Log in
Sign up
Antimicrobial Resistance
Antimicrobial Resistance: Understanding AMR, Its Global Impact, and Strategies to Combat It
Understanding Antimicrobials and Antimicrobial Resistance (AMR)
What Are Antimicrobials?
- Antimicrobials, including antibiotics, antivirals, antifungals, and antiparasitics, are medicines designed to prevent and treat infectious diseases in humans, animals, and plants.
What is Antimicrobial Resistance (AMR)?
- Antimicrobial Resistance (AMR) arises when bacteria, viruses, fungi, and parasites no longer respond to antimicrobial medicines.
- As a result, antibiotics and other antimicrobials lose their effectiveness, making infections increasingly difficult or impossible to treat. This leads to greater risks of disease spread, severe illness, disability, and death.
- AMR develops naturally through genetic changes in pathogens over time, but its spread is significantly accelerated by human activities, particularly the misuse and overuse of antimicrobials in treating, preventing, or controlling infections across humans, animals, and plants.
Why is AMR a Global Concern?
- Critical Role of Antimicrobials: Antimicrobials underpin modern medicine, enabling treatments for common infections and life-saving procedures like cancer chemotherapy, caesarean sections, hip replacements, and organ transplants.
- Threat to Global Health and Food Security: Drug-resistant pathogens compromise healthcare systems, reduce agricultural productivity, and threaten food security.
- Economic Impact: AMR drives up healthcare costs through prolonged hospital stays and intensive treatments while reducing productivity in patients, caregivers, and farming industries.
- Global Spread: AMR transcends borders, affecting all nations irrespective of income levels. Key factors include poor sanitation, inadequate infection control, limited access to vaccines and diagnostics, and weak policy enforcement.
- Impact on Vulnerable Populations: Communities in low-resource settings face heightened challenges, disproportionately suffering from the causes and consequences of AMR.
Addressing AMR demands global collaboration, awareness initiatives, enhanced healthcare infrastructure, and the responsible use of antimicrobial medicines in human, animal, and environmental health sectors.
Impacts of AMR on Humans, Animals, Plants, and the Environment
- Animals: Resistant bacteria in terrestrial and aquatic animals lead to increased suffering and losses, impacting the livelihoods of over 1.3 billion people reliant on livestock and 20 million in aquaculture.
- Environment: Antibiotics entering soil and waterways foster resistant bacteria, which can infect humans and animals. Antibiotic-resistant bacteria in animal manure can spread to the environment and wildlife.
- Human Health: Misuse of antibiotics in people leads to resistant strains affecting hospitalised patients. Infections like gonorrhoea, cystitis, or those linked to surgeries are becoming harder to treat.
- Food Safety: The link between AMR in animals and human deaths, especially via food-borne infections, remains unclear but is a concern.
To preserve antimicrobials’ efficacy and secure decades of health advancements, controlling AMR is imperative.
How Do Bacteria Become Resistant to Drugs?
Bacteria develop resistance by evading antibiotic effects through various mechanisms, posing a major ecological and public health challenge. Resistance can occur via:
- Intrinsic Resistance: Some bacteria naturally resist antibiotics by evolving structural changes. For example, penicillin, which targets cell walls, is ineffective against bacteria without cell walls.
- Acquired Resistance: Bacteria gain resistance through mutations or acquiring DNA from resistant bacteria. For instance, Mycobacterium tuberculosis is resistant to rifamycin.
- Genetic Change: DNA mutations in bacteria alter protein production, making antibiotics ineffective. E. coli and Haemophilus influenzae are examples resistant to trimethoprim.
- DNA Transfer: Bacteria share resistance genes through:
- Transformation: Incorporating naked DNA.
- Transduction: DNA transfer via phages.
- Conjugation: Direct bacterial contact.
An example is Staphylococcus aureus resistance to methicillin (MRSA).
Some bacteria, like E. coli and Enterococcus, are resistant to multiple antibiotics, including macrolides, tetracyclines, beta-lactams, and quinolones, posing a severe challenge to global health.
