Antibiotic Resis
Antibiotic Resistance
What are antibiotics?
Mechanisms of resistance
Man
Antibiotics are substances produced by micro-organisms that kill
other microorganisms. Most of them have been derived from soil
dwelling microbes, fungi and bacteria and some can in fact be
synthesised chemically.
Resistance can develop in four main ways. The bacteria can:
1. P
fo
in
re
tr
Discovery
The ancient Greeks and Indians used mouldy bread to treat wounds
and various others noted the beneficial effects of similar compounds.
In 1928 Alexander Fleming noted that a common fungus, Penicillium
notatum had destroyed bacteria in a Staphylococcus culture plate,
but it was not until the 1940s, when two chemists, Florey and Chain,
developed a method of mass production that it became available for
widespread use during the Second World War. Since then more than
100 different antibiotic compounds have been found, most of them
from soil-dwelling bacteria.
How antibiotics work
Antibiotics essentially work in two ways:
1. Bactericidal antibiotics kill the bacteria generally by either
interfering with the formation of the bacterium’s cell wall or its
cell contents. Penicillin is one of these.
2. Bacteriostatic antibiotics stop bacteria from multiplying
by interfering with bacterial protein production, DNA
replication, or other aspects of their cellular metabolism,
e.g. tetracyclines, sulphonamides
Some antibiotics are broad spectrum: these kill a whole range of
bacteria both Gram positive and Gram negative; some of which
are pathogenic. They may also kill the normal gut bacteria.
Narrow spectrum antibiotics affect only a small range of bacteria.
When antibiotics were introduced they were hailed as miracle
drugs. It seemed that the era of death from bacterial infections
was over. However, in only a few short decades things have
changed dramatically.
Bacteria reproduce in such vast numbers that a random mutation
can quickly result in a resistant strain. Antibiotic resistance – more
commonly known nowadays as antimicrobial resistance (AMR)
– is the ability of certain organisms to adapt and continue to multiply
in the presence of an antibiotic. (The term ‘antimicrobial’ also includes
drugs that act against viruses, fungi and protozoa, in addition to
those acting against bacteria.)
Resistant strains began to appear within a few years of the
introduction of antibiotics, so new antibiotics had to be found to
replace the ones to which resistance had developed. In the past
30 years only two new classes of antibiotics have appeared, so
the problem of antibiotic resistance is becoming more serious.
The World Health Organisation has classified antimicrobial resistance
as a “serious threat’ that ‘has the potential to affect anyone, of any
age, in any country”.
1. develop methods to inactivate or modify the antibiotic
2. alter its surface and so prevent the antibiotic from binding to it.
3. change its metabolic pathways to circumvent the antibiotic
4. reduce the concentration of the antibiotic within it by either
(a) reducing the permeability of its surfaces so less antibiotic
enters, or
(b) increasing the rate at which the antibiotic is actively pumped
out of the bacterial cell.
Factors that contribute to antibiotic resistance
2. S
e
3. P
o
a
e
re
4. D
in
Antibiotic Resistance Gen
1. Unnecessary prescription of antibiotics for viral infections against
which they are useless. Every time an antibiotic is taken it kills off
the more susceptible members of the germ population but it also
increases the chance that resistance will develop is some species
of bacteria in the body.
2. The overuse of broad spectrum antibiotics because the actual
causative organism has not been identified. The broad spectrum
antibiotic kills many species and, if resistance develops in any
bacterial species in the animal or human, then it will be able to
reproduce more easily because there is little competition. The
resistance genes may also transfer to other bacterial species.
3. Failure to finish a course of antibiotics. When an antibiotic is taken
the most susceptible bacteria die first leaving a population that is
more resistant. If the course of antibiotics is stopped before all the
bacteria are killed then the animal or human may have a relapse
and the bacteria that caused the infection will be much more
resistant to the antibiotic and harder to kill.
Antib
trans
two w
1. V
is
fr
2. H
a
sp
lo
4. Residues in food. Many farm animals, especially those farmed
intensively, are routinely given antibiotics at certain times in their
life even though they might not be sick. This reduces mortality
and increases live weight gain. There is a mandatory period after
treatment with antibiotics during which neither the animals nor
their products may be allowed to enter the food chain. This is
done to allow time for all traces of the antibiotic to be eliminated.
Even if foods containing residues of antibiotics are not allowed
to enter the food chain, the fact that an animal has been exposed
to an antibiotic treatment at a prior time in its life may allow
bacteria containing resistant genes to survive in food products
derived from that animal. Unless food hygiene measures are
adequate, bacteria with resistant genes may transfer resistance
to normal gut bacteria in those who consume the food products.
