Antimicrobial resistance explained
Microbes – friend or foe? Some microbes are essential to life, while others cause sickness in plants and animals, including humans. For decades, we have kept most infectious diseases under control, thanks to vaccines and antibiotic and antiviral medicines. However, it’s estimated that growing antimicrobial resistance has the potential to kill 10 million people globally per year by 2050.
It is a zombie apocalypse arising, it is a crazy thing and we really do need to start thinking about it.
Dr Siouxsie Wiles
Antibiotic resistance
Some plasmids can make their host bacterium resistant to an antibiotic. In this image, two halves of an agar plate containing the antibiotic kanamycin have been spread with the same strain of E. coli. The bacteria spread on the right-hand side of the plate contain a plasmid that confers resistance to kanamycin, so they can grow colonies even when it is present. On the left-hand side of the plate, the bacteria lack the kanamycin resistance plasmid and have been unable to grow.
The antibiotic age
Modern antibiotic medicines like penicillin, streptomycin and tetracycline came into use in the middle of the 20th century. Half of the antibiotic medicines we commonly use today were discovered between 1950 and 1960. They enabled doctors to treat serious – and sometimes fatal – bacterial infections like strep throat and pneumonia. Prior to antibiotics, even simple cuts and grazes could be dangerous. Human life expectancy increased by 8 years during the 1944–1972 period – thanks in part to antibiotics.
Antiviral medicines were first developed in the 1960s. In the beginning, it was a slow process to create them. Viruses are not living, so a virus needs a host cell to replicate itself. Medicines need to try to target the virus without harming the host cell. Advances in genetic sequencing have helped researchers to identify and treat viral diseases. Vaccines have been developed to help us acquire immunity to viruses like measles, hepatitis and influenza. Vaccinations are the main defence against most viruses. However, some viruses mutate at a fast rate – faster than we can alter and produce vaccines to combat them.
Antibiotic resistance
Antibiotic resistance is not a new concept. In 1945, Alexander Fleming (who discovered penicillin) warned that too small doses would educate microbes to resist penicillin rather than clear up the infection and that a host of “penicillin-fast organisms” could be passed to other individuals until they reach someone who penicillin cannot save.
Transferable antibiotic resistance was first discovered in Japan in the 1950s. Researchers also noted that resistance began to develop 2 or 3 years after a new antibiotic treatment was introduced.
Antimicrobial resistance: a major health issue
In this Royal Society Te Apārangi video, microbiologist Dr Siouxsie Wiles explains the growing health issues regarding antimicrobial resistance and what we can do to address the problem.
Antimicrobial resistance (AMR) explained
Any use of antibiotics automatically creates resistance. Antibiotics are designed to either kill or inhibit the growth of bacteria. Bacteria react to this threat – as to any threat from their environment – by evolving. Random mutations occur, and some may be resistant to the antibiotic. As bacteria continue to be exposed to the antibiotic, the resistant bacteria become more common. Meanwhile, successive mutations allow the bacteria to become resistant to ever-higher concentrations of the antibiotic medicine. Bacteria can also gain resistance via gene transfer from other bacteria, even between bacteria of different species.
Learn more about bacterial genetic expression to survive stress in the articles Bacterial DNA – the role of plasmids and Bacterial transformation.
How bacteria develop resistance to antibiotics
In this Royal Society Te Apārangi video, find out why antibiotics need to be used wisely to reduce the spread of antibiotic-resistant bacteria throughout our community.
Bacteria are not alone in developing resistance. Other microbes, including viruses, fungi and parasites, also mutate. Influenza is a viral infection and spreads rapidly. Vaccination is the preferred means for preventing influenza, but antiviral medications such as Tamiflu are used during flu epidemics. Research shows high rates of emerging resistance to Tamiflu, even after a single course of treatment. Resistance is also occurring in antiparasitic medicines, like those used to treat malaria.
Reasons for antimicrobial resistance
There are numerous reasons for the spread of antimicrobial resistance:
Incorrect and excessive use of antibiotics in humans and animals.
Globalisation allows resistant microbes to move from one part of the world to another via travel and trade.
Consumer products containing antimicrobial agents introduce stressors – similar to antibiotics – accelerating the development and spread of resistance in bacteria and fungi.
Antimicrobial medicines and agents used for humans and animals do not break down but are released into the environment via commercial, industrial or agricultural wastewater.
How to help slow the spread of antibiotic-resistant bacteria
This Royal Society Te Apārangi video provides advice on how we can help keep antibiotics effective for as long as possible.
There are a number of common-sense approaches we can take to help slow the spread of antimicrobial resistance:
Practising good hygiene and using soap and water rather than antimicrobial cleaning products.
Correct use of prescription antibiotics.
Rethinking medical tourism as a cheaper means of seeking medical treatment.
Staying up to date with vaccinations.
The articles Global report on antimicrobial resistance and Is the post-antibiotic era now here? provide additional information on these topics.
UMF testing
Not all Mānuka honeys have the same ability to kill bacteria. Rating the strength of different batches is important so that people can choose the right honey for their needs.
The hunt for new antimicrobial medicines
Nature of science
The field of science offers many ongoing challenges – the need for new thinking and innovation does not change. There will always be opportunities to further our understanding, make new discoveries and create new technologies in response to old and new challenges.
The growing need for new drugs to replace those that are no longer effective encourages researchers to look for novel solutions:
The article Antibacterial mushrooms highlights research regarding the antibacterial and antioxidant activities of native New Zealand mushrooms.
