Antimicrobial resistance: Next global, public health threat after COVID-19

As the dust settles from the SARS-CoV-2 pandemic, the lurking threat of antimicrobial resistance (AMR) once again rears its ugly head. Weighing in on this topic is Professor Dr Sasheela Sri La Sri Ponnampalavanar, Infectious Disease Professor, University Malaya Medical Centre (UMMC). Below is an excerpt from her bylined piece titled ‘Tackling the Next Global and Public Health Threat After COVID-19 – Antimicrobial Resistance (AMR).’

Now that the world has witnessed the long-lasting and devastating effects of a pandemic, it is imperative to focus on another urgent public health crisis—the alarming rise of antimicrobial resistance (AMR) across the globe.

Infections have become more difficult to treat as a result of the fact that microbes such as bacteria, fungi, and viruses no longer respond to commonly used treatment. With drug resistance, antimicrobial treatment no longer has the desired effect, which increases the risk of poor outcomes in patients with AMR-related infections. [Pathog Glob Health 2015;109(7):309–318]

At the height of the pandemic, newer COVID-19 variants kept emerging, and it was uncertain whether the vaccines and therapeutics available then were effective against them. As microorganisms, such as viruses, bacteria, and fungi, evolve and mutate over time, it is imperative to continue innovating and developing new and effective methods to combat them.

Despite a relatively low rate of bacterial coinfection, there was a significant increase in antibiotic prescriptions during the COVID-19 pandemic. Misuse of antibiotics in these patients may increase the selective pressure for antimicrobial resistance—a legacy of the COVID-19 pandemic. [Clin Microbiol Infect 2021;27(4):520–531]

In addition to unnecessary overprescribing of antibiotics, the increased risk of AMR is exacerbated by the public's lack of awareness of appropriate antibiotic use and ignorance of the consequences of misusing antibiotics. [PLoS One 2021;16(10):e0258698]

Due to AMR, antibiotics are becoming increasingly ineffective, which has made it more difficult to treat infections and led to an increased [in] the risk of death due to bacterial infection. [Available at https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. Accessed on 27 December 2022] This is why there is an urgent need for new antibacterial drugs on the market, but it is also essential that these antibiotics be used responsibly. Antibiotics should be prescribed to patients only when necessary and in the correct dose, frequency, and duration; otherwise, the new antibiotics will suffer the same fate as their predecessors and eventually lose efficacy.

Apart from the obvious consequences, AMR affects the national economy and their health system as it can result in productivity loss caused by sickness and premature death, as well as rise of healthcare cost that stems from prolonged hospital stays and care. [Infect Drug Resist 2019;12:3903–3910] 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. [Available at https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. Accessed on 27 December 2022]

The complexities of AMR necessitate a coordinated multisectoral approach. As patients are the end consumers of medical treatments, including antibiotics, they play a crucial role in determining how the AMR situation will evolve in the coming years. Patients should only take antibiotics prescribed by a physician, and they should follow the directions on the prescription precisely. In addition to avoid sharing or taking antibiotics that have been left over, the public should refrain from requesting antibiotics and purchasing medications without a prescription.

To continue raising awareness, healthcare professionals must also play a more proactive role in educating and guiding their patients to ensure they are able to benefit from healthcare while prescribing antibiotics only when necessary to ensure they are used correctly. In addition to prudent antibiotic use, strict infection prevention measures, such as hand hygiene, reduce the spread of AMR organisms in healthcare settings and the community.

Vaccinations also play an important role in the fight against AMR. Increasing evidence suggests that certain vaccines, such as those against influenza, pneumococcus, rotavirus, and Haemophilus influenza, can reduce the risk of antimicrobial resistance by preventing bacterial and viral infections. This would suggest that consumers, particularly children and the elderly, who adhere to their vaccination schedules may be able to reduce their use of antibiotics and thereby prevent the development of antibiotic-resistant infections.

Stakeholders such as governments, policymakers, and industry players must also take action to effectively combat AMR. Antibiotic research and development are required both as a tool to control outbreaks of novel diseases and as a treatment for known pathogens that have developed resistance to current treatments. Although it may take some time before AMR is eradicated in Malaysia and the rest of the world, if everyone is committed to doing their part, this is a goal that can be accomplished together.

The COVID-19 pandemic has primed everyone for the next global and public health threat. It is possible for all parties to work together to reduce the spread of COVID-19, including citizens adhering to new SOPs, pharmaceutical companies driving innovations that led to the development of vaccines and COVID-19 treatment, and governments establishing and enforcing guidelines for the public while also supporting the research and development of these innovations. The same urgency must be applied to AMR in order to prevent the next public health crisis.