The problem of antibiotic resistance

Drug misuse and overprescribing are the leading causes of antimicrobial resistance

The problem of antibiotic resistance


ntimicrobials include antibiotics, antivirals, antifungals and antiprotozoal medications. They are used to treat infections and must be used appropriately. These essential medicines have contributed to the country’s overall health by tackling infectious diseases.

Antibiotics treat bacterial infections and rational prescribing, i.e. choosing the right antimicrobial for the right patient at the right time and in the right dose, must be practiced by health professionals.

At present, in many low- and middle-income countries, there is no restriction on patients’ access to these drugs. Such harmful practices promote antibiotic use and misuse, leading to the worsening of already existing antibiotic resistance.

So, what is antimicrobial resistance? The AMR is an increase in microbes’ (bacteria, parasites, viruses, fungi, etc) survival despite the use of antimicrobials, for example, antibiotics. Resistant infections become difficult to treat with existing/ available antibiotics.

The AMR is one of the biggest global public health challenges, according to the World Health Organisation. The issue has gotten worse during the Covid-19 pandemic due to abuse and overuse of antimicrobials. It encompasses a majority of healthcare issues related to infectious diseases, healthcare emergencies and disease outbreaks. It can affect every segment of the population, from newborn infants to elderly patients.

Patients present to healthcare facilities to get effective treatment for their infectious diseases but with increasing rates of antimicrobial resistance, treatment options diminish, as most bacteria have become resistant and available antibiotics no longer work.

The extended infection due to antibiotic resistance, in turn, leads to prolonged hospital stay, limits the available options to treat infections and increases susceptibility to adverse outcomes, including death.

There are not enough new antibiotics to fight resistant bacteria. Therefore, existing antibiotics must be used more responsibly and only when truly indicated.

According to a systematic analysis published in 2022 in the Lancet, antibiotic resistance accounts for 76.8 deaths per 100,000 population in South Asia. Deaths due to respiratory tract infections and urinary tract infections are in some of the AMR-related infections.

Unsupervised and unnecessary use of second or third-line antibiotics is rampant in regions with non-functioning or poorly organised primary healthcare systems where, in addition to the above, lack of infection prevention and control measures and a growing burden of diseases, particularly non-communicable diseases, is also observed.

There are not enough new antibiotics to fight resistant bacteria. Therefore, existing antibiotics must be used more responsibly and only when truly indicated.

As per Global Research on Antibiotics Resistance, there has been a 46 percent rise in the consumption of antibiotics globally between the years 2000 and 2018. However, this rise was 116 percent in South Asia. Similar trends were noted in North Africa and the Middle East.

Pakistan started AMR surveillance in 2017. In 2019, the National Surveillance System was established. The main aim of the AMR surveillance system is to generate evidence of the burden of antimicrobial drug resistance among priority pathogens.

Antimicrobial resistance indicators are part of the United Nations sustainable development goals. Without AMR surveillance, it would be impossible to achieve health-related SDGs-3, especially in the countries where the burden of infectious diseases is already high.

To control antimicrobial resistance, patient-physician interactions and healthcare facilities have to be targeted. Control measures need to be taken in terms of availability of diagnostics tools, timely identification of drug-resistant strains, rational prescription of antibiotics, implementation of infection prevention and control practices and data collection to make data-driven policy decisions.

Increasing AMR awareness among the general public through media campaigns and sensitising healthcare managers and physicians about AMRs is imperative. These include understanding, surveillance, rational prescribing practices, stewardship initiatives, robust implementation of infection prevention and control and update of drug policies in addressing these issues at the health service delivery level.

It is important to sensitise the entire healthcare workforce, including private family physicians, on the prevention and control of the AMR and build their capacity. A training curriculum could be developed on understanding the basics of antimicrobial resistance, rational prescribing, one health approach, medical technologies and available vaccinations against common infectious diseases.

Antibiotics stewardship training programmes can be done at various levels, including senior health managers, doctors, nurses and all allied healthcare professionals. The Ministry of National Health should recommend priority actions with a particular focus on strengthening the health system, AMR surveillance, awareness, drug prescribing/ dispensing policy and one health approach.

Deaths due to resistant infections are likely to rise in future. Measures must be taken to protect and preserve antibiotics for the future and develop strategies to deal with the AMR.

Some of the measures to mitigate the AMR include improving hygienic conditions, waste management, access to clean drinking water, discouraging self-prescribing and empowering the public on disease/ infection prevention.

Provision of quality primary care services with trained front-line family practitioners, availability of first-line agents in dispensaries, pharmacies and healthcare facilities across the country, regular, continuous medical education of healthcare professionals, promoting antibiotic stewardship practices and abolishing health fraud (quackery) are crucial to addressing AMR at the community level.

Rigorous measures to prevent/ limit AMR must be implemented before we reach a stage where the situation becomes uncontrollable.

Dr Hina Jawaid is an associate professor in family medicine at University of Health Sciences, Lahore

Dr Abdul Jalil Khan is an associate professor in family medicine at Khyber Medical University, Peshawar.

The problem of antibiotic resistance