TOWARDS A HOLISTIC APPROACH FOR ANTIBIOTIC RESISTANCE POLICY

Background: Antibiotic resistance (AR) is a phenomenon where an organism is invulnerable to a given chemical and is therefore unaffected by treatment with that chemical. Although AR is a natural process, it has been enhanced by human use of antibiotics. There is significant concern and attention to the emergence of pathogenic strains resistant to these compounds. Recently renewed consideration has boosted activity for policy related to antibiotics and AR. While these are important steps to make, the process to this point has largely focused on AR in the clinical environment and has ignored the natural environment. Ignoring the environment neglects the interconnected ecology of our world in two main ways. One is by failing to consider that antibiotics and antibiotic resistance are natural and that the environment can act as a reservoir of resistance. The second misses that humans and their actions do not exist in a vacuum and simultaneously affect and are affected by their environments. A holistic approach-involving human environments and natural environments- is necessary to create lasting policy change to preserve antibiotics and understand antibiotic resistance. Methods: Antibiotic resistance in the United States was examined as a case study and was studied through reading literature reviews, scientific and policy articles, and antibiotic resistance policy. The author examined what political and market failures have occurred in addressing antibiotic resistance, what is known about antibiotic resistance in the natural environment, what is delaying action from being taken, and what policy recommendations should be made. Results: Market and political failures including negative externalities, collective action dilemmas, and organizational processes have contributed to the misuse of antibiotics and increased antibiotic resistance. The lack of a holistic approach and standardized testing that encompasses all environments along with the difficulty to meet the needs of a diverse group of stakeholders have helped delay meaningful action from being taken. Despite these problems, there is enough evidence and scientific consensus to take action on public policy for antibiotic resistance, while moving forward on increasing knowledge of resistance in the environment. Policy recommendations generally fit in the categories of increasing interconnected understanding, expanding antibiotic innovation, decreasing antibiotic use, and reducing resistance/resistant infections. An example of a recommendation would be to incentivize rapid diagnostic development, enabling more appropriate antibiotic therapies to be chosen for a patient’s infection. Conclusion: The knowledge already obtained from the clinical environment and the overall impacts of the substantial use of antibiotics by humans illustrate enough evidence and consensus to create public policy and action.