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Dentists’ role in the antimicrobial resistance battle

23 November 2015

Dentists’ role in the antimicrobial resistance battle

The BDA has encouraged all dentists to take the Antibiotic Guardian Pledge.

The British Dental Association (BDA) has called for dentists to do their bit in the battle against antimicrobial resistance.

"Dentists are responsible for approximately 10 per cent of all antibiotic prescriptions in the UK and evidence suggests that many patients could be treated more appropriately without antibiotics. It is important we all work together to ensure that the right treatment is given at the right time, with the right funding,” says Dr Graham Stokes, Chair of the BDA Health and Science Committee

This push is more relevant than ever with the recent discovery of the mcr-1 gene, which has been shown to confer resistance against the “last resort” antibiotic group, polymyxins.

This study, published in The Lancet journal, was initiated following the results of routine surveillance of E.coli bacteria from Chinese livestock, which revealed an increase in resistance to the polymyxin, colistin.

The mcr-1 gene was found in 21% of livestock tested, 15% of raw meat samples and 1% of patients.

The nature of this gene makes it far more concerning than any previously identified polymyxin-resistant gene. It is located in a section of the bacterial DNA called the plasmid, which is easily transferred between different bacterial strains, and even between bacterial species.

"The transfer rate of this resistance gene is ridiculously high, that doesn't look good," said Prof Mark Wilcox, from Leeds Teaching Hospitals NHS Trust.

The mcr-1 gene has already been transferred from E.coli to K.pneumonia and could spread to many more species. The resistant strains have been identified in Laos and Malaysia and the researchers warn that the gene is likely to spread worldwide.

Prof Timothy Walsh, who collaborated in this study, told the BBC: "If MCR-1 becomes global, which is a case of when not if, and the gene aligns itself with other antibiotic resistance genes, which is inevitable, then we will have very likely reached the start of the post-antibiotic era.

"At that point if a patient is seriously ill, say with E. coli, then there is virtually nothing you can do."

The scientists involved in this study believe that the resistance evolved as a result of the overuse of colistin, a polymyxin antibiotic, in animal-feed. China is one of the largest users of colistin in agriculture and in veterinary. However, its worldwide use is likely to increase over the coming years. 

The authors of the Lancet study call for a global effort to tackle this global problem: “There are many countries, including in Europe, that use polymixins in agriculture, and therefore the responsibility to acknowledge and address the use of antibiotics across human and veterinary sectors must be also global,”

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