Combating resistance

For almost two years, the gaze of the public, healthcare system and media has been fixated on a very blatant public health threat; all the while, a ‘silent pandemic’ has been quietly gripping the world for decades.

Antimicrobial resistance (AMR) — where bacteria, viruses, fungi and parasites learn to outsmart the drugs designed to kill them — is one of the top ten public health threats facing humanity, according to the World Health Organisation¹. Currently claiming 700,000 lives each year², AMR is set to incur a death toll of 10 million people by 2050², dealing a US$100 trillion blow to the global economy.

While analogies with COVID-19 have been drawn, Distinguished Professor Antoine van Oijen and Associate Professor Spiros Miyakis from the Molecular Horizons Research Institute at the University of Wollongong believe AMR is in many ways more comparable to the current climate crisis — for three important reasons. They claim these reasons give clues on how we can best combat the AMR problem.

Agricultural contribution

Much like the climate crisis, in which emissions come from cattle and sheep, agriculture plays a big role in AMR, with a large portion of antibiotic-resistant bacteria originating from livestock.

“Around the world, farmers are feeding antibiotics to livestock in large quantities, often for therapeutic reasons, but also as a growth promoter, since antibiotics are linked to weight gain. As a result, bacteria within these animals are learning how to fight back and become resistant to the medication. These bacteria can migrate into humans and bring their resistance with them, even if their human host has never before received a prescription,” van Oijen said.

While health professionals may be powerless to effect change within agriculture, it is important to recognise this key mechanism by which AMR can take place, researchers say.

“Every time you write a prescription for antibiotics, you are threatening not just that individual’s chances of responding well to medication in the future, but also the community’s chances. Exercising extreme caution in ensuring that prescriptions are appropriate is crucial,” van Oijen said.

Tragedy of the commons

In this respect, AMR shares further similarities with the climate crisis, in which the pursuit of personal outcomes can negatively impact society.

“AMR is where climate change was 20 years ago. Many people had an abstract sense of it being a problem, but weren’t ready to make changes in their personal behaviour, for the benefit of society,” van Oijen said.

While prescribing doctors are now more careful about writing scripts, thanks largely to the introduction of antimicrobial stewardship guidelines, personal pursuits often prevail over the bigger picture.

“In some parts of the world, doctors who send patients away with a script are perceived to be better doctors than those who don’t, regardless of whether that script is beneficial in the grand scheme of things. This has grown rates of precautionary antibiotic prescribing, adding to the AMR problem,” Miyakis said.

Compounding this, patients are rarely educated about the risks and benefits of precautionary medication scripts in the same way they would be for other medical procedures.

“If you have fluid in the lung, a doctor will outline the risks and benefits of inserting a tube to relieve that fluid. Rarely, if ever, are patients sat down and talked through the risks and benefits of an antibiotic script,” Miyakis said. “The question ‘Why are antibiotics necessary here?’ should be addressed by the patients and their doctors each time a script is given. Most respiratory infections, for example, are caused by viruses and do not require antibiotics.”

While most GPs are constrained by time, the researchers recommend at least some effort on this front. Doing so may curb the rate of redundant antibiotic consumption, they suggest.

Too little publicity, too late

In a similar vein, AMR, much like the climate crisis, has been chronically under-reported in public spheres. Historically, the topic has lacked air time in both media and education outlets, meaning GPs and the wider public may not recognise its importance.

“AMR has increasingly been reported on in the media, but not to the degree that it should. It hasn’t made people sit up and listen in the way COVID-19 reporting has,” Miyakis said.

“Meanwhile, the topic of AMR is only beginning to surface in higher education programs. A lot of clinicians practising today may not have studied it at all. That’s a problem because clinicians play such a fundamental role in curbing AMR.”

Community effort

Halting greenhouse emissions requires commitment from everyone, so too will AMR, according to the researchers.

“As clinicians, we must exercise extreme caution in terms of hygiene, prescribing and dispensing practices, and medical advice. Alongside patient outcomes, we must always think of the bigger picture, and ensure we are doing our part to combat this significant global threat,” Miyakis concluded.

^{1 https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance}

^{2 https://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future}

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