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Antimicrobial Resistance (AMR) is when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines. This means that antibiotics and other antimicrobial medicines become less effective.
The impact of antimicrobial resistance is that it gets harder – or becomes impossible – to treat infections and this means that diseases can spread more easily, causing additional severe illness or death.
The soil in the remote Arctic location of Svalbard has recently been shown to contain superbugs. Bacteria resistant to one or more antibiotics are everywhere, including in Arctic snow, Antarctic lakes and salad in our supermarkets. We know they are there from DNA analysis.
Antibiotic resistance genes can be detected by DNA sequencing, even if the microorganisms that contain them are difficult to grow in culture, which is often the case. The collective term for these genes is the resistome, and the risk posed by ever more widespread antibiotic-resistant microbes has been recognised as a global challenge. In 2019, authorities in the UK ranked the risk alongside that posed to the public by terrorism and pandemic flu.
The two main drivers behind the upsurge of superbugs are environmental use (e.g. in animal-based food production) and inappropriate use in human health.
While some parts of the world have taken action to curb the environmental use of antibiotics, others are doing quite the opposite. For example, the Environmental Protection Agency in the USA has recently agreed that up to 195,000 hectares of citrus trees in Florida can be treated with 176,000 kg of the antibiotic tetracycline per year, to combat citrus canker and citrus greening disease. It is estimated that over 9000 citrus hectares are also treated each year in California.
In most of Europe, the supply of antibiotics without prescription is prohibited, but in many European countries and elsewhere in the world they are nevertheless freely available for purchase. While some infections merit the use of antibiotics, many do not, and public understanding of how antibiotics work, how antimicrobial resistance arises and the risks it poses leaves much to be desired.
It has often been said that physicians prescribe antibiotics inappropriately due to pressure from patients whose poor health is not the result of microbial infection. Numbers of antibiotic prescriptions being issued in England are being monitored, and it was found that simply sending a letter informing GPs that they were in the top 25% of prescribers reduced their antibiotic prescriptions by an average of 3%.
A recent study revealed that many patients felt that obtaining a prescription validated their ill health. Being able to tell the boss, or your school, that you have been prescribed with medication was perceived to lend credibility to the condition. However, many patients are just as happy to leave the healthcare centre without antibiotics but with an official National Health Service form entitled ‘Treating your infection’. These steps are part of the Public Health England campaign to ‘Keep antibiotics working’ to which we should all lend our support.
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