Tackling The Next Public Health Threat: Antimicrobial Resistance (AMR) — Dr Sasheela Sri La Sri Ponnampalavanar

Although it might take time before we can curb the issue of AMR in Malaysia and across the globe, if we are committed to playing our parts, it is a goal that we can achieve together.

As Malaysia and most of the world transitioned to the endemic phase of Covid-19, it’s easy to forget that just two years ago, the pandemic led to millions of lives lost, rise in unemployment rates, and the near-collapse of health care systems due to the tsunami of cases.

Today, thanks to the quick development of medical innovations such as Covid-19 vaccines, we are now able to continue living our lives in the new normal, resuming productivity, and building towards economic recovery and growth. 

Now that we have seen the long-lasting and devastating impact that a pandemic can leave, it is vital that we draw our attention to tackling another urgent public health crisis, namely antimicrobial resistance (AMR), which continues to rise to alarming levels across the world.

To put things into perspective, at the height of the pandemic, we were still fighting against newer Covid-19 variants, and many were unsure if current vaccines and therapeutics were effective in combating them.

This stresses the importance of continuing to innovate and developing new and effective ways to combat microorganisms, including viruses, bacteria, and fungus as they change and mutate over time.  

AMR: The Silent Pandemic We Should All Know About 

Over the years, antimicrobial resistance has become an urgent health challenge on a global scale, as microbes such as bacteria, fungi, and viruses no longer respond to commonly used medicines, resulting in infections becoming harder to treat.

With drug resistance, antimicrobial treatment no longer serves their desired effect, which in turn will increase the risk of poor outcomes in patients with an infection caused by AMR

During the Covid-19 pandemic, there was a significant increase in antibiotic prescriptions despite a relatively low bacterial co-infection rate. The misuse of antibiotics in these patients can result in increased selective pressure for antimicrobial resistance, leading to a lasting consequence of the Covid-19 pandemic (Langford, Bradley J., et al. “Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis.” Clinical microbiology and infection 27.4 (2021): 520-531).

Apart from overprescribing of antibiotics unnecessarily, the increased risk of AMR is compounded by the lack of awareness of appropriate antibiotic use and a poor understanding on the consequences of misusing antibiotics among the public (Wong, Li Ping, et al. “Factors influencing inappropriate use of antibiotics: Findings from a nationwide survey of the general public in Malaysia.” PloS one 16.10 (2021): e0258698).

It is estimated that drug resistance claims 700,000 lives every year, and this toll is projected to increase exponentially to 10 million a year by 2050 without immediate action.

The unchecked growth of drug-resistant infections has allowed for AMR to become a slow-moving pandemic that requires urgent attention as it will have long-term consequences for the global public health and economy. 

Impacts On The Lack Of New Antibiotics To Fight AMR Is A Cause For Concern 

Before the discovery of antibiotics in the 20th century, contracting even a mild infection could result in the loss of life or significant morbidity such as loss of a limb. The discovery of antibiotics was a turning point in human history, revolutionising medicine and increasing the survival rates of infected patients over time.

However, the growing burden of AMR threatens the return to a world with a scarcity of effective treatments for patients who have common bacterial infections such as urinary tract infection, pneumonia, skin infection and surgical site infections.

As the effects of AMR continue to increase today, the antibiotic pipeline is slowing down, and the discovery and development of new antimicrobials is not able to keep up against the emergence of AMR. 

In 2019, the World Health Organization (WHO) had identified 32 antibiotics in clinical development which address its list of priority pathogens, however, only six were classified as innovative.

This is indicative of two things — firstly, the research and development of new antibiotics is a lengthy and complex process that doesn’t happen overnight; and secondly, more needs to be done to address the clinical pipeline of new antimicrobials to ensure that patients are able to receive the care that they need.  

At this juncture, antibiotics have become more ineffective as the global spread of drug-resistance has made it difficult to treat infections and increasing the risk of death. This is why there is an urgent need for new antibacterial drugs in the market, but with this, comes the importance of ensuring that these antibiotics are used wisely.

Patients should be prescribed antibiotics only when needed at the right dose, frequency, and duration, otherwise the new antibiotics will also suffer the same fate as its predecessors and eventually lose effectiveness

Additionally, the cost of AMR to national economies and their health systems is another crucial factor to note, as it can result in productivity loss caused by sickness and premature death, as well as rise of health care cost that stems from prolonged hospital stays and care

Without effective tools for the prevention and adequate treatment of drug-resistant infections, treatment may fail for an increasing number of patients. There will also be an increased risk in major medical procedures such as surgery, chemotherapy, and organ transplants.

Steps We Can Take To Prevent And Reduce AMR 

Understanding the devastating effects of AMR, we must now take the first steps in acknowledging that it is a complex problem that requires a united multisectoral approach. 

As patients are the end consumers of medical treatments including users of antibiotics, they play an important role in how the AMR situation will progress in the coming years. Patients should only take antibiotics prescribed by a doctor and they must correctly follow the prescription directions.

The public should also refrain from demanding for antibiotics and buying medication without a prescription, on top of sharing or taking leftover antibiotics. 

To continue raising awareness, our health care professionals must also play a more proactive role in educating and guiding their patients, to ensure they have the capacity to benefit from health care while prescribing antibiotics to patients only when required so that they are being used correctly.

Apart from judicious antibiotic use, maintaining strict infection prevention measures such as hand hygiene reduces the spread of AMR organisms in health care settings as well as in the community. 

Additionally, vaccinations also play an important role in combatting AMR. There is now increasing evidence that certain vaccines currently available such as influenza, pneumococcus, rotavirus, and Hemophilus influenza can decrease the risks of AMR by preventing bacterial and viral infections.

This would mean that consumers, particularly children and elderly people (Nichol KL, et al. N Engl J Med. “Effectiveness of Influenza Vaccine in the Community-Dwelling Elderly.” 357:1373-1381 (2007)), who keep up to date on their vaccination schedules may be able to reduce the use of antibiotics, and thus prevent antibiotic-resistant infections (Kingwell. Nat Rev Drug Discov. “Vaccines take a shot at antimicrobial resistance.” 17, 229–231 (2018)). 

Besides creating awareness among consumers and health care professionals, combatting AMR also requires action from governments, policymakers, and industry players to really address the crux of the issue.

Investment is required in antibiotic research and development, both as a tool to control novel disease outbreaks, and to treat known pathogens developing resistance to currently available treatments.

Although it might take time before we can curb the issue of AMR in Malaysia and across the globe, if we are committed to playing our parts, it is a goal that we can achieve together.  

We must learn from the Covid-19 pandemic to address the next global and public health threat. We have seen that it is indeed possible for all parties to work together to reduce the spread of Covid-19 – from citizens adhering to new SOPs, pharmaceutical companies driving innovations that led to the creation of vaccines and Covid-19 treatment, and governments who put in place and enforced guidelines for the people, while also supporting the R&D of these innovations.

With AMR, the same urgency is needed so that we can prevent the next public health crisis.

Prof Dr Sasheela Sri La Sri Ponnampalavanar is an infectious disease professor at University Malaya Medical Centre.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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