Imagine you’re invited to a family potluck dinner. Someone brings chicken, which is not prepared properly, and it’s carrying a drug-resistant strain of bacteria.
You help yourself to the food and a couple of days later you have an upset stomach.
“I simply ate too much food at that dinner,” you tell yourself. You pop a few antibiotics you have from a previously unfinished course.
The condition resolves and you forget all about it. But two weeks later you feel unwell again. Your friend passes by with some antibiotics, but despite taking them the condition worsens. When you finally go to the doctor, they admit you to hospital with urinary sepsis. Now, finally, the situation resolves, but it takes you weeks to recover and get back to work.
A series of events starting at the potluck dinner now means your life has been turned upside down, you are feeling less energetic, and you are frequently forced to go home early from work. On top of that, you’ve been told that the urinary sepsis that got you to hospital was caused by an antibiotic-resistant bacteria known for causing complicated infections. This worries you – will you be sick again? Will it be even worse next time?
This is a frightening scenario but one that is happening more frequently with antimicrobial resistance, also known as AMR. In the EU/EEA, it is estimated that more than 670,000 infections occur annually due to antibiotic-resistant bacteria, and some 33,000 people die as a direct result of these infections.
Globally, the numbers are staggering. At least 700,000 lives are lost every year because of AMR. This in turn has devastating effects on the global economy, amplifying inequality and deepening poverty. Indeed, the World Bank has estimated that the costs associated with AMR, if nothing is done to address it, will have the same impact as the Covid-19 crisis, not once, but year after year.
Imagine a world where common bacterial infections like an infected wound, strep throat or diseases such as tuberculosis or Aids, are no longer treatable. Or imagine not knowing if a loved one will survive their cancer treatment or a routine surgical procedure like a caesarean or a hip replacement because the antibiotics used during the procedure are no longer effective.
Without collective action, we can expect a future world in which otherwise treatable illnesses could once again be untreatable and standard procedures suddenly become too dangerous to perform.
Antimicrobials, which include antibiotics, are life-saving medicines that are used daily to treat – and prevent – infections from microorganisms. But when antibiotics are used excessively and inappropriately, they can end up killing the good bacteria and creating resistance in the bad ones to those medicines.
Inappropriate use happens when antibiotics are taken in the wrong dosage, in wrong intervals or when a treatment course is frequently interrupted. Inappropriate use is also when antibiotics are used for infections where they are unnecessary.
We know that over-the-counter sales of antibiotics still takes place because many people don’t understand or know how this contributes to the development of AMR. Moreover, within the different classes of antibiotics, the ones associated with the highest risk of causing AMR are also the ones most frequently sold.
In addition, many doctors lack access to diagnostics or lack the necessary understanding of how their seemingly negligible use of antibiotics contributes to the overall problem.
From preliminary data of antibiotic use in the WHO Eastern European region we know that the overall sale of antibiotics has increased dramatically during the pandemic and the situation may worsen during the coming winter months. This is especially concerning because antibiotics are meant to treat bacteria – not viruses like the one that causes Covid-19.
Antibiotics are also used for the prevention and treatment of disease in livestock and pets. Antibiotic-resistant bacteria can then spread through live contact between humans and animals or through food. Antibiotic drugs can also be excreted into the environment at farms, hospitals, and medicine production sites. In addition, left-over medicines from treatment courses can be thrown away. This contributes to antibiotics circulating in the environment for days or weeks.
The potluck dinner you went to nearly a year ago – and from which you are still recovering – is a case in point. It all began with the misuse of antibiotics at a chicken farm, where one chicken carrying drug-resistant bacteria ended up on your dinner table. It was prepared badly. Those were the first red flags. The next was your improper use of antibiotics, not once but twice, without a prescription and without following a full course.
Antimicrobials save countless lives around the world every day. They are responsible for huge progress in medicine, allowing us to prevent and treat diseases and infections. But our persistent misuse of antimicrobials puts this in danger.
We can all play our part to make sure this doesn’t happen. Buy food products without antibiotics in them. Don’t take antibiotics without a prescription. Lobby your government to regulate antibiotic use more strictly. Because one day, you may need those antibiotics to work.
Dr Danilo Lo Fo Wong is the senior regional adviser on antimicrobial resistance for the World Health Organisation in Europe
World Antimicrobial Awareness Week runs from 18-24 November