MedlinePlus presents Antibiotics versus Bacteria: Fighting the Resistance What if we couldn’t fight back? Tuberculosis. Gonorrhea. MRSA. These bad bugs are considered by the National Institute of Allergy and Infectious Diseases, or NIAID, to be some of the most threatening organisms on the planet today. They have all joined the RESISTANCE. That’s antimicrobial resistance, to be clear. Bacteria like these are quickly gaining the ability to thwart our antibiotics, leaving infections much more difficult to treat. And that’s a big problem. The CDC estimates that every year, more than two million people in the US get sick from antimicrobial resistant infections, resulting in at least 23,000 deaths. The worry is that other bacteria could join this resistance faster than we can develop solutions, or that bacteria become impervious to even more antibiotics, leading to essentially untreatable diseases. Who are these bacteria? Many different varieties of bacteria have developed antimicrobial resistance, but some are more worrying than others. Tuberculosis, or TB, is the number one infectious disease killer in the world, taking over one and a half million lives every year. TB is difficult to treat, and some resistant strains need years of daily treatment with multiple drugs, including months of painful injections and serious side effects that can leave patients deaf. Gonorrhea is worrisome because strains have become resistant to all but a few antibiotics. This sexually transmitted disease can share its resistance genes between bacteria, increasing the speed of resistance. Staphylococcus aureus, or Staph, is everywhere: on our personal items, our skin, in our noses. Staph is usually not harmful. But when it is, it can be difficult to treat especially in cases of Methicillin-resistant Staphylococcus aureus, or MRSA, which is now carried by 2% of Americans. These are just some of the leading bacteria in the resistance. There are others, and more are coming. How does resistance occur? Resistance is happening quickly because of overuse and misuse of antibiotics over a long period of time, such as not completing antibiotic courses as prescribed, and using antibiotics in agriculture to promote growth in animals. Bacteria multiply so fast, that even if we had the perfect antibiotic, resistance would still occur. And every time we use antibiotics, there is a chance that some bacteria survive due to changes in their DNA. The DNA can code for survival advantages such as: Changing the bacterial cell surface, preventing antibiotics from attaching or getting in. Making pumps that spit the antibiotics out before they have a chance to work. Or creating enzymes that “neutralize” the antibiotics. Antibiotics will kill most bacteria, including the helpful bacteria in our body. But the bacteria with the advantages can survive and reproduce. The resistant bacteria can pass the DNA changes on to their offspring, or sometimes even to each other, to generate new strains of antibiotic resistant bacteria. What can you do to fight the resistance? Using fewer antibiotics as a society can help prevent resistance, saving antibiotics for when they are most appropriate. The first step is preventing the need for antibiotics by avoiding infections, for example through hand-washing, immunizations, and safe food preparation. Using antibiotics the right way also helps, such as taking prescribed courses of antibiotics as directed to avoid leaving bacteria behind and giving them a chance to become resistant. Missed doses of antibiotics may allow a better environment for resistant bacteria to multiply and cause a resistant infection. By matching specific antibiotics to the bacteria that cause the infections, healthcare providers can fight antimicrobial resistance by reducing the number and strength of antibiotics patients take. Care should be taken that the infections are not already resistant to the antibiotics! Also, antibiotics should not be given for viral infections like colds or the flu, because viruses are not affected by antibiotics. Research at NIAID NIAID is researching ways to fight the antimicrobial resistance problem. Many avenues are being examined, including finding new antibiotics that expose weaknesses in the bacterial life cycle, looking at ways to boost the immune system to fight bacterial infections, creating bacterial communities that drown out the effects of the infectious bacteria, using special viruses that target and kill infectious bacteria, and improving diagnostic tests to better target bacteria with the most appropriate antibiotics. With good public health practices and cutting-edge research, we may be able to keep up with the resistance, and infectious diseases in general, but we all need to work together to stay one step ahead. Find out specific up-to-date research and stories from medlineplus.gov or search NIH MedlinePlus magazine, and learn more about NIAID research at niaid.nih.gov. MedlinePlus is a trusted source from the U.S. National Library of Medicine.