Any bacteria that acquire resistance genes, whether by spontaneous mutation or genetic exchange with other bacteria, have the ability to resist one or more antibiotics.

Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth; in other words, the bacteria are "resistant" and continue to multiply in the presence of therapeutic levels of an antibiotic.

Antibiotic resistance is a natural phenomenon. When an antibiotic is used, bacteria that can resist that antibiotic have a greater chance of survival than those that are "susceptible." Susceptible bacteria are killed or inhibited by an antibiotic, resulting in a selective pressure for the survival of resistant strains of bacteria.
Some resistance occurs without human action, as bacteria can produce and use antibiotics against other bacteria, leading to a low-level of natural selection for resistance to antibiotics. However, the current higher-levels of antibiotic-resistant bacteria are attributed to the overuse and abuse of antibiotics. In some countries and over the Internet, antibiotics can be purchased without a doctor's prescription. Patients sometimes take antibiotics unnecessarily, to treat viral illnesses like the common cold.

Some bacteria are naturally resistant to certain types of antibiotics. However, bacteria may also become resistant in two ways: 1) by a genetic mutation or 2) by acquiring resistance from another bacterium.

Mutations, rare spontaneous changes of the bacteria's genetic material, are thought to occur in about one in one million to one in ten million cells. Different genetic mutations yield different types of resistance. Some mutations enable the bacteria to produce potent chemicals (enzymes) that inactivate antibiotics, while other mutations eliminate the cell target that the antibiotic attacks. Still others close up the entry ports that allow antibiotics into the cell, and others manufacture pumping mechanisms that export the antibiotic back outside so it never reaches its target.

Bacteria can acquire antibiotic resistance genes from other bacteria in several ways. By undergoing a simple mating process called "conjugation," bacteria can transfer genetic material, including genes encoding resistance to antibiotics (found on plasmids and transposons) from one bacterium to another. Viruses are another mechanism for passing resistance traits between bacteria. The resistance traits from one bacterium are packaged into the head portion of the virus. The virus then injects the resistance traits into any new bacteria it attacks. Bacteria also have the ability to acquire naked, "free" DNA from their environment.

Any bacteria that acquire resistance genes, whether by spontaneous mutation or genetic exchange with other bacteria, have the ability to resist one or more antibiotics. Because bacteria can collect multiple resistance traits over time, they can become resistant to many different families of antibiotics.

Genetically, antibiotic resistance spreads through bacteria populations both "vertically," when new generations inherit antibiotic resistance genes, and "horizontally," when bacteria share or exchange sections of genetic material with other bacteria. Horizontal gene transfer can even occur between different bacterial species. Environmentally, antibiotic resistance spreads as bacteria themselves move from place to place; bacteria can travel via airplane, water and wind. People can pass the resistant bacteria to others; for example, by coughing or contact with unwashed hands.

Antibiotic resistance traits can be lost, but this reverse process occurs more slowly. If the selective pressure that is applied by the presence of an antibiotic is removed, the bacterial population can potentially revert to a population of bacteria that responds to antibiotics.

Antibiotics has become like eating chocolate in Nepal. Just go to a pharmacy pay Rs.10/15 and the shopkeeper gives you a pill and you take it. I am using the word shopkeeper instead of pharmacist because they really don’t care if it is over the counter medicine or the prescriptive! Most of them don’t even think it’s necessary to tell the patient what the right dose is. The shopkeeper gets his profit and the patient his medicine. Both the parties are pleased. Why should they care about the consequences– antibiotic resistance?

Out of thousands of pharmacies in Nepal, only a few hundred are currently run by pharmacists or assistant pharmacists. The remaining is run by “aushadibyabashi”. This means the majority of our pharmacies are in the hands of someone who is completely profit oriented and knows very little (only names and some uses) of some medicines. Antibiotics are expensive and offer greater profit margins. So, why wouldn’t the shopkeeper sell that medicine to anyone who comes asking for it? Why would he bother asking for prescriptions or telling the buyer about the consequences?

Similarly, companies offer attractive and mouthwatering commissions to the doctors to prescribe antibiotics. The more you prescribe the higher is your commission. Therefore, even higher dose antibiotics and also the reserved group antibiotics are found being randomly prescribed. We can see at least an antibiotic in every single prescription today. All the antibiotics that we currently have are already exposed and bacteria have developed resistance against most of them. Hospital acquired pneumonia has become very common. It is a situation where a patient is infected by antibiotic resistance species of bacteria and he/she has to die because of this infection rather than the disease they originally had.

This random practice of prescribing and selling of antibiotics has led to a catastrophic antibiotic resistance situation.

(Binod Adhikari is a Clinical Communication Strategist and Media & PR Manager at Grande International Hospital, Dhapashi, Kathmandu)