Can we solve the AMR crisis?

The AMR crisis can be tackled. While microbes will always evolve, we can monitor this, adjust our behaviour and find new ways to continue to treat infections effectively. But it will take a concerted effort from across the world to:

1. Look after the antimicrobials we already have.

  • We can do that by making sure the right antimicrobial is always used for the right infection at the right time.
  • That means we need accurate and accessible diagnostic tools available to tell us which microorganisems are responsible for a given infection.
  • We can also do that by managing prescribing practices in humans and animals and managing antimicrobial exposure in the environment, like through sewage or farming practices.
  • We can prevent infection in the first place, meaning fewer antimicrobials have to be used. We can do that through effective vaccination programmes, and infection prevention control practices such as ensuring access to clean water and effective hand-washing.
  • We can make sure we know where resistant pathogens are emerging, and how prescribing is happening through accurate surveillance systems and data sharing

2. Continue to create new antimicrobials. 

  • It is very difficult to produce new antimicrobials and bring them to market, and this process often takes many years
  • We need to keep investing in finding new antimicrobials to tackle microbes that are already resistant to current antimicrobials
  • We also need to develop new treatment strategies that reduce the chances of resistance development and reduce harm to our healthy microbiota. For example, by combining complementary therapies and new ways of delivering effective therapeutic doses directly to the site of infection
  • Once potential new antimicrobials are in development, we need better tools to test their efficacy in pre-clinical trials that better mimic the conditions in the body.

AMR is a very complicated problem, with a range of inter-linking solutions. The Microbiology Society has written our suggestions to policymakers for how we think the crisis needs to be addressed which you can read on our policy page. 

What are some alternatives to antibiotics?

New antimicrobials are needed for tackling antimicrobial resistance in all types of microbes.  However, the broad activity of antibiotics means that resistance to them risks us losing control of a huge number of bacterial infections; imminently and all at once. Microbiologists are therefore working hard with a range of other experts to develop alternatives to antibiotics that may be viable treatments in the future.

Some exciting areas of research are investigating a range of agents that may become the alternative antimicrobials of the future. These include:

Phytochemicals

Phytochemicals are biologically active compounds that are naturally produced by plants and have been developed as drugs, such as aspirin, derived from willow bark. A range of phytochemicals, such as flavonoids are part of natural plant defence systems and have novel antimicrobial activities, with multiple targets that differ from antibiotics.

Antimicrobial Peptides

Antimicrobial peptides (AMPs) are small peptides (10 – 60 amino acids long) with killing activity against bacteria, viruses, fungi and parasites and a wide variety of applications in medicine, animal husbandry, aquaculture, agriculture and food preservation. They are part of the innate immune system of many organisms including mammals, amphibians, insects, marine and plant life and microorganisms. Rational peptide design focuses on modification of natural AMPs to reduce toxicity, simplify large scale manufacture, reduce costs, and increase stability in the body.

Bacteriocins

Bacteriocins are highly specific natural AMPs produced by bacteria. They only inhibit other competing members of the same bacterial species. For example, different types of Escherichia coli produce unique bacteriocins called colicins that only kill other types of E. coli. Their narrow spectrum makes them attractive as precision alternatives to broad-spectrum antibiotics.

Phage therapy

Phage therapy is the use of anti-bacterial viruses called bacteriophages that can infect and kill specific bacterial cells. The advantages over antibiotics are that they are highly specific, so will not harm healthy bacteria in the body, they also multiply when they infect their bacterial targets, so they can be used in very low doses, and they can evolve to counter any bacterial resistance to them. Phage therapy has existed for over 100 years, but their specific nature makes them hard to develop as a general treatment for broad use under current regulations. New advances in genetic sequencing, synthetic biology and AI tools look set to change this.

Phage products 

The challenges of classic phage therapy could be overcome using potent phage components such as lysins and tailocins that rapidly kill their specific bacterial targets by causing them to burst open. Although they are derived from phages, they cannot self-replicate and can be engineered to attack different targets. This means that they are easier to regulate.

Anti-biofilm agents

Most bacteria commonly grow as biofilms, which feature a highly organised and protective matrix of secreted sugars and other components, providing refuge from stresses like antibiotics. Some recent research efforts have shifted into discovering new agents that can be used alongside traditional antibiotics to specifically disrupt or prevent the growth of biofilms, restoring antibiotic susceptibility.

Anti-virulence agents

Unlike antibiotics that kill or inhibit growth, anti-virulence agents are designed to make bacteria less able to cause severe disease. They work by inhibiting bacterial virulence factors in the body such as adhesins that are important for colonising tissues or toxins that cause tissue damage. This way, the novel therapeutics exert minimal selective pressure on a target microorganism, reducing the drive to develop resistance.

Anti-quorum-sensing agents

Quorum sensing is a type of communication system that bacteria use to sense how numerous they are and coordinate their activities accordingly. This strategy is used to tightly control the production of virulence factors like toxins that take a lot of energy and materials to produce. By inhibiting these lines of communication, anti-quorum sensing molecules are a type of anti-virulence agent, reducing production of many virulence factors all at once.

Immunotherapy

Immunotherapies are designed to boost the body’s natural immune system against microbial infections during treatment. Examples include administration of monoclonal antibodies that recognise specific microbial components and cause them to cluster together or tagging them for clearance by immune cells. Cytokines can also be boosted to signal to immune cells to travel to the sight of infection where they’re needed, resulting in more rapid recovery and reducing the volume of antibiotics needed.

Nanoparticles

Nanoparticles range in size from 1 to100 nanometres in diameter and can be made from various materials. With a large surface area, they have unique properties that can enhance the action of other antimicrobial agents. Although nanoparticles can kill microorganisms by several mechanisms on their own, appropriate surface chemistry design can modify them to carry antibiotics or AMPs targeting them to specific sites in the body. Further work is needed to standardise the way that nanoparticle activities are measured and to limit their toxicity.