Marc Siler

Writing 39C
R. Mykkanen
4/27/14
Antibiotic resistance has been an on-going battle since the beginning of pharmaceutical
medicine and is an issue of increasing importance with every passing year; it is imperative that
we work to solve this issue before it becomes even worse than it currently is. Upon initial
discovery, antibiotics were deemed wonder drugs and medical miracles. They helped to save
thousands of lives and increase the human lifespan. However, as soon as antibiotics became
available for the public, bacteria were already developing resistance. And now, each year,
thousands of people die due to infections from antibiotic resistant bacteria. Humans have relied
on antibiotics to remedy symptoms of fevers and sore throats and coughs so much that many may
take antibiotics for granted. Drug misuse, over prescription, and lack of antibiotic resistance
monitoring have contributed to the issue and now there are even types of bacteria that are
resistant to multiple types of drugs. One must realize that antibiotics have existed for only less
than a century, and now we are running out of new antibiotics.
In order to understand antibiotic resistance, one must understand what antibiotics are, and
how they work. Alexander Fleming first discovered antibiotics in 1928, when he observed that a
strain of Penicillium mold inhibited the growth of certain harmful bacterium, and named it
penicillin. Although Fleming made this discovery, he was unable to isolate, purify, and
synthesize the strain. This did not discourage other scientists from working with penicillin;
eventually two scientists from Oxford, Howard Florey and Ernest Chain, were able to describe
procedures for purification in 1940. This led to production and distribution of penicillin in the
40s (Aminov 8). Soon Pfizer, a pharmaceutical corporation, discovered a way of large-scale
production of penicillin by a process of deep tank fermentation (Flavell-While 55). Antibiotics
were now well on their way to the public. Yet, ever since antibiotics were being given out, drug
misuse and abuse did not help the issue of antibiotic resistance. Scientists put so much time and
effort in order to develop antibiotics, but now they must work harder to slow and fight back
against resistance.
Well, what are antibiotics? On a superficial level, antibiotics are easy to define: opposing
or against bacteria. However, they are much more complex than that. There are several ways
antibiotics work: they can inhibit cell growth, induce cell death, or weaken the bacterias cell
wall. Antibiotics inhibit cell growth by limiting the bacterias ability to synthesize DNA, RNA,
or protein. This prevents certain chemical reactions from taking place and hinders their ability to
grow and multiply. Some antibiotics work by destroying the cell walls because the bacteria
cannot survive without a cell wall, as it holds the cell together (Kohanski, Dwyer, Collins, 2-4).
Although antibiotics function the same, different types of bacteria cause different types of
infections, meaning that we need different types of antibiotics. Because antibiotics were able to
destroy and inhibit harmful bacteria, it was believed that infectious diseases would be no more--
that is until it was observed that bacteria were developing resistances.
According to the Center for Disease Control and Prevention (CDC), antibiotic resistance
is defined as the ability of bacteria or other microbes to resist the effects of an antibiotic. This
concept is far from new. Less than 20 years after Fleming discovered the effects of Penicillium,
he warned about the threats of antibiotic resistance during his Nobel Prize acceptance speech.
Fleming stated that as beneficial as penicillin may be, There [is] a dangerin
underdosage...[and] non-lethal quantities of the drug make [the bacteria] resistant (Penicillin,
31-32). Underdosage and drug misuse are big factors in antibiotic resistance. If not all the
bacteria are killed off, some bacteria survive and mutate to diminish the effectiveness of the
drugs. Bacteria can resist antibiotics in various ways: neutralizing the antibiotic, pumping the
antibiotic out, mutating genetic material, or transferring of DNA codes for resistance. If one cell
of bacteria has survived through one of these methods, it can multiply and become resistant to a
specific drug. What makes antibiotic resistance an even more pressing issue is that bacteria can
develop resistance to multiple types of antibiotics. These bacteria are considered superbugs and
are very dangerous. While the medical aspect is important, to social aspect is just as important.
Without proper drug management, the antibiotic resistance will only get worse. Drug misuse and
abuse only compounds the issue of resistance.
Currently in our society, there is a paradox regarding antibiotic resistance. The battle with
drug-resistant bacteria has already lasted several decades and has progressively gotten worse
while the research and development of new antibiotics has dramatically decreased. Between
1950 and 1970, it was a time that was considered the golden era of discovering new drug
classes.

