Antibiotics such as streptomycin or tetracycline thatAntibiotics such as streptomycin or tetracycline that

Antibiotics are a class of drug used to treat many bacterial infections. There are bactericidal antibiotics, such as penicillin, that function to unreservedly kill the bacteria cells. There also exists a type of antibiotic called a bacteriostatic, such as streptomycin or tetracycline that prevent the growth and reproduction of bacteria. “The first true antibiotic was discovered by accident by Alexander Fleming, a Professor of Bacteriology at St Mary’s Hospital London” (American Chemical Society, 2015). Antibiotics are usually chemicals produced by bacteria or fungi that are capable of inhibiting the growth and reproduction of bacteria, consequently killing the infection, or killing the bacteria outright as discussed above. Bacteria on the other hand are classed as either gram positive or gram negative. Gram positive refers to for example, Clostridium species and Bacillus species, which when saturated with Gram stain retain crystal violet within their cells and thus appear blue or purple under the microscope. Gram negative bacteria, for example, Pseudomonas species do not retain the crystal violet stain. The difference between the two groups is due to their different cell wall compositions (Griffin, 2018).Each year in the United States alone, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections (, 2018). Antibiotic resistance means that researchers have to engage in “an infectious arms race” (Hede, 2014), to develop new antibiotics to treat new, resistant, bacterial infections as quickly as they arise in hospitals all over the world. The consequence of antibiotic resistant bacteria can be catastrophic (Frieden, 2013), in the short term leading to increased morbidity in patients, increased mortality, longer patient hospital stay, increased cost of healthcare, and the subsequent spread of the multi-drug resistant bacteria (N. Naegeli and J. Roup, 2016).Literary Review:Antibiotics are used habitually, and over use is widespread. This has caused an abundance of different types of bacteria to become resistant (unresponsive) to antibiotics. Because resistance has become more common, many diseases cannot be treated as well as they could in the past (PubMed Health, 2013), as agreed with by (Lee Ventola, 2018) on this paper discussing antibiotic resistance. A common cause contributing to the antibiotic resistance crisis is people feeling their symptoms alleviate after 3 or 4 days of antibiotic use and not finishing the full course as prescribed (Duong, 2015). The residual bacteria remaining from the infection reproduce and multiply to a strain resistant to the antibiotics used to treat the infection. This is intrinsic resistance. Acquired resistance is the process of a bacterium changing in the way it protects itself from an antibiotic via a genetic change or the transfer of a gene coding for resistance from another bacterium cell in the process of horizontal gene transfer. According to the Duke Global Health Institute (Boyce, 2017), the main factors precipitating the threat of antibiotic resistance is the abuse of antibiotics and lack of viable drug alternatives, culminating in an acceleration of bacteria developing resistance. Antibiotic resistance is directly responsible for 25,000 deaths in Europe per year, most of which are avoidable by using antibiotics properly (Health and Food Safety, 2016). Moreover, pharmaceutical companies are often reluctant to inject money into the research and development of new antibiotics due to unfavourable returns on investment (Kanapaux, 2004). People will typically use antibiotics only for a week or two at most, hence they generate less of a profit than other drugs. For example, chemotherapy drugs to treat cancer, or long term pain medications (BNF 74, 2017). The World Health Organisation has developed a list of 3 main bacteria strains that fall under their critical priority class for the development of new antibiotics: acinetobacter baumannii, pseudomonas aeruginosa and enterobacteriaceae. These bacteria are most commonly contracted from contaminated food, water or hospital equipment     (://                         . The resulting infections can cause severe, life-threatening illnesses, including pneumonia and gastrointestinal illness, for which there are no effective treatments (9). – Done to here In terms of the future for antibiotics, the best way to solve the antibiotic resistance crisis is to increase infection prevention rather than treating infections already contracted. This means more thorough handwashing, more use of ppe and maintaining a generally high standard of hygiene in the clinical and community settings. Moreover, developing rapid diagnostic and biomarker tests that empower providers to withhold antibiotics from patients who don’t have bacterial infections and shorten antibiotic courses for those who do (10) could aid in the prevention of antibiotic resistance in the future by effectively eliminating unnecessary prescriptions for antibiotics. The most common tests found in GP practices today are the C reactive protein test (CRP) and urinalysis machine; CRP testing has reduced antibiotic prescribing for respiratory tract infections by 25% (17). However, this is can be a paradox, as often people do not feel that they have received treatment from their physician if they are not prescribed medication; this pressures doctors to prescribe antibiotics when they are not needed just to satisfy their patients demand for drugs to cure their infection. On the same note, many doctors are reluctant to restrict their antibiotic prescriptions, as other doctors who do not concern themselves with the problem will continue to over prescribe the drugs, depleting motivation for some doctors to prevent antibiotic resistance. Furthermore, a doctor’s main responsibility is with his or her patient, so not treating them for the sake of societal antibiotic resistance prevention does not sit well with many physicians (11). This can account for the majority of antibiotic prescriptions in England in 2014 being written by GP doctors (74%) compared to 11% for hospital inpatients, 7% for hospital outpatients, 5% by dentists and 3% in other community settings (15). According to the BMJ, these days, antibiotic prescribing is closely monitored by NHS trusts and GP practices across the UK, with the aim of reducing overuse and inappropriate use of antibiotics, in order to reduce the spread of antimicrobial resistance (12). This has been proven to be effective in the GP primary care setting with a reduction of 8.5% in prescribing of antibiotics, however NHS trust hosptals showed an increase of 33.3% between 2010 and 2014 (16). A study has also reported that a treatment regimen consisting of a high initial dose followed by an extended tapering dose of antibiotic optimises antibiotic use and improves the success of eradicating infections (30% less antibiotic drug required) (13). Therefore this method of antibiotic dosing may be something to research further in medical research for future use of antibiotics. On the other hand, MJ llewelyn argue that (14) that the body’s own immune system is capable of ‘mopping up’ the remaining live bacteria pathogen along with the debris following a course of interrupted antibiotic treatment, in essence, not finishing the course. The relation between antibiotic exposure and antibiotic resistance is unambiguous both at the population level and in individual patients. Reducing unnecessary antibiotic use is therefore essential to mitigate antibiotic resistance argues the article. Moreover, another challenging factor straining the effort to stay ahead of the antibiotic resistance curve is the use of antibiotics in agriculture to prevent livestock becoming diseased from bacteria. This has obvious economic advantages, less livestock die, so higher profits in farming(19). The report on agricultural use also reports that only 5% of the 139 academic papers identified in a separate literature review argued there was not a link between antibiotic consumption in animals and resistance in humans, while 72% found evidence of a link. The report’s authors suggest this supports a link and provides enough justification for policy makers to aim to reduce the global use of antibiotics in food production to a more appropriate level. Farmers will not cut out antibiotic use altogether unless there is a suitable and effective alternative, so tighter regulation over quantity dispersed to farm animals can ultimately reduce the rate of resistant bacteria growth.To conclude, it would be naive for any scientist to claim that they know the future for antibiotics and their applications for modern medicine, however it is fair to conclude that it is vital to reduce the volume of antibiotics given out; especially where they are not needed and won’t alleviate an infection. There is a resounding confidence amongst all of the literature I have researched for this paper that antibiotics have their place in modern medicine, and hopefully the future of modern medicine, but it is imperative that they are not abused. I don’t believe that there will be an apocalypse and/or an antibiotic free era (19), as the WHO is actively working to prevent this from happening.