SOE 2023: Antimicrobial resistance: The growing challenge and new innovations

Antimicrobial resistance is resistance to multiple classes of antibiotics, which makes it extremely challenging to treat infections caused by such organisms Image credit: ©Prrrettty – stock.adobe.com.

Antimicrobial resistance (AMR) is a serious growing problem in medicine that affects patients with malaria, tuberculosis and HIV, and is increasingly being reported for common bacterial diseases. The most worrying aspect of AMR is resistance to multiple classes of antibiotics that makes it extremely challenging to treat infections caused by such resistant organisms.

It is estimated that drug resistant infections contribute to nearly 5 million deaths every year. AMR poses a significant global threat of far-reaching proportions. If not addressed the economic impact of uncontrolled antimicrobial resistance will result in a dramatic rise in health expenditures and damage to food systems and livelihoods, leading to increasing levels of poverty and inequality.

AMR is also a problem in Ophthalmology, according to Prashant Garg, MD, Executive Chair, Paul Dubord Chair of Cornea, L V Prasad Eye Institute, Hyderabad, India. He described the magnitude of the AMR problem faced by ophthalmologists and the way forward at the European Society of Ophthalmology, Prague.

For example, Dr Garg pointed out that Staphylococcus aureus currently are resistant to moxifloxacin, gatifloxacin, and ofloxacin but susceptible to cefazolin, azithromycin, and chloramphenicol; gram-negative bacilli are showing increasing resistance to moxifloxacin, gatifloxacin, ofloxacin, and chloramphenicol, have intermediate resistance susceptibility to tobramycin, and are susceptible to ceftazidime. In a large multicentre prospective study conducted by the Asia Cornea Society it was observed that countries like India are facing the problem of multi-drug resistance among ocular infections

Moving forward

He advised steps clinicians can take to deal with the growing rates of antimicrobial resistance.

The first is the judicious use of antimicrobials, ie, use them for established infective diseases, use them in appropriate doses, use them prophylactically for the shortest possible time, and avoid repeated use.

He mentioned the use of corneal scrapings, smears, and cultures for the identification of causative organisms. While currently available methods of etiological diagnosis are associated with disadvantages such as the need for a well-equipped laboratory, trained microbiologists, higher costs, and sensitivity/specificity of microscopy, these methods can visualize organisms and facilitate immediate treatment, identify growth in cultures, determine antibiotic susceptibility, and help identify rare/uncommon organisms.

Dr Garg believes there is potential in the use of smart strategies, such as targeted local delivery of drugs using microbial-recognizing polymers. This strategy uses burst release kinetics with a fast high-concentration release of drugs.

Another smart strategy is facilitating enhanced drug retention using components such as polyvinyl alcohol, polyvinylpyrrolidone, chitosan, lysophosphatidylcholine, and fluoroquinoloine in the formulations and smart drug delivery devices such as microneedle patches.

He concluded, “Antimicrobial resistance is a serious problem that involves more than just systemic infections. We need a multipronged approach to tackle this problem. Early diagnosis and using smart delivery systems seems to offer solution to this problem.”