Figure 3. (Infectious Diseases Society of America, 2009)

Yet since then, the rate of discovery of novel drug classes suddenly dropped. In 1990, it was
reported that large pharmaceutical companies have stopped looking for new antibiotics or have
significantly reduced their efforts into research (Bad Bugs, No Drugs, 16) Figure 3 shows that
pharmaceutical companies have only developed five new antibiotic agents between 2003 and
2007. Also, there is a clear trend in the decrease of new antibiotics. Antibiotic resistance has had
a tremendous impact on the medical and pharmaceutical fields. And the cutback in research has
had a severe negative effect economically as well. In 1992, it was estimated that $1.3 billion
were spent trying to treat hospital-acquired infections from just six species of antibiotic-
resistant bacteria (Aminov, 12). $1.3 billion is a staggering number, and a number that has only
increased decades later. In fact, this number has grown to approximately $5 billion in the U.S
alone. Infections due to drug resistant bacteria have increased heath care costs because of longer
hospitalizations, extra physician visits, the higher cost of alternative antibiotics, more post-
hospital care, lost work days, and deaths The financial burden is not limited to only
hospitalization costs. Research and development of new antibiotics is very expensive and very
long. Its estimated that if a new research and development program were to start today, it would
cost anywhere from $800 million to $1.7 billion and take about 10 years to test for production of
a new drug (Bad Bugs, No Drugs, 15, 5). Also, there would be no guarantees that a new drug
would actually come into development. The return companies would receive from producing a
new antibiotic would not even come close to the amount of resources spent for research, so it
makes sense in a business standpoint that these pharmaceutical companies have stopped or
significantly decreased their research.
Simultaneously, thousands of lives continue to be taken by drug-resistant bacteria. The
CDC estimates that almost at least 2 million people acquire serious infections with bacteria that
are resistant to one or more of the antibiotics designed to treat those infections, [and] at least
23,000 people die each year as a direct result of these antibiotic-resistant infections (Antibiotic
Resistance Threats, 11). The Infectious Diseases Society of America (IDSA) wants to change
this. They released a report in 2004 that reiterated not only the impact antibiotic resistant
bacteria, but also the importance of reinvigorating research and development of new
antibiotics. They didnt stop there. They also lobbied the 109
th
congress about antibiotic
resistance, which led to the introduction of promising legislation in 2005 and 2006, however the
legislation was not enacted (Bad Bugs, No Drugs: No ESKAPE!, 1). The IDSA is making
positive progress in attempting to broaden the awareness on antibiotic resistance by increasing
the political and legislative involvement within the issue.
While the IDSA believes the answer to antibiotic resistance is through continuing the
same process that currently exists to find new antibiotics, there are those that believe it is time to
look for alternative methods. Currently, scientists utilize a process of metagenomic analysis of
antibiotic producing microbes. This involves testing for antibacterial properties, and amplifying
the bacterias DNA through the use of primers and specific testing methods, and running the
