Antimicrobials, including antibiotics, antivirals, antifungals and antiparasitics, are medicines used to prevent and treat infections in humans, animals and plants.
Antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them and, as the germs are not killed, they continue to grow.
As a consequence, there are resistant infections that can be difficult and sometimes even impossible to treat. The presence of antibiotics and antifungals pressures bacteria and fungi to adapt, accelerating antimicrobial resistance.
Antibiotics are antimicrobials, but not all antimicrobials
Antibiotic resistance refers specifically to bacteria resistance.
It is bacteria, not humans or animals, that become antibiotic-resistant.
Antibiotics … please handle with care
When antibiotics are used, some bacteria die, but resistant bacteria can survive and even multiply. The more antibiotics are used, the more chances bacteria will have to become resistant to them, meaning that when needed in the future, they will not work.
Another problem is that antibiotics and antifungals kill some germs that cause infections, but they also kill helpful germs that protect our body from infection.
Germs can develop defence strategies against antibiotics and antifungals, called resistance mechanisms, and thus antimicrobial-resistant germs will survive and multiply spreading resistance traits in their DNA to other germs. Resistant germs can spread between people, animals and the environment, and they can cause deadly infections.
Although antibiotic resistance occurs naturally, the main cause of antibiotic resistance is the misuse of antibiotics in humans and animals, making resistant bacteria more common, with a growing number of infections becoming harder to treat as the antibiotics used to treat them become less effective, leading to longer hospital stays, higher medical costs and increased mortality.
The truth is that human and animal health professionals over-prescribe antibiotics, people do not take them as directed, there is poor hygiene and poor infection prevention … it all becomes worse and more difficult to control.
Our actions can increase resistance developing and spreading and, even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat.
A global problem
Given the ease and frequency with which people now travel, antibiotic resistance is a global problem. Antibiotic resistance can affect anyone, of any age, in any country, and it is presently one of the biggest threats to global health, food security and development.
Antibiotic resistance is more common in some countries and different countries can have different types of resistant bacteria. Travellers can become sick and they can then bring these resistant bacteria back to their country of origin.
Antibiotic resistance is rising to dangerously high levels in all parts of the world. New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases. A growing list of infections are becoming harder and sometimes impossible to treat as antibiotics become less effective.
If antibiotics can be bought for human or animal use without a prescription, the emergence and spread of resistance is made worse.
In countries without standard treatment guidelines, antibiotics are often over-prescribed and over-used by the public.
Antibiotic resistance is putting the achievements of modern medicine at risk. Not only the treatment of chronic diseases like diabetes, asthma, and rheumatoid arthritis but also organ transplantations, chemotherapy and surgical procedures become much more dangerous without effective antibiotics for the prevention and treatment of infections.
Without urgent action, we are heading for a post-antibiotic era in which common infections and minor injuries can, once again, kill.
Change must not wait
Antibiotic resistance is accelerated by the misuse and overuse of antibiotics, as well as poor infection prevention and control. Steps can be taken at all levels of society to reduce the impact and limit the spread of resistance.
Our actions can increase resistance developing and spreading as even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat. Behaviour changes must also include actions to prevent and reduce the spread of infections through keeping vaccinations up to date, hand washing, avoiding close contact with sick people, practising safer sex and good food hygiene, thus reducing the use of antibiotics.
Hand hygiene is the most important way of preventing the spread of infections including antibiotic-resistant infections.
Food should be prepared hygienically and it is important to choose foods that have been produced without the use of antibiotics for growth promotion or disease prevention in healthy animals.
Antibiotics must be used only when prescribed by a certified health professional and must always be taken as prescribed.
Never demand, request, try to force for antibiotics to be prescribed if your doctor says you do not need them and never share or use leftover antibiotics.
Never forget: Antibiotics only work against infections caused by bacteria; they do not work against viruses that cause colds or the flu.
Antimicrobial resistance is an urgent global public health threat, killing at least 1.27 million people worldwide and associated with nearly five million deaths in 2019.
Antimicrobial resistance has the potential to affect people at any stage of life, as well as the healthcare, veterinary, and agriculture industries. This makes it one of the world’s most urgent public health problems.
COVID-19 and antimicrobial resistance
The threat of antimicrobial-resistant infections is not only still present but has gotten worse due, in large part, to the effects of the COVID-19 pandemic.
The pandemic resulted in more resistant infections, increased antibiotic use, and less data and prevention actions.
Antibiotic use throughout the pandemic varied across healthcare settings, but antibiotics were commonly prescribed to patients with COVID-19. Even though antibiotics are not effective against viruses like the one that causes COVID-19, they were used to prevent and treat associated bacterial infections.
The COVID-19 pandemic highlighted the need to stop the spread of germs before they can cause an infection. Treatment after infection occurs, is not the only solution and should not be the only option.
Ending note: After finishing writing this article, I found that from November 18 to 24 is World Antimicrobial Awareness Week (WAAW).
It is a global campaign, celebrated annually to improve awareness and understanding of antimicrobial resistance (AMR) and encourage best practices.
Best healthy wishes,
Dra. Maria Alice Pestana Serrano e Silva
Consultant in General and Family Medicine
General Manager/Medical Director – Luzdoc International Medical Service