Antimicrobials are medicines that inhibit the growth of microorganisms such as bacteria, fungi, viruses and parasites, and cause their death.
Over the years, due to overuse/misuse of antimicrobials, these microorganisms have mutated into “superbugs” that have the ability to resist antimicrobial treatment.
As a result, infections continue to persist, resulting in prolonged illness and the increased risk of death, as well as increasing the risk of spreading the bugs to other people.
Small organisms, big problems
Antimicrobials have revolutionised and transformed medicine, saving millions of lives.
But over the last two decades, antibiotics usage has increased for both medical and non-medical applications, leading to the development of antibiotic resistance.
The World Health Organization’s (WHO) Global Antimicrobial Surveillance System (GLASS) reveals that nearly 700,000 people around the world die each year because of drug resistance.
It also predicts that the figure could rise to one million deaths annually with an exponential increase in medical costs of over RM400 trillion.
Although this is global data, Malaysia is no different from the rest of the world.
Causes of the crisis
• Overuse/misuse of antimicrobials
Way back in 1945, Sir Alexander Fleming, in his Nobel Prize acceptance speech, had remarked that when the public demands these drugs, there will begin an era of abuse.
As predicted, due to the lack of regulations in many countries, these medicines are sold over the counter without prescription.
Antibiotics are also frequently prescribed improperly in terms of indication, choice, dose and duration of treatment.
Even when correctly prescribed, patients often do not finish the full course of their medicine, which contributes to antibiotic resistance.
On the flip side of the coin, unnecessary usage can also lead to harmful side effects.
• Widespread agricultural use
The majority of antibiotics are actually used as growth supplements in healthy animals, or as a preventative measure for animals living in crowded or unsanitary conditions.
When humans ingest such animals, resistant microorganisms can get transmitted to them and cause severe infections.
• New antibiotics
Due to financial and regulatory constraints, the development of new antibiotic drugs has almost come to a standstill.
Pharmaceutical companies do not find these investments to be profitable as these drugs are meant to be taken only for a short time, and are generally curative.
The problem is that the pace of new drug discovery simply cannot match the pace of growing resistance.
If existing antibiotics are not used judiciously, even the commonest infections may become difficult to treat.
Diffusing the time bomb
Antibiotic resistance is rising to precariously high levels, and without urgent action, the world is heading towards a post-antibiotic era.
Most of the causes responsible for this crisis can be tackled wisely.
One of the key strategies to prevent antibiotic resistance is by preventing infections of these antibiotic-resistant microorganisms.
This can be achieved by making drastic changes to the prescribing practices of antibiotics by doctors and their usage by patients.
How can you as a patient contribute?
• Never demand antibiotics. Only use antibiotics when prescribed by a health professional and always follow their advice.
Be sure to ask questions if anything is unclear.
• Always finish the full course of your prescribed antibiotics; never stop taking them halfway through the course, even when you feel better.
• Never share or use leftover antibiotics.
• Take good care of your personal health and hygiene.
Wash hands regularly, practice hygienic food preparation, avoid close contact with sick people and ensure your vaccinations are up to date.
• Go for meats and fishes that have been produced without the use of antibiotics.
Fighting the resistance
Antibiotic awareness week has been held every November since 2015.
This global initiative focuses on spreading awareness about antibiotic resistance, recommending guidelines for optimising antibiotic usage, and strengthening surveillance and research in countering antimicrobial resistance.
During the 68th World Health Assembly in May 2015, all member states were guided to set up national antimicrobial resistance surveillance systems that can yield reliable data.
In accordance to this, the Health Ministry and the Agriculture and Agro-Based Industry Ministry initiated the Malaysian Action Plan to combat antimicrobial resistance (MyAP-AMR).
This plan includes comprehensive educational and awareness programmes to educate both the public and professionals.
However, surveillance is still in its infancy, hence commitment and complementary efforts from all related sectors including veterinarians, farmers, fishery officers, health professionals and all related stakeholders, are required to tackle one of the biggest threats to global public health.
As responsible individuals, it is our duty to safeguard the world with our coordinated efforts against antibiotic resistance.
Otherwise, we will find our so-called “high-tech world” reverting back to the pre-antibiotic era in the not-too-distant future.