found DNA sequence (AGTC strand) through a database to determine if the bacterium has
already been discovered. While there is a database of over 5000 known bacteria (helpful and
harmful), not all environments have been discovered, leaving the possibility of discovering new
antibiotics that could change the world of medicine. However, this process is long a tedious and
not yielded the same amount of results as in the past. Also, scientists have chemically altered
existing antibiotics, but bacteria have become resistant to those as well. Essentially, we are
running out of wonder drugs. One alternative to antibiotic resistance is bacteriophage therapy.
Bacteriophages are viruses that infect bacteria, and bacteriophage therapy is the use those viruses
to treat bacterial infections. Bacteriophage therapy has been known to have a relatively good
success rate in treating bacterial infections that showed no susceptibility to antibiotics (Golkar,
Bagasra, Pace). There is huge potential for the future of medicine with this type of therapy and
can be viewed as a valuable asset. While there is more testing that still needs to be done because
of possible safety issues, bacteriophage therapy cannot be ignored.
Apart from bacteriophage therapy, many believe that healthcare agencies and physicians
have to be more watchful and careful about antibiotics. The CDC has tried to improve its
monitoring of antibiotics, but gaps in knowledge about antibiotic resistance still exists.
According to the CDC, there is no systematic surveillance of antibiotic resistance threats, data on
antibiotic use is not systematically collected, and programs to improve antibiotic prescribing are
not used in the United States (Antibiotic Resistance Threats, 27). Overuse of antibiotics has
played a significant role in bacteria becoming resistant, and it is because prescription drugs are
so readily available to people. A way to slow antibiotic resistance as much as possible could be
by limiting the amount of drugs prescribed. There are numerous discussions about how to
prevent antibiotic resistance and find solutions. Regardless, antibiotic resistance wont pause and
wait until we find a solution.
If you were to search the term antibiotic resistance on the internet, numerous
organizations pop up explaining how tremendous the issue of antibiotic resistance is. The Center
for Disease Control and Prevention (CDC). The World Health Organization (WHO). The Food
and Drug Administration (FDA). The National Institute of Allergy and Infectious Diseases
(NIAID). Those are only a few. Despite many organizations making efforts to control and limit
antibiotic resistance, the general public typically does not have an understanding of what it is.
This compounds the issue because of drug misuse and overuse. The enormous impact of
antibiotics cant be understated. Neither can the issue of antibiotic resistance. We have relied on
antibiotics for almost a century and have saved hundreds of thousands of lives. With the current
rate of antibiotic resistance, mankind is approaching a post-antibiotic era. With a lack of new
antibiotics and research, and limited amount of surveillance and programs regarding antibiotic
resistance, the issue will continue to get worse. Bacteria have been adapting to their
environments for thousands, if not millions, of years; antibiotic resistance cannot be stopped,
only slowed. Therefore we must keep pushing to develop antibiotics or other alternatives if we
want to continue to live and thrive in this world.















