By Levi Smith
Antimicrobial resistance (AMR) is a serious threat to global health that occurs when microbes become resistant to antibiotics or other medicines. AMR affects people of all ages, genders, and income levels, but is particularly prevalent in low and middle-income countries. Factors contributing to the rise of AMR include overuse and misuse of antibiotics, lack of knowledge about antibiotics in the general population, and a lack of development of new antibiotics by the pharmaceutical industry.
When we get sick with a sore throat, end up with an ear infection, or have a bad case of food poisoning, what do we do? Find medicine to cure our ailment, of course! Thanks to the wonders of modern medicine, many illnesses that would otherwise leave us bed-ridden - or worse, dead - end up only mildly inconveniencing us for a few days before we can return to our normal lives. However, this may not always be the case. Some of the “wonder drugs” that previously helped to cure these illnesses end up becoming completely useless, and it’s happening right now all over the world. It turns out that antimicrobial resistance is to blame, and the problem isn’t going to simply go away.
What is Antimicrobial Resistance?
Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi or parasites change over time and no longer respond to antibiotics or other medicines, making them increasingly difficult or, in some cases, even impossible to treat.1 Diseases such as MRSA, tuberculosis, shigella, HIV/AIDS, gonorrhea, and even common infections such as UTI, respiratory, and blood-stream infections feature some of the most common occurrences of antimicrobial resistant strains. Although AMR is a natural phenomenon, it is heavily accelerated by the use of antimicrobial medicines.2 In the United States, AMR bacteria and fungi cause an estimated 2.8 million infections and 36,000 deaths, with increasing rates each subsequent year.3 The estimated costs associated with AMR aren’t by any means low - in the United States, antimicrobial resistance costs the US 55 billion dollars every year.4
Who does AMR affect?
Resistant microbes can spread quickly around the globe through people, animals, or goods, meaning AMR thrives in the increased global connectivity of the 21st century. Although countries all around the world are affected, particular groups are at particularly high risks of experiencing AMR - namely countries located in Sub-saharan Africa, Asia, Latin America, and other low and middle-income countries.5 However, AMR rates vary significantly, and affect both high and low-income countries. For example, rates of penicillin resistance in France in 2005 were around 35%, while their neighboring country Germany had rates as low as 2.4%.
Why is AMR on The Rise?
It turns out there are many factors contributing to AMR, but high prescription rates are a leading contributor. High patient expectations of receiving medicine to cure their illness leads to pressure from doctors to prescribe antibiotics more frequently, as patient satisfaction is a common measurement of success in healthcare. As a result, doctors commonly prescribe antibiotics when they are unsure whether a patient’s illness is viral or bacterial - it is estimated that at least 30% of all prescribed antibiotics are unnecessary.6 In many developing countries, excessive use can be attributed to the availability of antimicrobial drugs that can be purchased without prescription of a physician or other qualified health professional.7 In both developing and affluent countries, there is a lack of knowledge about antibiotics in the general population, which contributes to incorrect use. For example, a survey among adults in the United Kingdom showed that 38% of respondents did not know that antibiotics do not work against most coughs or colds.8
Another key concern for future AMR rates is a lack of development of new antibiotics by the pharmaceutical industry. Of the 18 largest pharmaceutical companies, 15 have abandoned the antibiotic field due to lower returns compared to other drugs.9 Because antibiotics and other antimicrobial medicines are only used by a patient once, the return on investment for developing these drugs isn’t as high as drugs that must be taken continuously for years, such as those that manage hypertension, diabetes, and other chronic illnesses. Without increased funding for research and development of new antibiotics, all currently successful antibiotics will slowly become ineffective.
What Can We Do?
Antibiotic Stewardship Programs (ASPs) can help clinicians improve clinical outcomes and minimize harms by improving antibiotic prescribing.10 These programs aim to guide prescribers in administering antibiotics correctly and involve making a commitment to use antibiotics only when needed. An example of an ASP in action is the “delayed prescription” policy, which asks patients to wait three days before filling their prescription. This helps to simultaneously meet patient demands of receiving treatment while leaving the opportunity for the patient’s condition to improve without the use of antimicrobial medicine.
Additionally, public education campaigns to raise awareness about the dangers of AMR and how to prevent it could lead to more successful usage of antimicrobial medicine. Global cooperation of coordinated efforts to implement new policies, renew research efforts, and educate populations on AMR are greatly needed to divert this developing global health crisis and ensure that modern medicine maintains the upper hand on the dangers of antimicrobial resistance.
Resources
1.https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance 2.https://www.who.int/publications/i/item/9789241564748 3.https://www.cdc.gov/drugresistance/biggest-threats.html#:~:text=More%20than%202.8%20mil lion%20antimicrobial,people%20die%20as%20a%20result 4.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929930/#:~:text=The%20CDC%20estimated %20that%20the,billion%20for%20loss%20of%20productivity 5.https://www.cgdev.org/blog/drug-resistant-infections-are-one-worlds-biggest-killers-especiallychildren-poorer-countries#:~:text=A%20study%20out%20today%20in,those%20in%20high%2Di ncome%20countries. 6.https://www.cdc.gov/antibiotic-use/data/outpatient-prescribing/index.html#:~:text=CDC%20esti mates%20that%20at%20least,antibiotic%20was%20needed%20at%20all 7.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768623/ 8.https://academic.oup.com/jac/article/59/4/727/677332 9.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/ 10.https://www.cdc.gov/antibiotic-use/core-elements/hospital.html
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