Preventing Antimicrobial Resistance: Key Steps to Take

By Dr. Priyom Bose, Ph.D.Reviewed by Danielle Ellis, B.Sc.

AMR: Incidence and global prevalence
Importance of tackling AMR
Steps to prevent future AMR
Positive steps and future outlook
References
Further reading

Microorganisms that develop resistance to antimicrobial drugs are referred to as "superbugs" .¹ These microbes have been detected in more than 204 countries across the world. The World Health Organization has declared antimicrobial resistance (AMR) to be one of the top ten global public health threats.²

AMR: Incidence and global prevalence

Antimicrobial agents, such as antibiotics, antivirals, antifungals, and antiparasitics, are used to resist a wide range of infections. Common diseases, such as malaria, tuberculosis (TB), sexually transmitted infections, food poisoning, urinary tract infections (UTIs), HIV / AIDS, and bloodstream infections are treated using antimicrobial medicines.³

AMR occurs when common antimicrobial medicines do not effectively respond to microbial infection. This condition may result from inappropriate use of antimicrobial drugs, poor infection prevention measures, and insufficient global surveillance of infections. In addition, a lack of development of new antimicrobial drugs could also contribute to AMR.⁴

In many developing countries, antibiotics are freely sold over the counter without the need for any prescription.⁵ Overuse of antibiotics in livestock also causes AMR.⁶ Furthermore, the lack of effective diagnostics in many low-to-medium-income countries induces misuse of antimicrobials that may trigger the rise of superbugs.

In both developed and developing countries, an increasing loss of drug effectiveness due to AMR has been documented. A continuation of this trend could lead to a condition where the microbial infection will have "no cure and no vaccine."

Importance of tackling AMR

AMR is a global public health concern because it threatens to diminish the achievements of medicine and healthcare delivery. It is important to immediately tackle AMR because it could jeopardize the outcome of surgical procedures, such as hip and knee replacements, cesarean sections, and cardiac surgery, by causing infections at the incision site.⁷

The lack of effective antimicrobial drugs could also make routine surgical procedures more dangerous to perform and increase mortality rates. AMR increases an individual's suffering for longer because infections become more difficult to treat. This may lead to prolonged hospital admission.⁵

Steps to prevent future AMR

Several strategies have been formulated to prevent present and future AMR. Some of the key strategies are discussed below:

Training healthcare professionals

Competent healthcare workers could play a vital role in curbing AMR.⁸ However, a large proportion of healthcare workers lack proper training and education regarding AMR prevention, which prevents their ability to mitigate the spread of AMR. Therefore, the development of global standards in education and training for healthcare workers could be an important step in preventing AMR.

Increasing awareness of the impact of AMR among healthcare providers could be the important first step in preventing this condition. Providing healthcare workers with educational materials on AMR via digital learning technologies can strengthen their competence.⁹ This could promote behavioral changes that may contribute to a more reasonable use of antimicrobials. Recently, the WHO also published guidelines to help educate and train health workers on AMR.

Communication strategies

Increasing public awareness through clear and unambiguous messages on AMR is a useful strategy that engages all stakeholders. Communication specialists must produce three to four key messages relevant to the country setting instead of sending a high volume of information.¹⁰

Healthcare officials and social workers must target a smaller target group, such as school and college students, to raise awareness in the short and medium term. An increase in awareness is not guaranteed to lead to short—or medium-term behavioral change among stakeholders.

Global policies

The inappropriate use of antimicrobial drugs has also been attributed to a lack of robust policies on their proper use and poor monitoring of the medicine supply chain at the national and sub-national levels.¹¹ Health ministries or departments should get involved in spreading awareness about AMR.

Agencies of the UN, such as UNICEF and UNESCO should assist WHO, the Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (WOAH) in designing messages regarding AMR awareness on the international stage.¹²

How Can Antimicrobial Resistance Affect Poverty?

Children are central to AMR, which has led clinicians to develop national prescribing guidelines to prevent variations in prescribing practice in this population. At present, more than 40 countries follow local guidelines that ensure children receive optimal antibiotic doses for their age, weight, and condition.

Scientific research

Scientists worldwide have focused on repurposing drugs and developing new antibiotics. Global non-profit partnerships, such as CARB-X, are funding scientific research to develop new treatments, particularly for use in low—and middle-income countries.¹³ For instance, CARB-X awarded £2 million to the Jenner Institute at the University of Oxford to develop a novel vaccine to prevent multi-drug-resistant Neisseria gonorrhoeae.

The advanced genome sequencing facilities have enabled scientists to detect new variants promptly. Furthermore, platforms, such as the Pew Foundation's Shared Platform for Antibiotic Research and Knowledge (SPARK), facilitate the sharing of insights and data regarding AMR, which have immensely helped researchers engage in these studies. It also promotes real-time collaboration between academia, clinicians, industry, and governments, which will significantly help prevent the emergence and spread of resistant microbes.

Scientists have also observed that waterbodies act as a primary vector of AMR transmission because large amounts of antibiotic manufacturing wastes are disposed of here. In this context, Australian scientists detected Enterobacteriales, a type of resistant bacteria, in green sea turtles on the Great Barrier Reef.