Works Cited
Aminov, Rustam I. "A Brief History of the Antibiotic Era: Lessons Learned and Challenges for
the Future." Frontiers in Microbiology 1 (2010): n. pag. National Center for
Biotechnology Information. Web.
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109405/>.

"Antibiotics Attack." SEDICO. SEDICO Pharmaceutical Co., n.d. Web. 13 Apr. 2014.
<http://www.sedico.net/english/SedicoInformationCenter/Physicians/Antibiotics/Antibiot
ics_e.htm>.
Antibiotic Resistance Threats. Rep. Center for Disease Control and Prevention, n.d. Web.
<http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf>.
Bad Bugs, No Drugs. Rep. N.p.: n.p., n.d. Infectious Diseases Society of America, July 2004.
Web. 13 Apr. 2014.
<http://www.idsociety.org/uploadedfiles/idsa/policy_and_advocacy/current_topics_and_i
ssues/antimicrobial_resistance/10x20/images/bad%20bugs%20no%20drugs.pdf>.
Boucher, Helen W., George H. Talbot, John S. Bradley, John E. Edwards, David Gilbert,
Louis B. Rice, Michael Scheld, Brad Spellberg, and John Bartlett. "Bad Bugs, No Drugs:
No ESKAPE! An Update from the Infectious Diseases Society of America." Clinical
Infectious Diseases48.1 (2009): 1-12. Print.
Flavell-While, Claudia. "Pfizers Penicillin Pioneers." Chemical Engineer Feb. 2010: 54-
55. TCE Today. Web. 13 Apr. 2014.
<http://www.tcetoday.com/~/media/Documents/TCE/Articles/2010/824/824chemengcha
ngeworld.pdf>.
Fleming, Alexander. "Penicillin." Nobel Lecture. 11 Dec. 1945.Nobelprize.org/. Web. 12 Apr.
2014. <http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-
lecture.pdf>.
Golkar, Zhabiz, Omar Bagasra, and Donald G. Pace. "Bacteriophage Therapy: A Potential
Solution for the Antibiotic Resistance Crisis." Journal of Infection in Developing
Countries 129-136 8.2 (2013): 1-9. Academic Search Complete. Web. 15 Apr. 2014.
Kohanski, Michael A., Daniel J. Dwyer, and James J. Collins. "How Antibiotics Kill Bacteria:
From Targets to Networks." National Center for Biotechnology Information. U.S.
National Library of Medicine, 04 May 2010. Web. 13 Apr. 2014.
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2896384/>.
Spellberg, B., R. Guidos, D. Gilbert, J. Bradley, H. W. Boucher, W. M. Scheld, J. G. Bartlett,
and J. Edwards. "The Epidemic of Antibiotic-Resistant Infections: A Call to Action for
the Medical Community from the Infectious Diseases Society of America." Clinical
Infectious Diseases 46.2 (2008): 155-64. Web. 13 Apr. 2014.










Antibiotic Resistance Threats. Rep. Center for Disease Control and Prevention, n.d. Web.
<http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf>.
Relevance: This source is a report regarding antibiotic resistance. It informs the population about
the threat of antibiotic resistance, how to fight back, and even provides information about current
antibiotic resistant bacteria. Because antibiotic resistance is such a serious threat, this source is
very relevant to my composition paper.
Evidence: because this is a report to the public, a lot of evidence is provided through statistics.
The CDC uses infographics, charts, tables, graphs, etc. to relay their information to the public.
Author: For this particular source, there is/are no dedicated author(s). Rather, the CDC put this
report together collectively. The CDC works for the United States, so they definitely understand
various issues and topics within the medical community.
Publisher: The publisher is the Center for Disease control and Prevention. The CDC is the United
States national public health institution. Because they focus on disease control, the issue on
antibiotic resistance falls right under them.
Comprehensiveness: This report is very comprehensive. It is over 100 pages, and they even have
a table of contents, an appendix, a glossary and much more. The article discusses what antibiotic
resistance is, fighting back, and prevention. This source is mainly about the current and future,
but does not discuss the history of antibiotic resistance that much.
Timeliness: This report was released in 2013, so it is very relevant because of its age. It is less
than a year old, so the information is definitely new and up to date. This source is one of the
better sources because if its age.



Bad Bugs, No Drugs. Rep. N.p.: n.p., n.d. Infectious Diseases Society of America, July 2004.
Web. 13 Apr. 2014. <http://www.idsociety.org/uploadedfiles/idsa/policy_a
nd_advocacy/current_topics_and_issues/antimicrobial_resistance/10x20/images/bad%20
bugs%20no%20drugs.pdf>.
Relevance: This source is a report about the dangers on antibiotic resistance. It discusses the
history, the present, and the future of antibiotic resistance, so this source is very relevant to my
paper.
Evidence: In order to display how serious the issue of antibiotic resistance is, there was a lot of
facts and statistics involved. They also made sure to include charts to help the audience further
grasp what the IDSA was trying to portray.
Author: There was no specific author for this source. It is a report outlining the dangers of
antibiotic resistance that was put together by the IDSA as a whole.
Publisher: The publisher is the Infectious Diseases Society of America. The IDSA is a medical
association that specializes in infectious diseases, and this was published for the public in 2004.
Comprehensiveness: This source is very comprehensive. Within the report, it discusses the
history of antibiotic resistance, and a lot of past problems with this issue. They also discuss what
organizations can do in the future to prevent the issue from becoming worse.
Timeliness: This source was published in 2004, which means that it is 10 years old. Typically
one would try to avoid this source because of its age. However, this report had a large degree of
influence, because of its comprehensiveness and the fact that it was one of the first reports
calling out to continue to work against antibiotic resistance.




