85
population is a key step to prevent antimicrobial resistance, and together with the
implementation of antimicrobial stewardship programs in health care settings could
improve antimicrobial prescription (Marston et al. 2016). In fact, 50% of prescribed
antimicrobials are considered unnecessary and often medicaments are given without professional oversight (Centers for Disease Control and Prevention 2013).
Likewise, the use of antimicrobials as animal growth promoters and in routine
infection prevention in cattle further assist the dissemination of drug resistance, and
the use of antimicrobials in food production is actually higher than in clinical settings (80% of total antibiotic consumption in the United States) (Van Boeckel et al.
2015). These complicate the overall resistance scenario, since most of the drugs
considered ‘medically important’ for humans are also applied in animals. Moreover,
this practice comprises 62% of the currently used antibiotics and the remaining
percentage may also have a role (direct or indirect) (Marston et al. 2016).
4.2 Major Features on Antimicrobial Resistance
The acquisition of resistance was reported even before the ‘golden era’ of antimicrobials but the selective pressure yielded by then allowed a massive proliferation
and nowadays we faced an unprecedented challenge in health care with worldwide
repercussions (Balouiri et al. 2016; Mayers et al. 2017). The cessation of antimicrobial selections does not reverse the issue, if the gain of resistance was already undertaken, but would decrease its expansion and prevent other pathogens to become
resistant, minimizing the emergency (Holmes et al. 2016). Therefore, the development of new and alternative approaches to treat pathogen-induced illness is essential and efforts need to be carried out to avoid potential harmful outcomes and a
possible scenario where extensive resistance may happen again. Mitigation should
also involve public health factors such as improved access to sanitation and clean
water, the extent of immunization policies, antimicrobial quality control, and microbial diagnostic optimization (Roca et al. 2015; Balouiri et al. 2016; Marston
et al. 2016).
Antimicrobial therapy is usually initiated before the identification of the causative pathogen; thus, a rapid diagnostic and stewardship programs could optimize
treatments averting unnecessary antimicrobial therapies being able to differentiate
colonization from infection and bacterial from viral infections. Biomarkers are
being used to support diagnostics and guide health care professionals to prescribe
the best treatment available (Zaas et al. 2013). Vaccination is a prevention approach
that may circumvent the antimicrobial resistance issue since it would avoid the
infection and consequently the use of antimicrobials. For instance, enhanced worldwide coverage of the vaccine against Streptococcus pneumoniae could prevent
11.4 million antibiotic days per year in children under 5 years (Laxminarayan et al.
2016). Furthermore, anti-virulence strategies, monoclonal antibodies, humanized
immunoglobulins, and bacteriophages (phage therapy) are being used for treatment
4 In Silico Approaches for Prioritizing Drug Targets in Pathogens
population is a key step to prevent antimicrobial resistance, and together with the
implementation of antimicrobial stewardship programs in health care settings could
improve antimicrobial prescription (Marston et al. 2016). In fact, 50% of prescribed
antimicrobials are considered unnecessary and often medicaments are given without professional oversight (Centers for Disease Control and Prevention 2013).
Likewise, the use of antimicrobials as animal growth promoters and in routine
infection prevention in cattle further assist the dissemination of drug resistance, and
the use of antimicrobials in food production is actually higher than in clinical settings (80% of total antibiotic consumption in the United States) (Van Boeckel et al.
2015). These complicate the overall resistance scenario, since most of the drugs
considered ‘medically important’ for humans are also applied in animals. Moreover,
this practice comprises 62% of the currently used antibiotics and the remaining
percentage may also have a role (direct or indirect) (Marston et al. 2016).
4.2 Major Features on Antimicrobial Resistance
The acquisition of resistance was reported even before the ‘golden era’ of antimicrobials but the selective pressure yielded by then allowed a massive proliferation
and nowadays we faced an unprecedented challenge in health care with worldwide
repercussions (Balouiri et al. 2016; Mayers et al. 2017). The cessation of antimicrobial selections does not reverse the issue, if the gain of resistance was already undertaken, but would decrease its expansion and prevent other pathogens to become
resistant, minimizing the emergency (Holmes et al. 2016). Therefore, the development of new and alternative approaches to treat pathogen-induced illness is essential and efforts need to be carried out to avoid potential harmful outcomes and a
possible scenario where extensive resistance may happen again. Mitigation should
also involve public health factors such as improved access to sanitation and clean
water, the extent of immunization policies, antimicrobial quality control, and microbial diagnostic optimization (Roca et al. 2015; Balouiri et al. 2016; Marston
et al. 2016).
Antimicrobial therapy is usually initiated before the identification of the causative pathogen; thus, a rapid diagnostic and stewardship programs could optimize
treatments averting unnecessary antimicrobial therapies being able to differentiate
colonization from infection and bacterial from viral infections. Biomarkers are
being used to support diagnostics and guide health care professionals to prescribe
the best treatment available (Zaas et al. 2013). Vaccination is a prevention approach
that may circumvent the antimicrobial resistance issue since it would avoid the
infection and consequently the use of antimicrobials. For instance, enhanced worldwide coverage of the vaccine against Streptococcus pneumoniae could prevent
11.4 million antibiotic days per year in children under 5 years (Laxminarayan et al.
2016). Furthermore, anti-virulence strategies, monoclonal antibodies, humanized
immunoglobulins, and bacteriophages (phage therapy) are being used for treatment
4 In Silico Approaches for Prioritizing Drug Targets in Pathogens