I fully agree with the above responses. Please also have a look at this link.

https://www.nature.com/articles/s41598-019-46078-y.pdf

Yes, antibiotic resistance is a serious threat that we don’t all think about very often! In 2014, around 700,000 people across the world died due to infections associated with drug resistance, a number that is estimated to touch 10 million by 2050. The current CDC AR report, 2019 reveals the same trend of antibiotic-resistant infections and deaths.

There is a growing concern about the emergence of bacterial strains showing resistance to all classes of antibiotics, commonly used in human medicine. The successful treatment of healthcare-associated infections is hampered due to the high levels of resistance to survive against antibiotic therapies leading to severe inappropriate and irrational use of antimicrobial agents.

Particularly, low and middle-income countries (LMIC) have the highest rates of antibiotic resistance. This is predominantly problematic in hospital settings where increasing prevalence of multi-drug-resistant bacterial strains, rendering some patients effectively un-treatable and constitute a significant burden on the health-care system.

One of the major causes of growing antibiotic resistance was led by consumption surge in LMIC. In some countries the antibiotics consumption has increased by 103% from 2000 to 2015, further, the average amount of antibiotics consumed by 1,000 inhabitants in every day also increased by 63%, leading to antibiotic resistance which is the biggest threat to global health in the 21st century.

During his Nobel Prize lecture (1945), Sir Alexander Fleming, had said, “The time may come when penicillin can be bought by anyone in the shops. There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

Similarly, Professor Manteen from the National Institute of Public Health, Utrecht, Netherlands, also warned about the non-medical use of antibiotics and risk of possible microbial drug-resistance five decades ago (1962). Today, we are witnessing the global crisis of antibiotics resistance has attained a point where, if action is not taken, human medicine will enter a post-antibiotic world and simple injuries could once again be life threatening.

Dr Sunagar Raju

Thank you so much for your response; I have just read it and re-read it, and learnt a lot from it.

Yes, antibiotic resistance is threat to global public health not only to under developing countries but also to developed countries including U.S. As i havs written a review article recently & will send it to peer reviewed journals in next couple of days. I conclude that prevalence of antibiotic resistance is increasing alarmingly all over the world & main reason behind this is self medication (that is use of medicine without doctor prescriptions). So, there is a need to find out alternative studies like phage therapy (temporary solution) & more specefically immunotherapy (my current & future research focus) that is through innate immune response.

Thank you very much, Mubasher Rehman, for your response. In the UK (where I live and worked, before I retired - 2012), antibiotics can only be taken after being prescribed. However, we (nurse practitioners for bladder and bowel health) sometimes had success in treating people with urinary tract infections by using non-antibiotic remedies.

Potter's Antitis:

https://bhma.info/index.php/potters-antitis-cystitis-relief/

or - less often - D-Mannose:

https://www.webmd.com/vitamins/ai/ingredientmono-1114/d-mannose

Your review article will make very interesting reading.

@Mary C R Wilson, i totally agree with you.

During my study i saw that many of the eurpeon countries like croatia & many others have very high prevelance of self medication. These drugs are usually taken by suggestion by friend or through onlind sources they get help. But as you know well that there should be proper diagnosis, lab tests before prescribing antibiotics. These neglegance lead to antibiotic resistance problem. In my review article i highlighted the prevalnce of self medication worldwide & co relate it with antibiotic resistance & global public health. And i also suggest (immunotherapy) new therapeutic technique to treat an infection, because if we focus on antibiotic or phage therapy in future again resistance problem can occur, so we should focus on natural way to treat an infection that is through innate immune response. So, in my current research which i am doing i tried to investigate role of complement in disease. I hope this will help you to get a short summary regarding antibiotic resistance issue + alternative stretagies who we should follow & implement. Thanks

Yes, Wilson and Rehman you are right, the Intimidate action is required to adopt the regulatory requirements to set up pharmaceutical and pre-clinical safety assessment for the therapeutic applications of Non-Antibiotic Antimicrobials.

