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Analysis Antimicrobial Resistance in South East Asia

Antibiotic residues in the environment of South East Asia

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j2440 (Published 05 September 2017) Cite this as: BMJ 2017;358:j2440

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  1. Cecilia Stålsby Lundborg, professor1,
  2. Ashok J Tamhankar, national coordinator of the Indian initiative for management of antibiotic resistance12
  1. 1Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Environmental Medicine, RD Gardi Medical College, Ujjain, India
  1. cecilia.stalsby.lundborg{at}ki.se

Cecilia Stålsby Lundborg and Ashok Tamhankar discuss how antibiotic residues in the environment contribute to antibiotic resistance in South East Asia and propose actions to mitigate the problem

The global action plan on antimicrobial resistance1 emphasises the One Health approach—seeing humans, animals, the food chain, the environment, and the interconnectedness between them as one entity. With growing economic development in South East Asia, the production and use of antibiotics—and therefore also their residues in the environment—are expected to increase.

Antibiotic residues in the environment lead to resistant bacteria through selective pressure. Antibiotics like fluoroquinolones (for example, ciprofloxacin) and sulphonamides, (such as sulfamethoxazole) are chemically stable. Their residues are often detected in the environment, and resistance to them is frequently reported.23 Beta-lactam antibiotics produce readily degradable residues that are not easily detected but still contribute to resistance.23 Theoretically, a chance interaction between a single molecule of an antibiotic and a bacterium can trigger natural selection for resistance, or a mutation favouring resistance. Subsequently, a vertical gene transfer (from one generation to another) or a horizontal gene transfer (transfer of resistance genes from one bacterium to another through a plasmid) may occur (fig 1). Identification of a complete identical sequence of antibiotic resistance genes from soil bacteria and clinical pathogens has demonstrated the potential for horizontal gene transfer between environmental antibiotic resistant bacteria and pathogenic bacteria.2 Humans may be exposed to antibiotic residues or directly to antibiotic resistant bacteria, including pathogens, through food or environment, and potentially be infected. Reduced effectiveness of antibiotics may result in prolonged or poorly controlled infections.

Figure 1 How a plasmid, which might contain antibiotic resistance genes, gets copied from one bacterium to another

In this paper, we identify pathways that contribute to antibiotic residues in the environment and propose …

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