Are Beta Lactam Antibiotics Used As A Last Resort Of Antibiotics?

Antibiotics are inarguably one of the greatest advances in medical science of the past century. Although the first natural antibiotic Penicillin was not discovered until 1928 by Scottish biologist Alexander Flemming, evidence exists that certain plant and mold growths were used to treat infections in ancient Egypt, ancient India, and classical Greece (Forrest, 1982). In our modern world with the advent of synthetic chemistry synthetic antibiotics like Erithromycin and its derivative Azithromycin have been developed. Antibiotics have many uses including the treatment of bacterial and protozoan infection, in surgical operations and prophylactically to prevent the development of an infection. Through these applications, antibiotics have saved countless lives across the world and radically altered the field of medicine. Though a wonderful and potentially lifesaving tool, antibiotic use is not without its disadvantages. Mankind has perhaps been too lax in regulation and too liberal in application of antibiotics and growing antibiotic resistance is the price we must now pay. A recent study showed that perhaps 70% of bacterial infections acquired during hospital visits in the United States are resistant to at least one class of antibiotic (Leeb, 2004). Bacteria are not helpless and their genetic capabilities have allowed them to take advantage of society’s overuse of antibiotics, allowing them to develop

Widespread use of antibiotics has been very controversial in the media as well in the general population. Due to these controversies, it is very misunderstood to how antibiotics work leading to many patients in the hospital setting wanting to take them when it is not necessary or refusing to take when it is necessary for their survival. Some of this controversy is due to antibiotic resistance, which has spread an alarming rate in the 21st century (Walsh, 2000). Antibiotic resistance is the result of very strong bacteria or microbes that are resistant to the antibiotic prescribed and those microbes accumulate overtime by their survival, reproduction and transfer, leading to increased levels of antibiotic resistance.

Since antibiotics, such as penicillin, became widely available in the 1940s, they have been called miracle drugs. They have been able to eliminate bacteria without significantly harming the other cells of the host. Now with each passing year, bacteria that are immune to antibiotics have become more and more common. This turn of events presents us with an alarming problem. Strains of bacteria that are resistant to all prescribed antibiotics are beginning to appear. As a result, diseases such as tuberculosis and penicillin-resistant gonorrhea are reemerging on a worldwide scale (1).

it also belongs to the normal intestinal flora of humans Many bacteria from this genus, including Klebsiella pneumonia are capable of nitrogen fixation. This bacteria is an extremely virulent bacteria in part due to its polysaccharide capsule which makes it more difficult for phagocytosis to occur and also allows the bacteria to easily adhere to and colonize the respiratory and urinary tracts. This virulent bacteria has been given the title of superbug which refers to its resistance to many antibiotics. Its resistance to antibiotics is related to the presence of carbapenemase, an enzyme, in the organism which makes it resistance to carbapenamase. It is only pathogenic when the immune system is compromised due to a chronic illness or debilitation and therefore it is acquired mostly in healthcare settings, mainly long-term care facilities. When it is pathogenic, the bacteria is commonly the causative agent of bacterial pneumonia, a necrotizing lobar pneumonia, and urinary tract infections. Since this bacteria is resistant to many antibiotics and is very virulent, a combination of antibiotics are used to treat it including levofloxacin, ampicillin, meropenem, terizidone and many others. The control of this bacteria is aimed at the prevention of transmission in hospitals with strategies that include contact isolation precautions, proper hand washing and textbook nursing

According to previous, excessive use of antibiotics is one of the causes of drug resistance in different pathogens, this concern has caused many hospitals around the world develop guidelines and strategies to use appropriate antibiotics and are committed themselves to

Science had a type of antibiotics called, carbapenems. The big guns reserved for bacteria that had become resistant to other common antibiotics. Unfortunately, bacteria found a way to resist these antibiotics as well. This resistance is known as CRE: carbapenem resistant enterobacteriaceae. K. pneumoniae, an Extended Spectrum Beta-Lactamases (ESBLs) bacteria, is also Klebsiella pneumoniae carbapenemase (KPC). This means people infected with Klebsiella pneumoniae carbapenemase have few to no options to kill the infection and recover. Infact, bacteria are developing that are resistant to most, if not all antibiotics available to man or at least approved by the FDA in the United