In Ireland all milk is routinely tested for antibiotic residues. Some
countries allow farmers to purchase and administer antibiotics to
their animals. Care must therefore be taken to ensure that food
products in our shops and supermarkets are safe.
Mul
Toda
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at lar
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c Resistance
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mped
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their
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after
nor
is
ated.
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posed
cts
e
ance
ucts.
Some
cs to
ood
Antibiotic Resistance
Managing antimicrobial resistance (AMR)
1. Preventing infections and preventing the spread of resistance,
for example, by improving hygiene practices. This is very effective
in reducing the spread of infections, including those that are
resistant to antibiotics. This also helps to raise awareness of
transmission routes.
2. Surveillance in order to track transmission routes, measure the
extent of resistance and provide early warning of specific risks.
3. Promoting the responsible use of antibiotics around the world in
order to minimise inappropriate use. This could involve restricting
access to currently available antibiotics in order to preserve their
effectiveness into the future. Some antibiotic classes might be
reserved for specific infections.
4. Developing new drugs, vaccines and diagnostic tests and
incentivising the development of new antibiotic classes for the future.
Gene transfer
Antibiotic resistance can be increased by the ability of bacteria to
transfer their resistance to other bacteria. This transfer can occur in
two ways either vertically or horizontally.
1. Vertical gene transfer is the normal way genetic information (genes)
is passed on in most organisms. This is when information is passed
from the parent to the offspring, i.e. from one generation to the next.
2. Horizontal gene transfer is when genes are transferred within
a generation from one individual to another or even from one
species to another. Bacteria are particularly good at this, using
loops of genetic material called plasmids.
Species 1
pilus
resistant
Its aim is to make sure that health products that it regulates
do what they are intended to do and are as safe as possible,
whether they are intended for the Irish market or for export.
Antibiotic Resistance
Until 2014 the HPRA was known as Irish Medicines Board
(IMB). The new name better reflects its broader remit and
regulatory functions which now include:
•
•
•
•
•
•
•
•
•
Human medicines
Veterinary medicines
Clinical trials
Medical devices
Controlled drugs
Blood and blood components
Tissues and cells
Cosmetic products
The protection of animals used for scientific purposes
• Organs intended for transplantation
Species 2
Species 1
Plasmid with
antibiotic-
The HPRA (The Health Products Regulatory Authority) is
a state agency whose role is to protect and enhance public
and animal health by regulating medicines, medical devices
and other health products. It regulates clinical trials and
human organs for transplantation. It also monitors the safety
of cosmetics.
Vertical transfer
Horizontal transfer
Multidrug resistant bacteria
Today there is concern about the increasing occurrence of multidrug
resistant bacteria especially in hospitals even in the community
at large. These bacteria, commonly referred to in the press as
‘superbugs’, are resistant to almost all the known antibiotics.
They include MRSA (methicillin-resistant Staphylococcus aureus,
Clostridium difficile and multi-drug resistant tuberculosis. The
emergence of gram-negative pathogens that are resistant to virtually
all of the available antibiotics is a particularly serious problem for the
healthcare sector.
Fuctions of HPRA
• The HPRA grants licences to companies to make,
distribute and market medicines after a review of their
safety, quality and effectiveness.
• It continuously monitors medicines, medical devices and
other health products, responding quickly to any safety
or quality concerns.
• It produces safety and quality information to support the
safe use of health products.
• It inspects companies and facilities that test, make or
distribute health products to ensure that they comply with
relevant standards and legislation.
Find out more about the HPRA at www.hpra.ie
Find this and other lessons on www.sta.ie
Antibiotic
AntibioticResist
Resis
Antibiotic Resistance
Syllabus
SyllabusReferences
References
Student
StudentActivities
Activities
Exa
Ex
The
Themain
mainsyllabus
syllabusreferences
referencesforforthe
thelesson
lessonare:
are:
Use
Useavailable
availableresources
resourcestotolearn
learnmore
moreabout
aboutthe
thefollowing
followingtopics.
topics.
InIneach
eachcase
casesummarise
summariseyour
yourfindings
findingsinina adiagram,
diagram,poster
posteroror
electronic
electronicpresentation.
presentation.
