.9 per 1,000 admissions in only four years (2000–2004). Community-acquired MRSA was shown to have a daily incidence rate of between 10 and 30 per 100,000 patients in another Saudi investigation The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among S. aureus was 32%, that of penicillin G-resistant Streptococcus pneumonia (S. pneumonia) was 33%, and that of erythromycin-resistant S. pneumonia was 26% Seventy-six percent of the healthcare personnel tested positive for MRSA colonization [44], while 25.3 percent of 150 senior medical students and interns in Jeddah tested positive for nasal colonization with S. aureus. Around 7.0% had MRSA in their systems Forty percent of Saudi healthcare workers had S. aureus colonization, with 18 percent having MRSA [46]. According to a 2018 meta-analysis that compiled data from 7 separate studies involving 8,433 people, the national prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 38%. Regionally, the prevalence ranged from 32% in the central United States to 42% in the west. From 2000 to 2006, ciprofloxacin resistance among Enterobacter cloacae in Saudi Arabia increased from 8.3 percent to 17.4 percent Another research found that between 1998 and 2003, Klebsiella pneumonia's HA resistance to ciprofloxacin increased from 2.6% to 23.0%.

Since this is a problem on a worldwide scale, it is fitting that the WHO is helping to raise awareness of it and formulate policies to address it. Case in point: the recent appearance and subsequent discovery in Canada of gram-negative bacteria containing the NDM-1 gene. Bacteria belonging to the family Enterobacteriaceae, which includes but is not limited to Escherichia coli and Klebsiella pneumoniae. They are resistant to almost all antibiotics and have a plasmid that makes them immune to all beta-lactam antibiotics except aztreonam. These germs, which quickly went global, seem to have arisen in India. Local transmission seems to be the case for the NDM-1 bacterium recently found in 1 of 2 Ontario patients.

important medications may be prolonged by the elimination or decrease of underuse (related with insufficient dosage or duration), misuse (poor selection), and abuse (unnecessary use). According to the World Health Organization, "over half the world's antimicrobial production is used in food-producing animals". This is because of the "massive routine use of antimicrobials, to promote growth and for prophylaxis," in the industrialized production of food. The World Health Organization (WHO) released a set of policies for World Health Day, including a call for countries to commit to a fully funded national plan, increased surveillance and laboratory capacity, regulation and promotion of rational use of medicines, improved infection prevention and control, and support for innovations and research and development.

Table 1 shows that of the total respondents, 50.42 percent were enrolled in a health-related program (Medicine, Applied Medical Sciences, or Pharmacy) while 49.58 percent were enrolled in a non-health-related program (Education, School of Business, or Computer Science and Information Technology). Male respondents numbered 403 (48.85%) while female respondents numbered 422 (51.15%). Subjects in the research varied in age from 18 to 26. Most participants were in their twenties; students aged 18 to 22 made up over 90% of the entire sample.

Table 2 displays the percentage of college students who are aware of the issue of antibiotic resistance.

Awareness of antibiotic resistance was high among both male and female students. When students were divided into groups based on their ages, those between the ages of 22 and 23 had the highest rate of knowledge on antibiotic resistance. Students from health-related institutions made up 58.39% of the 620 aware participants, while students from other institutions made up 41.61%. A total of 205 kids, or 73.66 percent, came from schools where antibiotic resistance education was not required. The majority of students (40.73 percent, 95% confidence interval [CI]: 37.43 percent to 44.12 percent) learned about antibiotic resistance from medical experts including physicians, pharmacists, and nurses. However, Internet and social media were the primary source of knowledge for 39.76% of the students (95% CI: 36.37 - 43.14%).

Only 451 (54.67%) of the 825 people surveyed knew that antibiotic resistance is a major health concern in the world today. Antibiotic resistance was more well known to be a public health concern amongst female students. Students between the ages of 22 and 23 had the highest rate of awareness that antibiotic resistance is a public health issue, relative to other age groups. Of the 451 participants, 67.85% were students from health colleges and 32.15 % were students from non-health schools who were aware that antibiotic resistance is a public health concern. Table 3 shows that 70.59 percent of the 374 students who did not know that antibiotic resistance is a public health hazard were not enrolled in a health-related institution. Students relied on the Internet and social media for almost 40% of their antibiotic resistance knowledge (95% CI: 36.47 - 43.14%). Health care providers (doctors, pharmacists, and nurses) were the primary

(95% CI: 16.50-21.85%).

Table 4 shows that antibiotic usage was common among college students (67.09%, 95% CI: 63.63 - 70.04%). Students from non-health institutions made up a somewhat larger percentage of antibiotic misusers (56.16%) than students from health schools (43.84%) within the total sample size of 552. A total of 273 students (36.26% from non-health institutions and 63.74% from health colleges) were found to be antibiotic-safe. Antibiotics were more often abused by male pupils than female students. People younger than 20 years old were more likely to inappropriately utilize antibiotics than any other age group.

Several forms of antibiotic abuse among college students were examined. The most prevalent abuse of antibiotics was not finishing the full course of treatment, as seen in Table 5. This was then followed by the use of antibiotics that had already been used, the sharing of medicines, the failure to take the whole recommended amount, self-medication, and lastly the use of antibiotics that had long since expired.

