Demystifying antibiotic resistance

We examine the facts around antibiotic resistance, considering why it’s a problem and whether research can solve it.

The World Health Organisation describes antibiotic resistance as one of the biggest threats to global health and development today1

It’s a problem that can affect anyone of any age, anywhere in the world. Yet many people still don’t understand the causes or the significance of the issue.

What are antibiotics?

Most of us have taken them in the past, but many people are nonetheless confused as to what they can and should be used for.

Antibiotics are drugs used to treat – or sometimes prevent – certain bacterial infections. They work by destroying or impeding the growth of bacteria.

Antibiotics are not effective against viral infections (for example colds and flu).2

What are the different types of antibiotics?

There are hundreds of different known antibiotics. Most can be classified into six groups:

1. Penicillins

These are perhaps the best-known antibiotics. They are widely used to treat everything from skin infections to chest infections to UTIs. Examples include penicillin and amoxicillin.

2. Cephalosporins

These can be used for a variety of infections, including some more serious ones such as septicaemia and meningitis. Cephalexin is one example.

3. Aminoglycosides

These are most commonly used in hospitals to treat very serious illnesses because they can cause dangerous side effects. Examples include gentamicin and tobramycin.

4. Tetracyclines

Tetracyclines, though effective for various conditions, are most commonly used for skin conditions including acne and rosacea. Examples include tetracycline and doxycycline.

5. Macrolides

Lung and chest infections are often treated with macrolides. They are also used on patients with penicillin allergies. Erythromycin and clarithromycin are macrolides.

6. Fluoroquinolones

These antibiotics used to be prescribed for various infections, but are used less commonly than they used to be because they can have serious side effects. Examples include ciprofloxacin and levofloxacin.3

What is antibiotic resistance?


Antibiotic resistance is something that happens to bacteria and not to people or animals.

Some strains of bacteria have changed over time in response to the use of antibiotics. This can mean that the bacteria become resistant to the medicine, making it less effective or even ineffective.

So, certain bacterial infections can no longer be treated with antibiotics, making them harder to treat and therefore more dangerous.

Some of these drug-resistant infections have become known as ‘superbugs’. MRSA is a well-known example.4

It’s believed that antibiotic-resistant bacteria have developed because of an overuse of antibiotics (and perhaps misuse of them, too). A lack of research into new drugs has also been cited as a contributing factor.5

How do bacteria become resistant to antibiotics?

Bacteria are a type of biological cell. They evolve in response to their environment.

Like many organisms, they can evolve in order to survive. In the case of antibiotic resistance, certain strains of bacteria have evolved to resist the effects of antibiotics.

This starts as a random mutation, but because that mutation is able to survive antibiotic treatment, it is able to replicate.

While other bacteria are killed by antibiotics, the mutated (resistant) bacteria goes on to multiply and can therefore become the dominant strain.

These bacteria can go on to create drug-resistant infections.6

When did antibiotic resistance start?

Drug-resistant infections have been around nearly as long as we have been using antibiotics.


Sulfonamides were the first effective antibiotics to be introduced, in 1937. Sulfonamide resistance was reported before the end of that decade.

In the case of penicillin, bacteria able to resist the drug was identified even before doctors started using it to treat infections. The more widely penicillin has been used, the more commonplace resistant strains of bacteria have become.7

In fact, Sir Alexander Fleming – who discovered penicillin – warned against overuse of antibiotics as early as 1945.

Since then, antibiotics have been used across the world with varying degrees of regulation, not only in humans but also livestock, as both treatment and preventative measure. They have been used too frequently and at times incorrectly.

There is also the fact that the development of new antibiotics has slowed down significantly. The main reason for this is that it is not a particularly profitable investment for pharmaceutical companies. Regulations are tight and profit margins are small.3

Why should we be worried about antibiotic resistance?


Across the world, we have come to rely on antibiotics to treat a variety of illnesses. These include life-threatening diseases such as meningitis or pneumonia.

You may already have heard of drug-resistant superbugs such as MRSA or Clostridium difficile (also known as C. diff), but there is a risk that conditions previously treatable with antibiotics will develop resistance.

This is already a reality for some diseases. Certain strains of tuberculosis, for example, have become resistant to the antibiotics usually prescribed, meaning new and more lengthy treatment is needed.3

The worry is that antibiotic resistance will progress to a point where common conditions become costly and complicated to treat, and that eventually mortality rates will rise because we can no longer treat previously curable conditions.1

Should we stop using antibiotics altogether?

Healthcare professionals are becoming more discerning when it comes to prescribing antibiotics. You may have been prescribed them for certain conditions in the past but will no longer be offered a course for the same problem.

This is because medical professionals worldwide are trying to reduce the use of antibiotics. If they are used when they don’t need to be, there is more chance of resistant strains of bacteria developing.1

What can I take instead of antibiotics?

If you have been prescribed antibiotics, it is likely that your doctor sees a good reason for this, so you shouldn’t avoid taking them. And, you should complete the whole course, even if the problem seems to have gone before you take the last dose.

If you have not been prescribed antibiotics, again your doctor will have good reason for this decision.

For example, it may be that the infection is likely to clear up on its own, or perhaps you have a viral infection that won’t be affected by antibiotics.

Ask your doctor whether they think you need a prescription for other medications, or if perhaps there are over-the-counter options you could try. It may be that you don’t need to take medicine at all.8

There is no conclusive evidence that substances marketed as ‘natural antibiotics’ can help, and many can have side effects. It’s best to avoid these and instead focus on looking after yourself, eating well and getting enough sleep.

Although the World Health Organisation, NHS and other relevant bodies recommend that we reduce the use of antibiotics, there are some cases where they’re still necessary.

You’ll probably still be prescribed antibiotics if you have a bacterial infection that won’t go away without them, that might infect other people, or that is likely to get worse or even develop complications without treatment.

People who are more vulnerable to infections, such as the very young or elderly, will be prescribed antibiotics more readily than others.2

Defer to the advice of your medical professional, but don’t be afraid to ask them about it.

What is being done to reduce the risk of antibiotic resistance?


Antibiotic resistance is a global concern, and governments across the world are working together in order to reduce the threat.

There is a global action plan in place, endorsed by the United Nations, which seeks to address the root causes of the problem.

This includes public education on the issue and new recommendations on the use and distribution of antibiotics. Greater controls are in place on when and why these drugs are prescribed.

Increased funding and support of antibiotic research is another element of the fight against resistance. Work is currently underway to improve existing drugs, create new ones and accelerate the introduction of both.

Research is also being done into the development and spread of antibiotic resistant strains of bacteria in the hope that we can understand the problem better.1

The hope is that this global effort will slow down the development of antibiotic resistance as well as identifying alternative treatment options to tackle drug-resistant infections.

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