The world is currently in the grip of a pandemic, the likes of which had not been seen for more than 100 years. COVID-19 has infected more than 250 million, causing the death of at least five million people. Economic costs run into many trillions of euros.

Yet another silent pandemic is also taking place globally, one that may not have received as much visibility as COVID-19  but which is nonetheless equally, if not more, worrying. It threatens to be responsible for up to 10 million deaths by the year 2050 and cost the world economy a staggering $100 trillion.

Antimicrobial resistance (AMR) poses major challenges to modern healthcare. Unfortunately, it is not as straightforward to understand as something like COVID-19.

Antimicrobial resistance is not a new infection but a situation where bacteria, which were previously destroyed by antibiotics, undergo a change such that those same antibiotics are no longer effective on them.

To give an example; urine infections are normally caused by a bacterium known as E. coli. In the past, these E. coli bacteria were very sensitive and the infections they caused would be easily treatable by most antibiotics. However, over time, this microbe has developed the ability to withstand the effects of many of these antibiotics. Therefore, if they are used to treat the infection, they will not work and the infection will not be cured.

You may ask: can we not use another antibiotic instead? The problem is that bacteria tend to increase their resistance to more and more antibiotics over time. As a result, we are now facing a real situation of superbugs that are practically untreatable by any antibiotic we have available. The consequences are unimaginable.

Modern healthcare depends on antibiotics. Intensive care, hip replacement surgery and cancer treatment are just three treatments that we now take for granted. However, they are only possible because antibiotics are available to prevent and treat potentially life-threatening infections that often accompany these serious interventions.

To quote Dame Sally Davies, former chief medical officer for England: “Without the drugs used to fight infections, common medical interventions such as caesarean sections, cancer treatments and hip replacements would become incredibly risky and transplant medicine would be a thing of the past.”

How does antimicrobial resistance happen? To put it simply, it is directly related to the amount of antibiotics used. It is, therefore, no surprise that Scandinavian countries, where antibiotics are used very judiciously and old antibiotics like penicillin continue to be the drug of choice for common respiratory infections, have the lowest resistance rates in Europe.  On the other hand, antibiotic use is highest in the Mediterranean and Eastern Europe; so is antimicrobial resistance.

The ‘antibiotic apocalypse’ would dwarf the impact of COVID-19 that we have seen in the past year or two- Michael Borg

What can we do about this? Realistically, it is the medical profession that must take the lead. Studies have shown that a large proportion of antibiotics prescribed in the community and even hospitals (up to 50 per cent in some studies) are unnecessary.

As doctors, we need to think twice, to make sure every antibiotic prescription that we sign off is justified and necessary. But the public also has a role to play. Common infections such as colds and flu are invariably caused by viruses on which antibiotics do not work. It is important that we do not pressure health professionals such as doctors and pharmacists to give us antibiotics.

Even in cases of a sore throat, antibiotics offer minimal improvement and the infection needs to take its time to heal – with or without antibiotics. We should also never use any left-over antibiotics on our own decision or share antibiotics with friends or family.

As we celebrate World Antibiotic Awareness Week, we all – medical professionals and the public alike – need to renew our commitment towards more prudent use of antibiotics to ensure we avoid what some have termed as the ‘antibiotic apocalypse’ that would dwarf the impact of COVID-19 we have seen in the past year or two. 

Michael Borg, Chair, National Antibiotic Committee.

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