Enterobacter aerogenes have been found to produce a greater amount of bioethanol due to a process called metabolism (ScienceDirect). Many Enterobacter aerogenes have flagella, and thus motility, that distinguish them from Klebsiella pneumoniae bacteria (Kara, 2016). Traditional approaches for treating Enterobacter infections involve single- agent antimicrobial therapy such as an aminoglycoside, a fluoroquinolone, and a cephalosporin. However, newer theories have adopted combination-therapy employing multiple antibiotics with different core structure. In some Enterobacter aerogenes resistant to aminoglycoside, resistance has been associated with a bacterial genetic element known as integron. Integrons contain genes that confer antibiotic resistance capabilities and its incorporated into bacteria genomes via genetic recombination (Kara, 2016). Finally, we have learned that Enterobacter aerogenes have some positive and negatives implications on human

aeruginosa is one of the most common isolated strains exhibited natural resistance to antibiotics, in addition to its ability to develop resistance to further drugs (Yezli et al., 2014). A gram-negative Escherichia coli colonizes the gastrointestinal tract of human as normal flora and some of them acquired a virulence features that confers their ability to cause infections (Croxen et al., 2013). It is a major cause of urinary tract, enteric diarrhoea and systemic infections as bacteraemia, cellulitis, nosocomial pneumonia, infectious arthritis, peritonitis and the leading cause of neonatal meningitis (Pitout, 2012). Recently, E. coli has a global dissemination as one of the most predominant isolates with resistance to β- lactam and other antibiotics (Yezli et al., 2015). Enterococcus species are gram-positive cocci spread in an intestinal tract, airways, skin and other mucosal surfaces that the most important species are E. faecalis and E. faecium (Savini et al., 2012). Enterococci become one of the infection sources acquired in hospitals that cause urinary tract infections, bacteraemia, endocarditis, wound infections, meningitis as well as intraabdominal and pelvic infections (Agudelo Higuita and Huycke,

Resistance to the most conventional antimicrobial drug against anaerobe gram negative bacteria such as β-lactam/β-lactamase inhibitors, fourth- generation fluroquinolones, carbapenms, metronidazole, Clindamycin and other antibiotics in B. fragilis group have reported word wide(13-16).Metronidazole , a 5-nitroimidazole agent , is useful antimicrobial drug that commonly administrate for prophylaxis and treatment of B. fragilis infections(17). It is significant to recognize the rising resistance to metronidazole within the B. fragilis group. Clinical failures following metronidazole therapy due to Bacteroides strains with increased resistance have been described(18, 19). Different mechanisms of resistance have been proposed(17, 18). understanding of the resistance status and the mechanisms of resistance are important for the option of antimicrobial therapy and the design of new antimicrobial agents, as well as in prevention of dissemination of resistant strains in clinical

Until the 1970s, many new antibiotics found that at first is still sensitive. The last new class of antibiotics discovered in the 1980s (Figure 2.1). After the 1980s increasingly difficult to find new antibiotics, to maintain the efficacy of existing antibiotics were necessary measures to minimize the increase and spread of resistance to antibiotics, while efforts to find and develop new methods of treatment of the infection is still continued.1,15

The development of antibiotic resistant strains are on the rise especially in developing countries and are creating a crisis in the effective treatment of infections.1,5

Antibiotics are the key drugs for treatment of infections and are among the most commonly prescribed drugs in Pediatrics department. Their indiscriminate use increases the risk of bacterial drug resistance and thus has prompted the need to use antibiotics judiciously in pediatric practice [1]. The prescribing pattern deals with monitoring, evaluating and suggesting modifications in the prescribing pattern, so as to make patient care safe, effective and cost effective [2]. Antibiotics are commonly prescribed to treat various infectious conditions. Several studies reported that 50% to 85% of children receive antibiotics in developed and developing countries. Rational antibiotic prescription is very important to avoid multiple drug resistance,

Antimicrobial resistance (AMR) is a problem so serious that "it threatens the achievements of modern medicine",3 and has developed faster than new antimicrobial agents coming to the market despite preventive efforts such as prudent use of available antibiotics,5 exemplifying the urgent need for additional research in this field. Antimicrobial resistance is common among organisms responsible for widespread and life-threatening disorders such as sepsis, bacteremia, pneumonia, urinary tract infections, bone and respiratory disorders. Over the past few years, antimicrobial resistance has significantly increased among gram-negatives such as Escherichia coli6,7 (E. coli), Klebsiella pneumoniae8 (K. pneumoniae) and gram-positives such as Enterococcus

The increasing resistance by microbes to the available antimicrobials widely used in treating different bacterial infections and/or for minor surgical operations is posing a challenge to the medical professional, scientists and is a public health concern. It has been over 70 years since antibiotics were made available and became the answer to scale back bacterial infection. But the anti resistance trend being experienced within health care setting is increasingly becoming a reality that has to be stopped in its tracks. There is nothing new promising in the pipeline to counteract the apparent confirmed resistance by microbes against antimicrobials thrown at them. These are generally gram- negative bacteria that have a barrier in the cell

Recently, a woman in Nevada died at the hands of a “superbug” that was resistant to every antibiotic available in the U.S., a sobering incident to the medical community. The patient was infected with Klebsiella pneumoniae bacteria that had become resistant to cabapenems (a class of antibiotics that are typically used as a last resort when other antibiotics have failed), therefore becoming a “Carbapenem-Resistant Enterobacteriaceae” (CRE). The bacteria was discovered to be resistant to no less than 26 different antibiotics. Such a story could potentially become true for other patients as more multidrug resistant strains develop and spread, rendering the current antibiotics in use today useless. Antibiotics play a huge and important role in