Leav
Le
Leaving
LeavingCertificate
CertificateBiology
Biology
• • Distribution
Distributionofofbacteria
bacteriaand
andfungi
fungiininnature
nature(3.1.2)
(3.1.2)
• • Understand
Understandthe
theterm
term‘pathogenic’
‘pathogenic’
(3.1.3):
(3.1.3):Definition
Definitionand
androle
role
ofofantibiotics.
antibiotics.Economic
Economicimportance
importanceofofbacteria.
bacteria.Potential
Potential
abuse
abuseofofantibiotics
antibioticsininmedicine
medicine
Leaving
LeavingCertificate
Certificate
Agricultural
AgriculturalScience
Science
• • The
Thecow.
cow.Common
Commondiseases
diseases– –cause,
cause,symptoms,
symptoms,prevention
prevention
and
andcontrol.
control.Bacteriology
Bacteriologyininrelation
relationtotoclean
cleanmilk
milkproduction.
production.
Leaving
Leaving
Certificate
Certificate
Chemistry
Chemistry
• • Organic
Organicnatural
naturalproducts
products– –range
rangeand
andscope
scopeand
andtwo
two
examples
examples(7.4)
(7.4)
Learning
LearningOutcomes
Outcomes
On
Oncompletion
completionofofthis
thislesson,
lesson,students
studentsshould
shouldbebeable
ableto:to:
• • Describe
Describethe
thedifference
differencebetween
betweenananantibiotic
antibioticand
andanan
antimicrobial
antimicrobialsubstance
substance
• • Outline
Outlinehow
howantibiotics
antibioticswere
werediscovered
discovered
• • Know
Knowthe
thetwo
twoways
waysantibiotics
antibioticswork:
work:bactericidal
bactericidaland
and
bacteriostatic
bacteriostaticand
andbebeable
abletotoexplain
explainthe
thedifference
difference
• • Distinguish
Distinguishbetween
betweenbroad
broadand
andnarrow
narrowspectrum
spectrumantibiotics
antibiotics
• • Explain
Explainwhat
whatisismeant
meantbybyantibiotic
antibioticresistance
resistanceand
andstate
statethe
the
four
fourmechanisms
mechanismsofofantibiotic
antibioticresistance
resistance
• • Describe
Describethe
thetwo
twolevels
levelsofofgene
genetransfer;
transfer;vertical
verticaland
and
horizontal
horizontal
• • Name
Namesome
someresistant
resistantstrains
strainsofofbacteria.
bacteria.
(b)
(b)
(i)(i)
1.1.The
Thedifferent
differentfamilies
familiesofofantibiotics
antibioticsand
andhow
howeach
eachworks.
works.
2.2.What
Whatspecies
speciesofoffarm
farmanimals
animalsare
areroutinely
routinelygiven
givenantibiotics
antibiotics
and
andwhat
whatdiseases
diseasesthey
theyare
aregiven
givenfor?
for?
Are
Arethey
theygiven
givenforforany
any
other
otherreason
reasonthan
thantotocure
curediseases?
diseases?
3.3.The
Theuse
useofofantibiotics
antibioticsduring
duringthe
theSecond
SecondWorld
WorldWar
Warand
and
which
whichclasses
classesofofsoldiers
soldierswere
weregiven
givenpriority
prioritytotoreceive
receivethis
this
scarce
scarceresource.
resource.
4.4.The
Thestandard
standardmethod
methodofoftesting
testingbacterial
bacterialdiseases
diseasesforfor
resistance
resistancetotoparticular
particulardrug
druggroups.
groups.
(ii)(ii)
(iii)
(iii)
(iv)
(iv)
(v)(v)
(vi)
(vi)
Antibiotic Resistance
5.5.The
Thedevelopment
developmentofofantimicrobial
antimicrobialresistance
resistanceininviruses
virusessuch
such
asas
AIDS
AIDSand
andInfluenza.
Influenza.
(c)(c)
6.6.The
Thetop
topten
tenmultiple
multipledrug
drugresistant
resistantdiseases.
diseases.
(i)(i)
7.7.How
Howthe
thehuman
humanbody
bodydefends
defendsitself
itselffrom
fromdisease
disease
(ii)(ii)
8.8.The
Thestructure
structureofofbacteriophages
bacteriophagesand
andthe
thehistory
historyofoftheir
theiruse
use
asasa atreatment
treatmentforforbacterial
bacterialdiseases.
diseases.
(iii)
(iii)
9.9.How
Howbacteria
bacteriaare
areidentified
identifiedincluding
includingthe
theuse
useofofGram’s
Gram’sstain.
stain.
(iv)
(iv)
10.
10.
