By Dr. Thamara Hapuarachchi - Sri Lanka College of Microbiologists

Antimicrobial resistance (AMR) occurs when organisms causing infections evolve ways to survive treatments.  The term antimicrobials includes antibiotic, antiprotozoal, antiviral and antifungal medicines.

Resistance is a natural phenomenon occurring in microbes but is increased and accelerated by numerous factors such as misuse and overuse of antimicrobials, poor infection control practices and global trade and travel. 

This is a significant concern with antibiotics. Many recent therapeutic advances (such as cancer chemotherapy and organ transplantation) require antibiotics to prevent and treat the bacterial infections that can be caused by the treatment. 

Without effective antibiotics, even minor surgery and routine operations risk becoming high risk procedures as serious infections may not be treatable. 

Especially alarming is the rapid global spread of multi- and pan-resistant bacteria (also known as “superbugs”) that cause infections that are not treatable with existing antibiotics.

Antimicrobial resistance threatens the very core of modern medicine. Systematic misuse and overuse of these drugs in human medicine and food production have put every nation at risk. Few replacement products are in the pipeline. 

Without harmonized and immediate action on a global scale, the world is heading towards a post-antibiotic era in which common infections could once again kill easily.

AMR is a complex problem that requires a united multi-sectoral approach. The Global Action Plan on Antimicrobial Resistance required countries to commit to the development and implementation of multi-sectoral national action plans to minimise this threat. Accordingly Sri Lanka has developed the National Strategic Plan (NSP) 2017-2022 providing the roadmap to combat AMR at national level. 

The NSP is developed under five key strategies which include improving awareness and understanding of antimicrobial resistance through effective communication, strengthening the knowledge and evidence base through surveillance and research, reducing the incidence of infection through effective sanitation, hygiene and infection prevention measures, optimising the use of antimicrobial medicines in human and animal health and preparing the economic case for sustainable investment and increase investment in new medicines, diagnostic tools, vaccines and other interventions.

What can we, as responsible citizens do to minimise AMR?  Minimising the use of antibiotics is an important step in preventing resistance.  Antibiotics do not act on viral infections, such as influenza, dengue, the common cold, a runny nose or most sore throats and should not be taken for these common ailments. Antibiotics should never be taken without a qualified doctor’s prescription and guidance and should not be taken over the counter without a prescription. Even if you are offered an antibiotic prescription, make sure it’s necessary and never share antibiotics with others or use leftover prescriptions. When using antibiotics ensure that the full prescription is completed even if you are feeling better. 

Remember, each time you take an antibiotic when it is not necessary, the effectiveness of the antibiotic decreases and it might not work the next time you most need it.

Preventing infections is an important step in reducing the emergence of AMR by reducing the need for antimicrobials. Ensuring that you are appropriately vaccinated against bacterial and viral infections is a key element.  

Minimising spread of infections by staying at home when sick, ensuring proper cough etiquette when coughing (by covering your mouth and nose using your covered elbow or shoulder when sneezing or coughing), washing hands frequently and teaching children to wash their hands frequently, is similarly important. 

Antibiotics are commonly used in agriculture and livestock for various unnecessary reasons. A large and compelling body of scientific evidence demonstrates that antibiotic use in agriculture contributes to the emergence of resistant bacteria and their spread to humans. 

The World Health Organisation and other regulatory bodies have strongly recommended a complete restriction of medically important antibiotics for growth promotion and disease prevention without diagnosis. Many countries have already taken action to reduce the use of antibiotics in food-producing animals. Consumers are also driving the demand for meat raised without routine use of antibiotics, with some major food chains adopting “antibiotic-free” policies for their meat supplies.

Celebrated annually, the World Antimicrobial Awareness Week (which falls from 18 to 24 November) aims to increase awareness of global antimicrobial resistance and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of drug-resistant infections. By making yourself aware of the dangers of AMR and knowing how best to prevent it, you can ensure that the advances of modern medicine which we are taking for granted in this decade will continue to be available for the next few decades as well.