Ten Strategies to Combat Antimicrobial Resistance (AMR)
- Global Public Awareness Campaigns
Educating societies on the dangers of overusing and misusing antimicrobials is critical. Public campaigns could significantly reduce unnecessary antimicrobial prescriptions—by up to 36%—when effectively delivered over the long term. - Improved Sanitation and Infection Prevention
Enhancing healthcare systems and living standards is essential to reducing the demand for antibiotics. For instance, improving sanitation in low-income countries could decrease antibiotic use for diarrhoea treatment by up to 60%. - Limit Antimicrobial Use in Agriculture and Minimise Environmental Impact
Agriculture and aquaculture account for a significant proportion of global antibiotic use—over 70% in the U.S. alone. Antibiotics used for growth promotion or preventive purposes should be curtailed. Additionally, up to 90% of antibiotics excreted by animals enter the environment, further spreading resistance. - Enhanced Global Surveillance
Monitoring drug resistance and antimicrobial consumption is vital. Scientists and physicians need accurate, structured data on human and animal antibiotic use, resistance rates, and molecular mechanisms of AMR to anticipate threats and design solutions. - Promote Rapid Diagnostic Tools
Over 67% of antimicrobial therapies are prescribed unnecessarily due to misdiagnoses. Developing accurate, rapid diagnostic tests would allow physicians to prescribe antibiotics only to those who truly need them. - Encourage Vaccine Development and Alternatives
Increasing vaccination rates can reduce the need for antibiotics. Promising vaccine candidates, such as those targeting Clostridium difficile and Pseudomonas aeruginosa, are in development. Alternatives to antibiotics, including phage therapy, probiotics, antibodies, and lysins, also require greater investment. - Expand and Support the Workforce in Infectious Disease Management
Combating AMR requires trained professionals such as microbiologists, pharmacists, veterinarians, and infection control specialists. Countries should invest in training, recruiting, and rewarding experts to strengthen AMR initiatives. - Global Innovation Funds for Early-Stage Research
Early-stage research for new antimicrobial drugs is risky and often unappealing to commercial funders. Establishing global innovation funds could support non-commercial and high-risk research critical to AMR control. - Incentivise Antibiotic Development and Improvement
Pharmaceutical companies face challenges in developing new antibiotics due to market uncertainty and existing drugs’ relative effectiveness. Governments and global organisations should introduce incentives and rewards for developing and launching new antimicrobial therapies. - Build a Global Coalition for Real Action
International cooperation is essential. Placing AMR on the political agenda using One Health principles can drive change. Initiatives such as engaging the G20 and United Nations can create impactful global actions to combat AMR effectively.
By adopting these strategies, we can mitigate AMR’s global impact on health, agriculture, and the environment while ensuring sustainable antimicrobial use across sectors.
What is World Antimicrobial Awareness Week (WAAW)?
- World Antimicrobial Awareness Week (WAAW), celebrated annually from 18-24 November, is a global initiative aimed at increasing awareness of antimicrobial resistance (AMR). It encourages the adoption of best practices among One Health stakeholders to curb the emergence and spread of drug-resistant infections.
- AMR represents a grave threat to public health, impacting human and animal health, food production, and the environment. This year’s theme, “Educate. Advocate. Act now.”, calls on the global community to spread knowledge about AMR, advocate for decisive commitments, and implement concrete actions to address this escalating challenge.
The Role of Pharmacists in Antimicrobial Stewardship
Pharmacists are vital members of the healthcare team and play a key role in promoting antimicrobial stewardship. Their contributions extend across multiple facets of antibiotic management, ensuring responsible use and optimal patient outcomes:
- Medication Dispensing: Pharmacists act as the final checkpoint to verify prescriptions, ensuring antibiotics are dispensed correctly and educating patients on appropriate usage.
- Medication Review: By reviewing medication profiles, pharmacists can identify potential drug interactions, allergies, or duplications, reducing unnecessary antibiotic use.
- Education and Counseling: Pharmacists inform patients about the importance of completing antibiotic courses, potential side effects, and the dangers of non-compliance.
- Collaboration with Healthcare Providers: Pharmacists work closely with physicians and other providers to recommend appropriate antibiotics, alternatives, or narrower-spectrum drugs when needed, contributing to effective antibiotic stewardship.
- Monitoring and Surveillance: Pharmacists track and report antibiotic usage patterns in healthcare settings, identifying trends and opportunities for improving prescribing practices.
Summary
- Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi, and parasites evolve to resist antimicrobial medicines, rendering treatments ineffective. Pharmacists play an indispensable role in combating AMR by ensuring antibiotics are prescribed, dispensed, and utilised responsibly.
- Through their expertise in medication management, patient education, and collaboration with healthcare professionals, pharmacists are at the forefront of effective antimicrobial stewardship, critical to the global fight against drug-resistant infections.