The
Thefunction
functionofofthe
theHPRA
HPRA
(formerly
(formerlyknown
knownasasthe
theIrish
Irish
Medicines
MedicinesBoard)
Board)ininIreland.
Ireland.
(v)(v)
True/False
True/FalseQuestions
Questions
a)a)Antibiotics
Antibiotics
always
always
killkill
bacteria?
bacteria?
T TF F
b)b)Most
Most
antibiotics
antibiotics
are
are
derived
derived
from
from
soil
soil
dwelling
dwelling
organisms.
organisms. T TF F
General
GeneralLearning
LearningPoints
Points
These
Theseare
areadditional
additionalrelevant
relevantpoints
pointswhich
whichare
areused
usedtotoextend
extend
knowledge
knowledgeand
andfacilitate
facilitatediscussion.
discussion.
c)c)Horizontal
Horizontal
gene
gene
transfer
transfer
occurs
occurs
between
between
different
different
species.
species.T TF F
d)d)Fleming
Fleming
was
was
the
the
first
first
person
person
toto
show
show
that
that
antibiotics
antibiotics
can
can
cure
cure
disease.
disease.
T TF F
e)e)AllAll
bacteria
bacteria
are
are
pathogenic.
pathogenic.
T TF F
• • The
Thetransfer
transferofofgenes
genesbetween
betweenspecies
specieshas
hasbeen
beenbig
bignews
news
forforthe
thelast
lastnumber
numberofofyears,
years,especially
especiallyininrelation
relationtotoGM
GMfood,
food,
while
whilebacteria
bacteriahave
havebeen
beenquietly
quietlydoing
doingit itforforbillions
billionsofofyears
years
using
usingplasmids.
plasmids.
f) f) You
You
should
should
stop
stop
taking
taking
aa
course
course
ofof
antibiotics
antibiotics
asas
soon
soon
asas
you
you
feel
feel
better.
better.
T TF F
• • Teixobactin
Teixobactinisisthe
thefirst
firstnew
newantibiotic
antibioticininthirty
thirtyyears
yearsand
andwas
was
discovered
discoveredbybyresearchers
researchersfrom
fromNorth-Eastern
North-EasternUniversity
Universityinin
Boston
Bostonusing
usingananelectronic
electronicchip
chiptotogrow
growthe
themicrobes
microbesininthe
the
soil
soiland
andthen
thenisolate
isolatetheir
theirantibiotic
antibioticcompounds.
compounds.It Itappears
appearstoto
bebeeffective
effectiveinintreating
treatingsome
someofofthe
themost
mostdifficult
difficultinfections.
infections.
It Itworks
workswell
wellininmice
micewith
withvery
veryfew
fewside
sideeffects
effectsbut
butstill
stillhas
has
totobebescaled
scaledupuptotoproduce
producequantities
quantitiestototest
testononhumans.
humans.
Positive
Positivetests
testsononmice
micedodonot
notguarantee
guaranteesuccess
successininhumans.
humans.
h)h)Many
Many
new
new
antibiotics
antibiotics
have
have
been
been
discovered
discovered
inin
the
the
last
last
thirty
thirty
years.
years.
g)g)Using
Using
too
too
many
many
broad
broad
spectrum
spectrum
antibiotics
antibiotics
encourages
encourages
resistance.
resistance.
T TF F
T TF F
i) i) Narrow
Narrow
spectrum
spectrum
antibiotics
antibiotics
killkill
aa
whole
whole
range
range
ofof
bacteria.
bacteria.T TF F
j) j) Antimicrobial
Antimicrobial
compounds
compounds
killkill
viruses
viruses
and
and
parasites.
parasites.
T TF F
k)k)Antibiotics
Antibiotics
are
are
substances
substances
made
made
byby
microorganisms
microorganisms
that
that
killkill
viruses.
viruses.
T TF F
Check
Checkyour
youranswers
answerstotothese
thesequestions
questionsononwww.sta.ie.
www.sta.ie.
Leav
Le
(i)(i)
(ii)(ii)
(iii)
(iii)
(iv)
(iv)
(v)(v)
cResistance
Resistance
Antibiotic Resistance
Examination
ExaminationQuestions
Questions
Did
DidYou
YouKnow?
Know?
pics.
cs.
r
Leaving
LeavingCertificate
CertificateBiology
Biology(HL)
(HL)2007,
2007,Q.Q.1414(b(b&&c)c)
scs
ny
any
(ii)(ii) What
Whatare
arethe
thetwo
twomain
mainbiochemical
biochemicalcomponents
componentsofofa avirus
virus
particle?
particle?