Table 6 shows that among college students, females had a 41.67 percentage point lower risk of misusing antibiotics than males do (OR = 0.5933, p = 0.0003).

There was a 55.57 percent decrease in antibiotic overuse among health college students compared to those who attended non-health institutions (OR = 0.4443, p 0.0001). Antibiotic abuse was 36.02 percent less common among students 35 and older than among those 16 and younger (OR = 0.6398, p = 0.0033). There was a 27.96% decrease in antibiotic overuse among students who were aware of antibiotic resistance compared to those who were not (OR = 0.7204, p = 0.0642). Antibiotic abuse was 51.32 percent less common among students who were aware of antibiotic resistance as a public health concern compared to those who were not (OR = 0.4868, p 0.0001).

Students who were aware of antibiotic resistance were 3 percentage points less likely to misuse antibiotics compared to students who were not aware of antibiotic resistance (OR = 0.9700, p = 0.8724), while controlling for sociodemographic factors. As can be seen in Table 7, there has been a shift of 34.64 percentage points in the correlation between knowledge of antibiotic resistance and improper use of antibiotics. Antibiotic abuse was 33.74 percent less common among students who were aware that antibiotic resistance is a public health concern, after controlling for gender, age, and institution type (OR = 0.6626, p = 0.0151). Antibiotic abuse has decreased by 36.25 percent because students became aware that antibiotic resistance is a public health issue (Table 8).

In conclusion, this survey found that 80% of college freshmen were familiar with the concept of antibiotic resistance, with 50% understanding that this issue represents a public health threat. The research also found that students who were aware of antibiotic resistance were less likely to abuse antibiotics than those who were not. In addition, compared to students who were not aware that antibiotic resistance is a public health concern, those who were were less likely to abuse antibiotics. Awareness of antibiotic resistance and the fact that antibiotic resistance is a public health hazard led to a decrease in antibiotic overuse among college students.

1. Khilnani, Gurudas & Khilnani, Ajeet Kumar. (2019). Antibiotic Resistance. 10.5281/zenodo.5765831. 2. Bonna, Atia & Pavel, Shahed & Ferdous, Jannatul & Khan, Sabbir & Ali, Mohammad. (2022). Antibiotic Resistance: An Increasingly Threatening but Neglected Public Health Challenge in Bangladesh. International Journal of Surgery Open. 10.1016/j.ijso.2022.100581. 3. Nadgir, Chinmayee & Biswas, Dalia. (2023). Antibiotic Resistance and Its Impact on Disease Management. Cureus. 15. 10.7759/cureus.38251.

5. Ferri, Maurizio & Ranucci, Elena & Romagnoli, Paola & Giaccone, Valerio. (2015). Antimicrobial Resistance: A Global Emerging Threat to Public Health Systems. Critical reviews in food science and nutrition. 57. 10.1080/10408398.2015.1077192. 6. aidi SF, Alotaibi R, Nagro A, et al. Knowledge and attitude towards antibiotic usage: A questionnaire-based survey among pre-professional students at King Saud bin Abdulaziz University for Health Sciences on Jeddah Campus, Saudi Arabia. Pharmacy (Basel) 2020; 8(1): 5. 7. Alghadeer S, Aljuaydi K, Babelghaith S, Alhammad A, Alarifi MN. Self-medication with antibiotics in Saudi Arabia. Saudi Pharm J 2018; 26(5): 719-24. 8. Al-Shibani N, Hamed A, Labban N, Al-Kattan R, Al-Otaibi H, Alfadda S. Knowledge, attitude and practice of antibiotic use and misuse among adults in Riyadh, Saudi Arabia. Saudi Med J 2017; 38(10): 1038-44. 9. AboAlSamh A, Alhussain A, Alanazi N, Alahmari R, Shaheen N, Adlan A. Dental students‘ knowledge and attitudes towards antibiotic prescribing guidelines in Riyadh, Saudi Arabia. Pharmacy (Basel) 2018; 6(2): 42. 10. World Health Organization. Antibiotic Resistance: Multi-country public awareness survey [Internet]. Geneva, Switzerland: WHO Available from: https://www.who.int/drugresistance/documents/baselinesurveynov2015/en/ 11. Higuita-Gutiérrez LF, Roncancio Villamil GE, Jiménez Quiceno JN. Knowledge, attitude, and practice regarding antibiotic use and resistance among medical students in Colombia: A cross-sectional descriptive study. BMC Public Health 2020; 20(1): 1861. 12. Zucco R, Lavano F, Anfosso R, Bianco A, Pileggi C, Pavia M. Internet and social media use for antibiotic-related information seeking: Findings from a survey among adult population in Italy. Int J Med Inform 2018; 111: 131-9. 13. Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis 2014; 14(1): 13. Lancet Infect Dis 2014; 14(8): 742-50. 15. Hawking MK, Lecky DM, Touboul Lundgren P, et al. Attitudes and behaviours of adolescents towards antibiotics and self-care for respiratory tract infections: A qualitative study. BMJ Open 2017; 7(5): e015308.

Pharmacist, Prince Sultan Military Medical City, Riyadh KSA