Reversibility of antibiotic resistance

Abstract

Although theoretically attractive, the reversibility of resistance has proven difficult in practice, even though antibiotic resistance mechanisms induce a fitness cost to the bacterium. Associated resistance to other antibiotics and compensatory mutations seem to ameliorate the effect of antibiotic interventions in the community. In this paper the current understanding of the concepts of reversibility of antibiotic resistance and the interventions performed in hospitals and in the community are reviewed.

Drug-mediated metabolic tipping between antibiotic resistant states in a mixed-species community

“…Antibiotic cycling, whereby different antibiotics are prioritised and restricted through time, can lead to the reversal of resistance if resistant microbes pay the price for their abilities to resist by having reduced fitness when drugs are not around (3,4). This idea has been tested clinically, with mixed outcomes.…”

Antimicrobial resistance at a community level

“…Some (but certainly not all) studies have shown reduction in the prevalence of resistant bacteria in hospitals that reduce antimicrobial use; 3 others have shown reduced prevalence of resistance bacteria when regional usage is reduced. 4 Antimicrobial agents are overused in people with viral respiratory infections and numerous other self-limiting illnesses. This issue is exacerbated by the ready availability of antibiotics without prescription in many countries.…”

Fingerprinting microbiomes towards screening for microbial antibiotic resistance

“…Accordingly, antibiotic misuse may result in a seriously antibiotic-abundant circumstance for microbes as well as humans. Consequently, in response to such environmental stimuli, bacteria acquire the capability of antibiotic resistance, and ultimately superbugs may emerge 20 . It is worth highlighting that microbiota from humans and natural environments are not separated but connected via various routes of exposure.…”