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"The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism."

Sir Alexander Fleming (1945 Nobel Prize winner for the discovery of penicillin)

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The 18th - 25th November is World Antimicrobial Awareness Week, a campaign run by the World Health Organisation and the Pan American Health Organisation. Antimicrobial resistance (AMR) is a growing global health problem, with antibiotic resistant infections causing 700,000 global deaths per year. At current rates, this number is projected to grow to 10 million deaths per year by 2050. AMR occurs due to the mutation of bacteria, viruses, fungi and parasites over time which can cause resistance to medicines. We can help prevent infections through measures such as vaccinations, improved hand hygiene, increased availability to clean water and antimicrobial stewardship in community and hospital settings [1].

The following video from TedEd outlines how antibiotic resistance has progressed over time and summarises some key ways to prevent new resistant microbes from developing. 

AMR - Where Are We Now?

In 2015, the World Health Organisation (WHO) endorsed a Global Action Plan (GAP) to tackle the global issue of AMR. They urged member states to develop tailored, country specific national action plans with a ‘One Health approach’. Over 130 countries have developed their action plans to date but there is still a way to go to ensure all of these plans are implemented [2]. 

We know that AMR disproportionately affects low or middle income countries where antibiotic consumption is still alarmingly high and the infrastructure to monitor infectious disease is not well developed. For example, India, one of the world's largest consumers of antimicrobials saw the proportion of Staphylococcus aureus which are methicillin resistant nearly double between 2008 and 2014 while other countries with effective programmes for antimicrobial stewardship and/or infection prevention, saw the proportion of methicillin-resistant S. aureus decrease [3].

Investment in agriculture, safe drinking water and healthcare is vital to fight the growing problem of AMR and the Global Action Plan hopes to encourage world governments to step up to the challenge of AMR. On a hospital and community level, initiatives such as simple hand washing and antimicrobial stewardship in healthcare settings can significantly decrease infectious diseases and the use of antimicrobials [4]. These initiatives are paramount to reversing the tide of resistance. This has never been so critical as the COVID 19 pandemic has accelerated  antimicrobial resistance through over prescription of antibiotics to treat viral respiratory infections [5]. 

How is MedShr helping to tackle AMR?

At MedShr, we have developed Global Education Networks to provide a platform for healthcare professionals to share their experiences of tackling global health problems such as AMR on the ground. We are promoting good antimicrobial stewardship as an effective way to prevent antimicrobial resistance. 

Key Elements of Antimicrobial Stewardship Programmes [6]

• Guideline driven antibiotic prescribing 

• Antibiotic prescribing is re-assessed when sensitivity results are received

• Patients are prescribed antibiotics for the appropriate length of time

• Every member of the medical team is accountable 

• Education on antimicrobial resistance and appropriate antibiotic prescribing is delivered to all medical staff 

If you have been involved in an antimicrobial stewardship programme, your experiences may help others on MedShr to implement their own. For those who are working in settings without antimicrobial stewardship programmes, the full text to core elements of hospital antimicrobial stewardship programmes can be found here.

We hope to empower clinicians to tackle issues such as antimicrobial resistance through sharing knowledge and expertise, as well delivering the most up to date clinical guidance and publications. If there are no antibiotic guidelines in your region, discussing a case on MedShr could help guide the best management of your patient whilst impacting other patients by protecting them from antimicrobial resistant organisms. 

Given the projection of 10 million deaths attributable to antimicrobial infection by 2050, we all have a duty to act now to raise awareness of the severity of the problem and to do something about it. Join MedShr and our Global Health Networks to spread awareness and stop resistance. 

Click below to see all of MedShr's Global Education Networks and what we are doing to help clinicians in developing nations to improve the health of patients in their communities

References 

[1] WHO New Room - Fact Sheet: Antimicrobial Resistance

[2] Chua, Alvin Qijia, et al. "An analysis of national action plans on antimicrobial resistance in Southeast Asia using a governance framework approach." The Lancet Regional Health-Western Pacific 7 (2021): 100084

[3] Dixit, Avika, et al. "Antimicrobial resistance: progress in the decade since emergence of New Delhi metallo-β-lactamase in India." Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine 44.1 (2019): 4

[4] Pokharel, Sunil, Shristi Raut, and Bipin Adhikari. "Tackling antimicrobial resistance in low-income and middle-income countries." (2019): e002104

[5] Manesh, Abi, and George M. Varghese. "Rising antimicrobial resistance: an evolving epidemic in a pandemic." The Lancet Microbe 2.9 (2021): e419-e420

[6] Centre for Disease Control and PRevention (CDC) - The Core Elements of Hospital Antibiotic Stewardship Programs ANTIBIOTIC STEWARDSHIP PROGRAM ASSESSMENT TOOL