In Bioluminescence and superbugs, Dr Siouxsie Wiles explains how she uses bioluminescent bacteria as a tool for assessing how well antibiotics and vaccines work against superbugs.
How honey heals wounds and From bees to bandages explain the antibacterial properties of honey.
Bioactive milk proteins attack acne explains how bioactive proteins act as a powerful antimicrobial agent.
New Zealand company Mende Biotech uses old tōtara fence posts to create Totarol™ – an antibacterial and antimicrobial compound.
Spreading awareness and improving community health literacy
In 2017, South Wellington Intermediate School teacher Matt Boucher was on a Royal Society Te Apārangi Science Teaching Leadership Programme at the University of Otago’s Wellington campus (which is associated with Wellington Regional Hospital).
Matt developed a keen interest in microbiology and attended a series of meetings with the infectious disease team. Matt and a couple of the antimicrobial pharmacists on the team, Chris Little and Emma Henderson, could see the potential to engage young people in some authentic science learning around a problem that affects them and their wider community – the pressing issue of antimicrobial resistance.
Together, they designed a local poster competition to enable children to create their own messages about antimicrobial resistance and the basic steps needed to stop the spread of disease such as hand washing and wound care.
Winning poster 2018
The overall winner for the 2018 Antibiotic awareness poster competition was Libby from Cust School.
In 2018, the competition was picked up by the Health Quality & Safety Commission, Ministry of Health and ACC as part of the Commission’s annual Patient Safety Week. The competition was promoted through schools, media releases and social media activity, and more than 250 entries were received from across the country.
Regional winner – ‘Fight Germs’
Melody from Te Kāpehu Whetū in Northland was a regional winner in the 2018 Antibiotic awareness poster competition.
There were several prizes up for grabs, including 10 $50 movie vouchers for the highly commended posters and a special edition scooter for each of the regional winners. The overall winner received a trip to the laboratory at Wellington Regional Hospital to experience science in action!
Regional winner – ‘Remember to wash your hands’
Pippa from South Wellington Intermediate School was a regional winner in the 2018 Antibiotic awareness poster competition.
2018 competition award winners
The overall winner of the 2018 poster competition was Libby from Cust School. Regional winners were Pippa from South Wellington Intermediate School, Ruby-Jean and Astra from Belmont School and Melody from Te Kāpehu Whetū.
Regional winner – ‘I have a cold’
Ruby-Jean and Astra from Belmont School in Lower Hutt were regional winners in the 2018 Antibiotic awareness poster competition.
Related content
Learn more about the history of antibiotics and antimicrobial resistance with this article and timeline. Find out what you can do to reduce the risk. The context for learning provides ideas on how to incorporate this wicked problem into authentic cross-curricular learning.
Watch our webinar The science of superbugs – teaching antimicrobial resistance awareness in Aotearoa with Dr Siouxsie Wiles.
In this recorded webinar, Dr Kristin Dyet talks about her role as a microbiologist and the importance of AMR awareness.
The Hub team created the collection Antimicrobial resistance resources to support teaching and learning about AMR. It is ready for you to use and customise as you choose.
In a case study on tetracyclines, a family of antibiotics, the New Zealand Parliamentary Commissioner for the Environment takes a closer look at the environmental fate of these medicines.
Student activity ideas
Why not get your students to design their own poster about the issue of increasing antimicrobial resistance? Alternatively they could create activities such as a word search or crossword.
The Science of Medicines – Whakatere Waka is an innovative community project that promotes scientific literacy regarding the use and understanding of medicines. The project has a gaming component – we’ve used several of their ideas in the activity Game design for viruses and vaccines. A second activity Viruses and immunity – interpreting infographics uses fact sheets they’ve created.
Citizen science
Help the Infection Inspection project develop a faster test for antibiotic resistance by using your observation skills to identify bacteria that have been impacted by antibiotics.
Useful links
Royal Society Te Apārangi has produced a series of articles and videos about antimicrobial resistance, including the te reo Māori resource He uaua ake te rongoā i ngā whakapokenga ātete rongoā.
Find out more about the Infectious disease and antimicrobial resistance report from The Office of the Prime Minister's Chief Science Advisor released in March 2022. There are a series of recommendations under six themes to help Aotearoa New Zealand unite against the threat of infectious disease and antimicrobial resistance.
The Ministry of Health has information and links on its website – Resources for antibiotic awareness.
Learn more about Totarol™ – the tōtara-based antibacterial plant extract .
Listen to Dr Siouxsie Wiles as she discusses the rise of resistant superbugs in this Radio New Zealand interview.
Watch antibiotic resistance evolve in this video from Harvard Medical School.
See Te Tāhū Hauora Health Quality & Safety Commission website for information on Patient Safety Day.
This video from the BioInteractive website shows real footage of the effects of adding penicillin to a culture of bacteria.
In this 2021 SpinOff article Why you should care about antimicrobial resistance Siouxsie Wiles and Toby Morris write about the serious threat of antimicrobial resistance with animated cartoons helping to explain more.
In 2024 the World Health Organization (WHO) published its first-ever guidance on wastewater and solid waste management for manufacturing of antibiotics, intended to provide an independent scientific basis for targets in regulation to prevent emergence and spread of antibiotic resistance.
Acknowledgement
Three of the videos used in this article were produced by the Royal Society Te Apārangi. For more information about antimicrobial resistance, visit their Expert Advice webpage.
Royal Society Te Apārangi
Royal Society Te Apārangi is an independent, not-for-profit membership organisation that supports New Zealanders to explore, discover and share knowledge.
