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Every time antibiotics are misused, we inch closer to a world where common infections become untreatable. According to global health data, bacterial antimicrobial resistance was directly responsible for 1.27 million deaths worldwide in 2019 and contributed to 4.95 million deaths that same year. These figures highlight an urgent public health crisis that demands immediate and coordinated action. One of the most effective responses to this crisis is a practice known as Antimicrobial Stewardship.
Antimicrobials are therapeutic substances used to prevent or treat infections. They include antiseptics, antibiotics, antivirals, antifungals and antiparasitics.
Antimicrobials can kill microorganisms and/or prevent their growth by targeting key steps in cellular metabolism such as the synthesis of biological macromolecules, the activity of cellular enzymes, or cellular structures such as the cell wall, cell membranes.
Difference between antibiotics, antivirals, antifungals and antiparasitic
Antibiotics are pharmacological agents designed to combat bacterial infections,
They either kill bacteria outright (bactericidal) or inhibit their growth (bacteriostatic), allowing the immune system to eliminate the infection.
Antibiotics are indicated for infections caused by bacteria, such as pneumonia, strep throat, urinary tract infections (UTIs), and bacterial skin infections. However, antibiotics are ineffective against viruses or fungal infections.
Antivirals
What Are They?
Antivirals are drugs used to treat infections caused by viruses. Unlike bacteria, viruses are not living organisms and replicate within host cells, making them harder to target. Antivirals work by interfering with the virus’s ability to multiply and spread in the body.
Antivirals are indicated viral infections like the flu (influenza), HIV, herpes, and hepatitis C. Unlike antibiotics, they don’t destroy the virus but reduce its replication to control the infection.
Antifungals
What Are They?
Medications that are used to treat fungal infections are known as antifungals. These drugs work by targeting fungal cell membranes, effectively killing the fungus or stopping its growth.
Antifungal medications are indicated to treat fungal infections such as athlete’s foot, ringworm, candidiasis (thrush), and more serious infections like invasive aspergillosis.
Antiparasitics
Antiparasitic drugs are used to treat infections caused by parasites such as protozoa and helminths. They are essential in managing diseases like malaria, trypanosomiasis, and intestinal worm infections.
What Is Antimicrobial Resistance
Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death.
AMR is a natural process that happens over time through genetic changes in pathogens. Its emergence and spread is accelerated by human activity, mainly the misuse and overuse of antimicrobials to treat, prevent or control infections in humans, animals and plants.
How Misuse and Overusse Drive Resistance
The fact that bacteria develop resistance to a drug is normal and expected. But the way that drugs are used affects how quickly and to what degree resistance occurs.
Understanding how resistance develops requires examination of the specific behaviours that accelerate it;
Treating viral infections with antibiotics
One of the most common forms of antibiotic misuse is prescribing or consuming antibiotics for viral infections,
Taking antibiotics for a viral infection like a cold or the flu (for which antibiotics are ineffective) is an example of misuse of antibiotics.
Antibiotics treat infections caused by bacteria. But they don't treat infections caused by viruses (viral infections).
For example, an antibiotic is the correct treatment for strep throat, which is caused by bacteria. But it's not the right treatment for most sore throats, which are caused by viruses.
Incomplete antibiotic courses
When a patient discontinues antibiotics therapy prematurely typically upon feeling better the bacteria that have not yet been eliminated are often the most resistance or harmful ones.
These surviving organisms multiply and spread, resulting in infections that are harder to treat with the same antibiotic in the future.
Antibiotic use in agriculture and animal husbandry
Another example is giving antibiotics to healthy animals to promote their growth and prevent disease. Antibiotic use in farm animals allows the resistant bacteria to thrive within the animals, and then the drug-resistant bacteria can be transferred to humans when they consume meat products. As a result, infections in humans harboring resistant forms of bacteria become more difficult to treat.
What Is Antimicrobial Stewardship?
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials. The education of the health workforce is of crucial importance, as they form the front line in safeguarding the effectiveness of antimicrobial medicines.
Antimicrobial Stewardship in Healthcare Settings
In hospitals and clinical institutions, antimicrobial stewardship programs (ASPs) are implemented by multidisciplinary teams comprising physicians, clinical pharmacists, and microbiologists. These programs include:
Conducting culture and sensitivity testing before prescribing antimicrobials to identify the specific causative organism and its susceptibility profile.
Establishing formulary restrictions that limit the use of broad-spectrum antibiotics to cases where they are clinically justified.
Implementing prior authorization protocols that require approval before certain high-risk antibiotics can be prescribed.
Conducting regular review of ongoing antimicrobial therapy to assess appropriateness and make adjustments as needed.
The Role of the Public in Antimicrobial Stwardship
The public also plays a role in antibiotic stewardship. You can help reduce the development of antibiotic resistance if you:
• Avoid pressuring your health care provider to give you an antibiotic prescription. Ask your health care provider for advice on how to treat symptoms.
• Wash your hands regularly with soap and water for at least 20 seconds. Clean any cuts or wounds to avoid bacterial infections that need antibiotic treatment.
• Get all recommended vaccines. Some vaccines protect against bacterial infections, such as diphtheria and whooping cough (pertussis). Check to see if you need any vaccines before travel, too.
• Lower your risk of getting a bacterial infection spread by food. Don't drink raw milk. Wash your hands before making food and before eating. Cook foods to a safe internal temperature.
• Use antibiotics only as prescribed by your health care provider. Take the prescribed daily amount. Complete the entire treatment. Tell your health care provider if you have any side effects.
• Never take leftover antibiotics for a later illness. They may not be the correct antibiotic. And they likely don't include a full treatment course.
• Never take antibiotics prescribed for another person or let anyone else take your antibiotics.