References

Providing self-care advice for cold and flu keeps antibiotics working. 2019. https://tinyurl.com/ropzn8p (accessed 20 November 2019)

Centers for Disease Control and Prevention. Antibiotic prescribing and use in doctor's offices. 2017a. https://tinyurl.com/wmzt9bt (accessed 25 November 2019)

Centers for Disease Control and Prevention. Antibiotic resistance questions and answers. 2017b. https://tinyurl.com/y8zvd638 (accessed 25 November 2019)

NHS England. World Antibiotic Awareness Week, 18-22 November. 2019. https://tinyurl.com/rylgv2k (accessed 25 November 2019)

Pharmaceutical Journal. Little progress made to develop incentives for new antibiotics, vaccines and diagnostics, AMR review concludes. 2019. https://tinyurl.com/wlurfpw (accessed 20 November 2019)

Review on Antimicrobial Resistance. Tackling drug-resistant infections globally. 2016. https://amr-review.org/ (accessed 20 November 2019)

How to stop antibiotic resistance? Here's a WHO prescription. 2015. https://www.who.int/mediacentre/commentaries/stop-antibiotic-resistance/en/ (accessed 20 November 2019)

Tackling antibiotic resistance

02 December 2019
Treatments
02 December 2019
Volume 24 · Issue 12

Following on from World Antibiotic Awareness Week (WAAW), which took place from 18 to 22 November, there has been considerable discussion surrounding how to prevent the further emergence and spread of antimicrobial resistance. This year's campaign marks the first in a new five-year National Action Plan in the UK for tackling antimicrobial resistance, which will aim to reduce inappropriate prescribing and control and prevent infection (NHS England, 2019).

Developing resistance

The development of antibiotics has been revolutionary for medicine and public health. However, given the resistance that is now building up against them, we are facing one of the most significant and urgent threats to global health. As former Prime Minister David Cameron put it: ‘If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine.’ (Review on Antimicrobial Resistance, 2016)

Antimicrobial stewardship

Many nurses in the community may increasingly find themselves in the role of non-medical prescriber. Prescribers can contribute to preventing the spread of antibiotic resistance in various ways. The Centers for Disease Control and Prevention (CDC) (2017a) in the United States recommends the following:

  • Prescribe antibiotics only when they are likely to benefit the patient
  • When an antibiotic is likely to provide benefit to a patient, prescribe one that specifically targets the organism that is most likely causing the patient's illness
  • Encourage patients to use the antibiotic as instructed
  • Collaborate with one another, as well as with office staff and, importantly, patients, to promote appropriate antibiotic use.
    • Disease-causing bacteria develop antimicrobial resistance through genetic adaptations

    Empowering patients

    In this age of the informed and empowered patient, health professionals are no longer in the paternalistic position of treating patients without their involvement. The problem of antimicrobial resistance belongs to every member of society (Ashiru-Oredope, 2019); however, many patients probably are unaware of how they might take any action against this global threat.

    The CDC (2017b) provides the following advice for the general public, which can aid health professionals in supporting and educating patients:

  • Express any concern about antibiotic resistance to your health professional
  • Ask your health professional if there are steps you can take to feel better and get symptomatic relief without using antibiotics
  • Take the prescribed antibiotic exactly as your health professional tells you
  • Safely throw away leftover medication
  • Ask about vaccines that could be recommended for you and your family to prevent infections that may require an antibiotic
  • Never skip doses
  • Never take an antibiotic for a viral infection, such as a cold or the flu
  • Never pressure your health professional into prescribing an antibiotic
  • Never save antibiotics for the next time you get sick
  • Never take antibiotics prescribed for someone else.

    • Progress report

    In 2014, a review was commissioned by the then UK Prime Minister to analyse the global issue of rising drug resistance and drug-resistant infections, and to propose concrete actionable steps that could be taken in an effort to tackle the problem internationally (Review on Antimicrobial Resistance, 2016). However, a recently published progress report noted that, while there has been progress in raising awareness, there is less evidence about any impact being made on behaviour (The Pharmaceutical Journal, 2019). In fact, it is suggested that ‘multinational pharmaceutical companies actually have fewer projects to develop antibiotics than they did when the report was launched 3 years ago’ (The Pharmaceutical Journal, 2019).

    Conclusion

    It was estimated by the World Health Organization (WHO) that half of all antibiotic prescriptions in 2015 were for viral conditions, for which they do not provide any benefits (Sprenger, 2015). While drugs will inevitably lose their ability to kill the bacteria that cause diseases over time as a result of the natural selection and genetic adaptation of bacteria, there is much that can be done to slow this process, such as more generous and rapid investment in new drug development; more effective use of infection prevention strategies; safe, informed and sparing use of antibiotics by patients; and a push towards appropriate prescribing in what has become an over-medicalised society.