• •Necrotizing
Necrotizingfasciitis
fasciitisisisa aserious
seriousquick
quick
spreading
spreadingbacterial
bacterialskin
skininfection
infectionthat
thatkills
killsthe
thebody’s
body’ssoft
softtissue.
tissue.
(Necrotizing
(Necrotizingmeans
means‘causing
‘causingtissue
tissuedeath’).
death’).It Itisisoften
oftenreferred
referred
totoininthe
thepress
pressasasthe
the‘flesh
‘flesheating
eatingbug’.
bug’.The
Thecommonest
commonest
cause
causeisisprobably
probablyGroup
Group
AA
Streptococcus
Streptococcusbut
butit itcan
canalso
also
bebecaused
causedbybyClostridium,
Clostridium,Escherichia
Escherichiacoli,
coli,Klebsiella
Klebsiellaand
and
Aeromonas
Aeromonashydrophila
hydrophilaand
andStaphylococcus
Staphylococcusaureus,
aureus,many
manyofof
which
whichhave
haveantibiotic
antibioticresistant
resistantstrains.
strains.The
Thebacteria
bacteriaattack
attackthin
thin
layers
layers(fasciae)
(fasciae)and
andproduce
producetoxins
toxinsthat
thatcan
candamage
damageand
andkillkill
surrounding
surroundingtissue.
tissue.
• •The
Thedamage
damagetototissue
tissuecan
canrestrict
restrictblood
bloodflow
flowand
andprevent
preventthe
the
antibiotic
antibioticreaching
reachingallallareas
areasofofdead
deadtissue
tissuesosothe
thedead
deadtissue
tissue
frequently
frequentlyhas
hastotobebesurgically
surgicallyremoved
removedeven
eventotothe
theextent
extentofof
removing
removinglimbs.
limbs.Healthy
Healthypeople
peoplevery
veryrarely
rarelyget
getthe
thedisease;
disease;
it itisisnormally
normallythose
thosewith
withananunderlying
underlyinghealth
healthcondition
conditionand
anda a
lowered
loweredimmune
immuneresponse.
response.It Itisisnot
notcaught
caughtbybycontact
contactwith
withanan
infected
infectedperson.
person.
s
uch
h
ese
ain.
n.
TF F
TF F
TF F
TF F
TF F
TF F
TF F
TF F
TF F
TF F
TF F
(b)
(b)
(i)(i) Comment
Commentononthe
thedifficulty
difficultyofofdefining
definingviruses
virusesasasliving
living
organisms.
organisms.
(iii)
(iii)Name
Nametwo
twodiseases
diseasescaused
causedbybyviruses.
viruses.
(iv)
(iv)Give
Giveananexample
exampleofofa abeneficial
beneficialapplication
applicationofofa avirus.
virus.
(v)(v) What
Whatisisananantibiotic?
antibiotic?
(vi)
(vi)Antibiotics
Antibioticsshould
shouldnot
notbebeprescribed
prescribedforfora aperson
personsuffering
suffering
from
froma aviral
viralinfection.
infection.
Suggest
Suggesta areason
reasonforforthis.
this.
(c)
(c)
(i)(i) What
Whatisismeant
meantbybythe
theterm
termimmunity?
immunity?
(ii)(ii) Outline
Outlinebriefly
brieflythe
therole
roleofofB Blymphocytes
lymphocytesininthe
thehuman
human
immune
immunesystem.
system.
(iii)
(iii)Distinguish
Distinguishbetween
betweenactive
activeand
andpassive
passiveimmunity.
immunity.
(iv)
(iv)“Vaccination
“Vaccinationgives
givesrise
risetotoactive
activeimmunity”.
immunity”.Explain
Explainthis
this
statement.
statement.
(v)(v) InIncertain
certainsituations
situationsa aperson
personisisgiven
givena aspecific
specificantibody
antibody
rather
ratherthan
thanbeing
beingvaccinated.
vaccinated.
1.1.IsIsthis
thisananexample
exampleofofactive
activeororpassive
passiveimmunity?
immunity?
2.2.Under
Underwhat
whatcircumstances
circumstancesmight
mightananantibody,
antibody,rather
rather
than
thana avaccination,
vaccination,bebegiven?
given?
3.3.Comment
Commentononthe
theduration
durationofofimmunity
immunitythat
thatfollows
followsthe
the
administration
administrationofofananantibody.
antibody.