Positive steps and future outlook

The most important step in curbing this problem is spreading awareness among the general public and other stakeholders about the impact of AMR. Better stewardship of existing antibiotics and appropriate training and education for healthcare workers could also prevent AMR in the global scenario. Researchers play a crucial role in developing new treatments (e.g., vaccines and antibiotics), as well as diagnostics.

A proper surveillance system detects new superbugs and helps prevent their global transmission. Considering rapid climate change and its link with AMR, more research and surveillance have been recommended for the early detection of microbes with antibiotic resistance. Manufacturers must also ensure that the antibiotic supply chain is safe, secure, transparent, and follows recommended standards.

References

1. Painuli S, Semwal P, Sharma R, Akash S. Superbugs or multidrug resistant microbes: A new threat to the society. Health Sci Rep. 2023 Aug 2;6(8):e1480. doi: 10.1002/hsr2.1480. PMID: 37547359; PMCID: PMC10397562.
2. Antimicrobial Resistance. World Health Organization. https://www.who.int/europe/news-room/fact-sheets/item/antimicrobial-resistance. Assessed on October 19, 2024.
3. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Global Health; Committee on Global Health and the Future of the United States. Global Health and the Future Role of the United States. Washington (DC): National Academies Press (US); 2017 May 15. 4, Addressing Continuous Threats: HIV/AIDS, Tuberculosis, and Malaria. Available from: https://www.ncbi.nlm.nih.gov/books/NBK458475/
4. Murray C. et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022; 399, 10325, 629 – 655. DOI: 10.1016/S0140-6736(21)02724-0
5. Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014 Dec;5(6):229-41. doi: 10.1177/2042098614554919. PMID: 25436105; PMCID: PMC4232501.
6. Bava R, Castagna F, Lupia C, Poerio G, Liguori G, Lombardi R, Naturale MD, Mercuri C, Bulotta RM, Britti D, et al. Antimicrobial Resistance in Livestock: A Serious Threat to Public Health. Antibiotics. 2024; 13(6):551. doi.org/10.3390/antibiotics13060551
7. Aljeldah MM. Antimicrobial Resistance and Its Spread Is a Global Threat. Antibiotics (Basel). 2022 Aug 9;11(8):1082. doi: 10.3390/antibiotics11081082. PMID: 36009948; PMCID: PMC9405321.
8. Ajuebor O, Shetty N, Mah K, Cometto G. Health workers' education and training to prevent antimicrobial resistance. Bull World Health Organ. 2019 Dec 1;97(12):791-791A. doi: 10.2471/BLT.19.241802. PMID: 31819283; PMCID: PMC6883273.
9. Mudenda S, Chabalenge B, Daka V, Jere E, Sefah I, Wesangula E, Yamba K, Nyamupachitu J, Mugenyi N, Mustafa ZU, Mpundu M, Chizimu J, Chilengi R. Knowledge, awareness and practices of healthcare workers regarding antimicrobial use, resistance and stewardship in Zambia: a multi-facility cross-sectional study. JAC Antimicrob Resist. 2024 May 17;6(3):dlae076. doi: 10.1093/jacamr/dlae076. Erratum in: JAC Antimicrob Resist. 2024 Jul 03;6(4):dlae106. doi: 10.1093/jacamr/dlae106. PMID: 38764535; PMCID: PMC11100357.
10. Mathew P, et al. Communication strategies for improving public awareness on appropriate antibiotic use: Bridging a vital gap for action on antibiotic resistance. Journal of Family Medicine and Primary Care 8(6):p 1867-1871, June 2019. | DOI: 10.4103/jfmpc.jfmpc_263_19
11. Kamere N, Rutter V, Munkombwe D, Aywak DA, Muro EP, Kaminyoghe F, Rajab K, Lawal MO, Muriithi N, Kusu N, Karimu O, Barlatt SHA, Nambatya W, Ashiru-Oredope D. Supply-chain factors and antimicrobial stewardship. Bull World Health Organ. 2023 Jun 1;101(6):403-411. doi: 10.2471/BLT.22.288650.
12. Wernli D, Harbarth S, Levrat N, Pittet D. A 'whole of United Nations approach' to tackle antimicrobial resistance? A mapping of the mandate and activities of international organisations. BMJ Glob Health. 2022 May;7(5):e008181. doi: 10.1136/bmjgh-2021-008181. PMID: 35613837; PMCID: PMC9134163.
13. Davies, S. C., & Oxlade, C. (2021). Innovate to secure the future: The future of modern medicine. Future Healthcare Journal, 8(2), e251-e256. https://doi.org/10.7861/fhj.2021-0087

Further Reading

• All Antimicrobial Resistance Content
• How Antimicrobial Resistance Amplifies the Burden of Sepsis
• What are Extensively Drug Resistant (XDR) Bacteria?
• What are Extensively Drug Resistant (XDR) Bacteria?
• Antimicrobial Resistance in the 21st Century