Antibiotics are chemical substances most commonly produced by bacteria or fungi. Antibiotics kill or inhibit the growth of bacteria depending upon the bacterium's susceptibility to the antibiotic. Naturally occurring antibiotics produced by microorganisms at low subinhibitory concentrations serve as protection or communication for the producing species.¹ Sir Alexander Fleming discovered penicillin in 1928 when he observed the restriction of bacterial growth on a bacterial culture contaminated with mold. Fleming's discovery sparked the antibiotic era, which began in 1943 when penicillin became available to treat bacterial infections. However, we may see an end to the antibiotic era and the beginning of the post-antibiotic era if antibiotic resistance were to spin out of control. The dawn of a post-antibiotic era may seem far-fetched; however, the possibility is real because bacteria evolve at a much more rapid rate than plants and animals. A brief timeline of antibiotic resistance starts with penicillin. The first cases of penicillin antibiotic resistance were seen in 1947. Vancomycin became available in 1972, and vancomycin-resistant cases were later seen in 1988. Imipenem became available in 1985, and imipenem-resistant cases were later seen in 1998. And daptomycin became available in 2003, with resistant cases seen in 2004.² Adding to the problem of antibiotic resistance is the negative impact of the emergence of antibiotic resistance drugs on pharmaceutical profits. Spending time and research on new antibiotic development does not pay off due to bacteria's ability to acquire resistance to antibiotics even when new classes of antibiotics are developed. Antibiotic resistance is the development of bacterial resistance to antibiotics which allows for the replication and growth of bacteria in the presence of an antibiotic by adaption through genetic mutation. There are point mutations to gain antibiotic resistance and horizontal gene transfer. Point mutations are mutations within the bacterium. And horizontal gene transfer is the passing along of new genetic material through mechanisms such as conjugation (directly from bacterium to bacterium), transduction (mediated by a bacteriophage), and transformation (uptake of extracellular genetic material).¹ Today our medical system relies on antibiotics to treat and cure previously fatal infections. Antibiotics are needed to support surgeries, to support the use of implantable medical devices such as joint replacements, and prevent opportunistic infections in immunocompromised and transplant patients. Our culture has changed social norms on health and safety topics such as smoking, wearing seat belts, and wearing helmets while bicycling. It is also possible to change social norms related to the overconsumption of antibiotics. Additionally, some possible strategies to combat antibiotic resistance are:

• Surveillance of how antibiotics are used.
• Employ gatekeeping of antibiotic prescriptions.
• Employ gatekeeping of antibiotics used for livestock and agriculture (80% of antibiotics in the United States are used on animals/ livestock).² 

References:

1 McKenna M. Maryn McKenna: What do we do when antibiotics don't work any more? YouTube. https://www.youtube.com/watch?v=o3oDpCb7VqI. Published June 25, 2015. Accessed February 21, 2022.

2 Beaudoin A, Norton LE. Antibiotic Resistance and Stewardship. In: Boulton ML, Wallace RB. eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.