Antibiotic resistance is one of the biggest threats to global health today. It occurs when bacteria change and become resistant to the antibiotics used to treat the infections they cause. Overuse and misuse of antibiotics in humans and animals are the main drivers of antibiotic resistance. To stop antibiotic resistance, we need to use antibiotics in a more responsible way, reduce infections through improved hygiene and vaccination, develop new antibiotics and use alternatives to antibiotics where possible.
What is antibiotic resistance?
Antibiotics are medicines used to prevent and treat bacterial infections. They work by killing bacteria or preventing them from reproducing and spreading. Antibiotic resistance occurs when bacteria change to protect themselves from an antibiotic. The antibiotic can no longer kill the bacteria or stop them from multiplying. The resistant bacteria are then able to survive, multiply and spread. As a result, antibiotics become ineffective and infections become harder to treat.
Antibiotic resistance develops naturally over time, usually through genetic changes or mutations. However, the overuse and misuse of antibiotics in humans and animals is accelerating the process. The more antibiotics are used, the greater the chances that bacteria will develop resistance. Overusing antibiotics also kills off the beneficial bacteria that protect against infection.
Why is antibiotic resistance increasing?
There are two key drivers of antibiotic resistance: the overuse and misuse of antibiotics.
Overuse
Antibiotics are overused in both humans and food animals. In human medicine, antibiotics are often overprescribed. For example, antibiotics may be given for viral infections like colds and flu where they are ineffective. Antibiotics are also overused to promote livestock growth and prevent disease in healthy animals.
The overuse of antibiotics allows resistant bacteria to thrive while susceptible bacteria are eliminated. Over time, antibiotic resistant bacteria can spread. When antibiotics are needed to treat infections, there are fewer effective options available.
Misuse
Antibiotics are often misused in ways that increase resistance. Examples include:
- Not taking the full course of antibiotics as prescribed, which allows some bacteria to survive.
- Using antibiotics for the wrong infections, making them less effective.
- Taking antibiotics bought without a prescription, which may be inappropriate.
- Poor hygiene in hospitals, allowing bacteria to spread between patients.
- Poor waste management from pharmaceutical manufacturing, allowing resistant bacteria to spread.
All types of misuse expose bacteria to antibiotics and give them opportunities to develop resistance.
What is the impact of antibiotic resistance?
Antibiotic resistance has a number of concerning impacts on human health:
- Infections caused by resistant bacteria fail to respond to the usual antibiotic treatment.
- Resistant infections often require longer, more expensive treatments and extended hospital stays.
- Resistant infections can result in disability or death when antibiotics are unable to kill the bacteria.
- Common medical procedures like surgery, organ transplants and cancer chemotherapy become much riskier without effective antibiotics for prevention and treatment of infections.
- Antibiotic resistance increases healthcare costs significantly as more expensive medications and interventions are required.
It’s estimated that by 2050, antibiotic resistance could be responsible for 10 million deaths per year and up to $100 trillion in lost economic output if solutions are not found.
How can antibiotic use in humans be improved?
More responsible use of antibiotics in human medicine is critical to slow resistance. Strategies include:
Reduce unnecessary antibiotic prescribing
Antibiotics should only be used to treat bacterial infections, not viruses. Prescribers should adhere to guidelines on the best antibiotics to use for specific conditions. New rapid diagnostics can help determine if an infection is bacterial or viral.
Improve antibiotic stewardship
Hospitals and healthcare facilities should have stewardship programs ensuring antibiotics are prescribed appropriately and for the right duration. Antibiotic cycling and mixing can also help prevent resistance.
Take a full antibiotic course
Patients should never save antibiotics for later or stop treatment early without medical advice. The full course ensures bacteria are completely eliminated rather than developing resistance.
Restrict over-the-counter antibiotic sales
Regulations are needed to reduce non-prescription antibiotic use which may be unnecessary or inappropriate. Prescription-only access can help limit overuse.
Improve infection prevention
Better hygiene, testing and isolation procedures in healthcare can prevent infections spreading and reduce antibiotic use. Vaccination also lowers infections requiring antibiotics.
Develop new antibiotics
Continued pharmaceutical research and development is essential to find new antibiotics able to treat resistant infections. But any new antibiotics must be used responsibly to avoid further resistance.
Use alternatives to antibiotics where possible
Non-antibiotic approaches such as bacteriophages, antibodies and probiotics may provide alternatives for treating some bacterial infections, reducing reliance on antibiotics.
How can antibiotic use in animals be improved?
Prudent use of antibiotics in agriculture and aquaculture is also key:
Ban antibiotic growth promoters
Using antibiotics routinely to promote growth and prevent disease in healthy animals should be prohibited, as this provides constant selection pressure for resistance.
Restrict preventative antibiotic use
Antibiotics should not be used to prevent infections in healthy animals. Their use should be limited to treatment of diagnosed bacterial disease.
Enforce proper animal husbandry
Improved hygiene, housing and nutrition minimizes animal infections needing antibiotics. Increased vaccinations also reduces antibiotic use.
Promote alternatives to antibiotics
Alternatives like bacteriophages, probiotics, antibodies and essential oils may allow some reduction in antibiotic use in animals. Strict regulations are needed on their use.
Improve veterinary oversight
Veterinary supervision ensures appropriate antibiotic use in animals. Prescription-only access can help reduce overuse of animal antibiotics.
Develop new animal-only antibiotics
Antibiotics used exclusively in animals and not humans may reduce resistance in human medicine. But resistance can still develop and impact human health.
What are national and international efforts to stop antibiotic resistance?
Governments around the world have implemented national action plans to tackle antibiotic resistance through coordinated policies on antibiotic use and resistance surveillance. International organizations have also launched major initiatives:
World Health Organization (WHO)
The WHO Global Action Plan outlines measures all countries should take to address antibiotic resistance. The WHO has launched multiple programmes to improve antibiotic use and developed the Global Antimicrobial Resistance Surveillance System (GLASS) to track resistance worldwide.
United Nations (UN)
The UN General Assembly has adopted a Political Declaration on Antimicrobial Resistance requiring countries to develop national plans and surveillance. It also established an ad hoc interagency coordination group on antimicrobial resistance.
World Organization for Animal Health (OIE)
The OIE promotes the responsible and prudent use of antimicrobials in animals worldwide. It has developed standards and guidelines for use adopted by member states.
European Union (EU)
The EU has banned using antibiotics for growth promotion and requires member states to have national action plans on veterinary and human antimicrobial use. It also funds research networks focused on antibiotic resistance.
What can you do to stop antibiotic resistance?
Everyone has a role to play in combating antibiotic resistance. Some key actions you can take are:
- Only use antibiotics prescribed by a certified health professional.
- Never demand antibiotics if your doctor says you don’t need them.
- Always complete the full antibiotic course, even if you start feeling better.
- Never use leftover antibiotics or those prescribed for someone else.
- Practice good hygiene and get recommended vaccines to prevent infections.
- Prepare and handle food properly to avoid infections that may require antibiotics.
- Reduce antibiotic use in livestock and fish by choosing responsibly sourced food.
- Dispose of any unused antibiotics through approved collection programs.
- Support policies, programmes and innovations aiming to improve antibiotic use.
Conclusion
Antibiotic resistance is a growing crisis threatening our ability to treat common infections and save lives. Concerted efforts are needed across human medicine, veterinary medicine, agriculture, the environment and public policy to promote more responsible use of antibiotics worldwide. This includes better surveillance, prevention and control practices, public education, research and improved access to avoid overuse. With sustained global commitment and action from all stakeholders, it is possible to prevent a return to the pre-antibiotic era and protect these life-saving medicines for the future.