Leaving
LeavingCertificate
CertificateBiology
Biology(HL)
(HL)2005,
2005,Q.Q.1515(b)
(b)
(i)(i) Draw
Drawand
andlabel
labela adiagram
diagramtotoshow
showthe
thebasic
basicstructure
structureofof
a atypical
typicalbacterial
bacterialcell.
cell.
(ii)(ii) Other
Otherthan
thanbeing
beingprokaryotic,
prokaryotic,state
statetwo
twoways
waysininwhich
which
a atypical
typicalbacterial
bacterialcell
celldiffers
differsfrom
froma atypical
typicalhuman
humancell
cell
(e.g.
(e.g.cell
cellfrom
fromcheek
cheeklining).
lining).
(iii)
(iii)Describe
Describehow
howsome
somebacteria
bacteriarespond
respondininorder
ordertotosurvive
survive
when
whenenvironmental
environmentalconditions
conditionsbecome
becomeunfavourable.
unfavourable.
(iv)
(iv)What
Whatisismeant
meantwhen
whena abacterium
bacteriumisisdescribed
describedasas
being
beingpathogenic?
pathogenic?
(v)(v) What
Whatare
areantibiotics?
antibiotics?Use
Useyour
yourknowledge
knowledgeofofthe
theTheory
Theoryofof
Natural
NaturalSelection
Selectiontotoexplain
explainthe
thepossible
possibledanger
dangerinvolved
involvedinin
the
themisuse
misuseofofantibiotics.
antibiotics.
Antibiotic Resistance
Biographical
BiographicalNotes
Notes
Ernest
ErnestDuchesne
Duchesne(1874-1912)
(1874-1912)
InInhis
hisdoctoral
doctoralthesis
thesispublished
publishedinin1897,
1897,
the
theFrench
Frenchphysician,
physician,Ernest
ErnestDuchesne
Duchesne
showed
showedthat
thatthe
thefungus
fungusPenicillium
Penicillium
glaucum
glaucumhad
hadthe
theability
abilitytototreat
treatsome
some
bacterial
bacterialinfections.
infections.He
Hecarried
carriedout
outhis
his
experiments
experimentsononguinea
guineapigs
pigsand
andsuggested
suggested
that
thatthe
thetoxin
toxinproduced
producedbybythe
thefungus
funguscould
could
possibly
possiblybebeused
usedtototreat
treathumans.
humans.After
Aftergraduation
graduationhehejoined
joinedthe
the
army
armyand
anddid
didnot
notcontinue
continuethe
theresearch.
research.
Like
Likemany
manygood
goodideas
ideasthese
thesewere
werestated
statedand
anddiscovered
discoveredbefore
before
the
thescientific
scientificcommunity
communitywas
wasfarfarenough
enoughadvanced
advancedtotofully
fully
understand
understandthe
theimplications.
implications.Fleming
Flemingwas
waslucky
luckytotonotice
noticethe
the
same
samething
thingatatjust
justthe
theright
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andthus
thushehegot
gotallallthe
theglory.
glory.
Duchesne
Duchesnedied
diedofoftuberculosis
tuberculosisatatthe
theyoung
youngage
ageofof37.
37.
Revise
ReviseThe
TheTerms
Terms
Can
Canyou
yourecall
recallthe
themeaning
meaningofofthe
thefollowing
followingterms?
terms?
Revising
Revisingterminology
terminologyisisa apowerful
powerfulaid
aidtotorecall
recalland
andretention.
retention.
antibiotics,
antibiotics,antimicrobial
antimicrobialresistance
resistance(AMR),
(AMR),bacteria,
bacteria,bactericidal,
bactericidal,
bacteriostatic,
bacteriostatic,broad
broadspectrum,
spectrum,broad
broadspectrum
spectrumantibiotics,
antibiotics,
Clostridium
Clostridiumdifficile,
difficile,fungi
fungiand,
and,Gram
Grampositive,
positive,metabolic
metabolicpathways,
pathways,
microbes,
microbes,micro-organism,
micro-organism,MRSA,
MRSA,narrow
narrowspectrum
spectrumantibiotics,
antibiotics,
pathogenic,
pathogenic,plasmids,
plasmids,protozoa,
protozoa,residues,
residues,Staphylococcus,
Staphylococcus,
sulphonamides,
sulphonamides,Tetracyclines,
Tetracyclines,tuberculosis,
tuberculosis,vaccination.
vaccination.
Check
Checkthe
theGlossary
Glossaryofofterms
termsfor
forthis
thislesson
lessonon
onwww.sta.ie
www.sta.ie