Spellberg, B., R. Guidos, D. Gilbert, J. Bradley, H. W. Boucher, W. M. Scheld, J. G. Bartlett,
and J. Edwards. "The Epidemic of Antibiotic-Resistant Infections: A Call to Action for
the Medical Community from the Infectious Diseases Society of America." Clinical
Infectious Diseases 46.2 (2008): 155-64. Web. 13 Apr. 2014.
Relevance: This source deals with the report from the IDSA. This source is a little of a follow up
to the 2004 report, that reiterates what the IDSA was saying. This is very relevant to my paper,
because in the title, it states A call to action. My paper discusses point-of-views and arguments
about the issue of antibiotic resistance, so another group of people or organization is warning
about the dangers of antibiotic resistance.
Evidence: This source has multiple tables and figures. They also have many statistics to back up
their claims. Statistics are great ways to providing evidence to the audience. Using tables and
figures help the audience to see things in a different way.
Author: There are multiple authors linked to this report, they are: Brad Spellberg, Robert Guidos,
David Gilbert, John Bradley, Helen W. Boucher, W. Michael Scheld, John G. Bartlett, and John
Edwards Jr. The authors all have various affiliations that include, UCLA, UCSD, John Hopkins,
and other hospitals. Because of these affiliations with all these school, hospitals, and medical
centers, they are credible because of their experience with the topic.
Publisher: The publisher is the Center for Disease control and Prevention. The publisher is the
Center for Disease control and Prevention. The CDC is the United States national public health
institution. Because they focus on disease control, the issue on antibiotic resistance falls right
under them.

Comprehensiveness: In the report, they discuss why antibiotic resistance occurs, why
development of antibiotic resistance has decreased, alternatives for the future, and what other
organizations can do to help the cause. It is very comprehensive about the topic of antibiotic
resistance, and covers the main points of the issue within the report.
Timeliness: This source was published in 2008, which was 6 years ago. It isnt relatively new,
but it is not very old either. The source is so comprehensive, that it can still maintain its
relevance even though it may not be very new.
















Boucher, Helen W., George H. Talbot, John S. Bradley, John E. Edwards, David Gilbert,
Louis B. Rice, Michael Scheld, Brad Spellberg, and John Bartlett. "Bad Bugs, No Drugs:
No ESKAPE! An Update from the Infectious Diseases Society of America." Clinical
Infectious Diseases 48.1 (2009): 1-12. Print.
Relevance: This source is a scientific study that analyzes the development of new antibiotics at
the time. This is relevant to my research because it deals with research and development.
Evidence: Because this source is a scientific study, actual testing was conducted. Therefor there
is loads of evidence and data involved. This source makes sure to include tables and figures
when presenting results from the study.
Author: There are multiple authors linked to this report, they are: Brad Spellberg, Robert Guidos,
David Gilbert, John Bradley, Helen W. Boucher, W. Michael Scheld, John G. Bartlett, and John
Edwards Jr. The authors all have various affiliations that include, UCLA, UCSD, John Hopkins,
and other hospitals. Because of these affiliations with all these school, hospitals, and medical
centers, they are credible because of their experience with the topic.
Publisher: The publisher is the Center for Disease control and Prevention. The publisher is the
Center for Disease control and Prevention. The CDC is the United States national public health
institution. Because they focus on disease control, the issue on antibiotic resistance falls right
under them.
Comprehensiveness: For this study, everything related to their research was published. It
includes methods, results, conclusion, etc., and basically follows the standard structure of a
report from a scientific research.
Timeliness: This report was published in 2009. This is right where sources are relevant because
of its age. Five years and less is a good range for sources.