What is Multidrug resistance?

Multidrug resistance is the insensitivity or resistance of a microorganism to the administered antimicrobial medicines with different structures and the molecular formula (Tanwar, Das, Fatima, & Hameed, 2014). According to the World Health Organization (WHO), the resistant microorganisms that include bacteria, fungi, viruses, and parasites are able to fight the antimicrobial drugs. As a result, the antimicrobial drugs become ineffective in treating microbial infections leading to persistence and spreading of infections.

The emergence of resistance among various microbial species to different antimicrobial drugs has caused a public health threat all over the world. The development of multidrug resistance is a natural process, although, it can be due to inappropriate use of antimicrobial drugs, lack of adequate sanitary conditions, inappropriate food handling, and poor infection prevention and control practices. These factors encourage the further spread of multidrug resistance

The occurrence of multidrug resistance is a serious predicament to improved health care. Effective antibiotics were discovered in the 1940s and people were happy with the assumption the discovery will conquer diseases. The public was over-optimistic not until the re-emergence of antibiotic resistance infections such as tuberculosis and human tumors that develop resistance to chemotherapeutic drugs. The story of multidrug resistance revolves around the presence of active membrane transporters (mammalian P-glycoprotein) that pump chemicals, cytotoxic molecules out of cells including antibiotics, antimalarial, herbicides, and cancer chemotherapeutics in human.

Cellular resistance to a single class of cytotoxic drugs can be due to alteration of the target protein, decreased membrane permeability, or drug metabolism. However, the primary cause of multidrug resistance is the active transport of drugs out of cells. Each active transport protein is specific to a substrate, for instance, amino acids, polypeptide or sugar.

Various factors contribute to the emergence of drug resistance. Although most microbial resistance is a result of selection pressure placed on susceptible microbes through the use of therapeutic agents, there are other factors that could lead to resistance.

• Over-prescription by physicians

Over-prescription of antimicrobials, particularly antibiotics and especially in the absence of appropriate indication can lead to resistance. In addition, some diagnostic uncertainty such as lack of patient follow-up and lack of knowledge regarding therapies. Moreover, the antimicrobials drugs are readily available in many developing countries and can be purchased over the counter without a prescription. This can lead to drug abuse which can later lead to resistance

• Human behavior

Some behavior that leads to resistance include self-medication, noncompliance to doctor`s recommendations, for instance, forgetting to take medication, refusing medication, premature discontinuation of medication when one begins to feel better or using only half the dosage or better still cannot afford the full course of therapy. Self-medication can lead to unnecessary, inadequate, and ill-timed dosing.

• Hospital settings

Hospital settings have various practices that contribute to resistance problems. The facilities have a large number of patients with the majority having suppressed immune systems in close proximity and who receive prolonged antimicrobial therapy. Generally, since the hospitals have large numbers of people with low immunity, the drug resistance organisms are easily transmitted to them through air, equipment, or through direct or indirect contact with contaminated environment or contaminated hands of medical staff.

• Use of antimicrobials in animals

The use of antimicrobial agents in animals reared for food such as poultry, pigs, cattle, sheep, or goats contribute to drug resistance. When antimicrobials are used on these animals for therapeutic or in promotion of growth, the antimicrobials are later transmitted to humans through food products. Example of resistant microbes transmitted include salmonella and campylobacter.

Multidrug resistance raises concern in its economic impact on patients, physicians, drug industry, and health care providers. Physicians are motivated by professionalism and better health outcomes. However, ineffective treatment can result in death and persistent disease. The availability of more antimicrobial agents than needed to treat an infection is worrying, therefore, clinicians are alarmed by the absence of effective agents for treatment. The patient experience added costs of treatment of a resistant organism for the fact that they pay retail prices for drugs and services or increase in premiums for those with health coverage. The health care business sees reduced illness and less deaths as an accomplishment that is achieved through financial efficiency.

To preserve the efficiency of antimicrobial agents, the health care business must take measures in the economic costs of antimicrobial-drug resistance. Also, the drug industry is motivated by profits and focus on potential clients who include the patients or health care systems. Antimicrobial drug resistance affects the drug industry in that the firms would wish to maintain their line of antimicrobial drugs which are threatened by resistance and resistance can make obsolete a competitor’s product opening up the field for a product that could have been less marketable for the reason that it is effective.

• Patients should only use drugs prescribed by health professionals
• Drugs should be taken as per the doctor’s instructions
• Avoid self-medication
• Complete the treatment course
• Do not use leftover drugs
• Do not use drugs prescribed for another person
• Avoid frequent use of drugs
• Prevention is better than cure
• Only the correct dosage should be prescribed with respect to the disease
• Scientists should develop new diagnostic measures and develop novel drugs for effective treatment

The rapid increase in multidrug resistance or resistant microorganisms is indisputable. Multidrug resistance creates an inadequacy of available microbial drugs prompting the continuous development of newer drugs while rendering the present ones ineffective. There is a need for awareness programs to facilitate the appropriate use of antimicrobial drugs and to reestablish dominance over diseases. Multidrug resistance could be unavoidable, posing a worldwide threat, however, a cooperative action to combat it is necessary.

Higgins, C. (2007). Multiple molecular mechanisms for multidrug resistance transporters. Nature, 446(12). doi:10.1038/nature05630

Institute of Medicine (US) Forum on Emerging Infections; Knobler SL, Lemon SM, Najafi M, et al., editors. The Resistance Phenomenon in Microbes and Infectious Disease Vectors: Implications for Human Health and Strategies for Containment: Workshop Summary. Washington (DC): National Academies Press (US); 2003. 5, Factors Contributing to the Emergence of Resistance. Available from: https://www.ncbi.nlm.nih.gov/books/NBK97126/

McGowan Jr, J. E. (n.d.). Economic impact of antimicrobial resistance. Emory University School of Medicine, Atlanta, Georgia, USA. Retrieved from wwwnc.cdc.gov

Tanwar, J., Das, S., Fatima, Z., & Hameed, S. (2014). Multidrug resistance: An emergency crisis. Interdisciplinary Perspectives on Infectious Diseases. doi:10.1155/2014/541340