In fact, the non-antibiotic antimicrobial based treatment to clear bacterial infections has been around for almost a century, particularly in Former Soviet Union and Eastern Europe. However, the successful intervention of modern antibiotic therapy overshadowed the global applications of such practices.

Today, in the USA, more people are killed by MRSA than by AIDS. Though, there is no such report on crude infectious disease mortality rate in developing countries, but absence of evidence is not evidence of absence.

Currently, the health care system from both developed and developing countries are facing a major threat from multidrug-resistant pathogens. It is right time to adopt Non-Antibiotic Antimicrobials as an alternative prophylactic approach to treat bacterial infections at the minimum for non-medical applications. For instance, food industry, agricultural sectors, aquaculture and domestic uses. This will minimize the rate of antibiotic production and usage—and therefore also antibiotic residues in the environment that leads to resistant bacteria.

Right time to dust-off long forgotten weapon: In the current scenario the phage therapy is garnering a well-deserved rebirth. As a result, for the first time, the US clinical trial of intravenously administered bacteriophage therapy received FDA approval to evaluate the safety and efficacy of an experimental bacteriophage therapy for patients with ventricular assist devices (VAD) associated Staphylococcus aureus infections. Further, FDA & USDA also approved the PhageGuard-E, PhageGuard-S & PhageGuard Listex (the natural phages against E. coli O157, Salmonella and Listeria monocytogenes respectively) as a GRAS (Generally Recognized as Safe) for dairy and food processing products.

I agree, and we need to severely limit 'Self-prescribing". An article in the Lancet

Lancet Infect Dis 2019

http://dx.doi.org/10.1016/

S1473-3099(19)30444-X Describes the corrupt supply of antibiotics by company drug reps.

Another cause of abc resistance is their use in agriculture and this is not just feeding to farm animals. President Trump has recently approved the use of 440,000kg of tetracycline and streptomycin to spray citrus trees in Florida, and this is only one example (published in New York Times and Nature.

Also, non-antibiotic treatment of many infections is preferable and effective, and antiseptics should be used more widely.

Dr Roger Bayston

Thank you very much for your response. I had difficulties in finding the link you gave, so am adding this (I hope it is correct), in case others are unable to access it:

Chang, J., Xu, S., Zhu, S., Li, Z., Yu, J., Zhang, Y., ... & Ross-Degnan, D. (2019). Assessment of non-prescription antibiotic dispensing at community pharmacies in China with simulated clients: a mixed cross-sectional and longitudinal study. The Lancet Infectious Diseases.

Article Assessment of non-prescription antibiotic dispensing at comm...

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30324-X/fulltext

This is not automatically full text but available on Science Direct, for those able to access it that way. I have saved the pdf and will read with great interest.

I didn't find it in Nature, but this - I think - relates to the other topic you raised:

https://www.nytimes.com/2019/05/17/health/antibiotics-oranges-florida.html

https://www.pharmacist.com/article/citrus-farmers-facing-deadly-bacteria-turn-antibiotics-alarming-health-officials

Thanks again for your response.

In Morocco, where i live and worked on antibiotic resistance, i confirm that the situation is alarming and very few people take in consideration the antibiotic prescription, i site here, that if you want to buy any antibiotic and consum it, we don't have rules and strict regulations, anyone can get ant use any antibiotic he or she wants. this is increasing the antibiotic resistance.

Adel El Mekes

Thank you very much for your response. Yes, this form of antibiotic use is very frightening; as others above have also expressed their concern.

I fully agree with the above responses. Please also have a look at this link.

https://www.nature.com/articles/s41598-019-46078-y.pdf

Dr Arvind Singh

Thank you for this reply; the authors of this valuable paper are also ResearchGate members:

Article Antibiotic drug-resistance as a complex system driven by soc...

https://www.researchgate.net/project/Modelling-antibiotic-drug-resistance-using-socio-economic-factors

Antibiotic resistance and the resulting risk for ineffective treatment of infections are serious and growing problems.

Kindly go through the link for more details

https://academic.oup.com/clinchem/article/58/8/1182/5620739