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As a member of the public, you have a role to play in helping curb the growing crisis of AMR. This will be through the way you interact with antibiotics when it comes to infections in you or your family. Proper use and disposal of antibiotics is a key way how you personally can fight against AMR. Find out what you can do to help fight AMR here:

What you can do Questionnaire

Antimicrobial Resistance (AMR) is the health threat of our time. It is the ability of microbes (such as bacteria, viruses, fungi) to counteract the effectiveness of antimicrobial drugs (such as antibiotics, antivirals, antifungals) used against them. Practically, when exposed to antimicrobial drugs, such microbes can mutate and develop resistance. These microbes are sometimes referred to as “superbugs’’. Even when used appropriately, antimicrobials can create a selective pressure for resistant microbes. However, the development of resistance is accelerated by the misuse and overuse of antimicrobials in human, animal, and plant health along with the pollution of the environment with antimicrobials and antimicrobial resistance genes.

Antibiotics are the most commonly used antimicrobial drugs. They are only effective in treating infections caused by different types of bacteria; they are not active against viruses or fungi.

Resistance genes can be found in humans, animals, the food chain and the environment (i.e. water, soil, air). These resistance genes can spread easily, from human to human, from humans to animals, and from the environment to both humans and animals.

AMR is a serious and an urgent threat to global health as antimicrobials have been one of the key pillars of modern medicine since the discovery of penicillin by Alexander Fleming in 1928. Any of us could be the next victim of AMR. According to United Nations experts, in the next 30 years 2.4 million people in Europe, North America, and Australia could die from drug-resistant infections (UN IACG, 2019). As life-saving antibiotics stop being effective, AMR could end our capacity to combat infections and halt all surgical procedures.

Sources of Antimicrobial Resistance

Hospitals are majors hubs for the development of antimicrobial resistant agents, particularly of the ones critical for human health.

Klebsiella pneumoniae is an opportunistic pathogen that can cause respiratory and bloodstream infections in humans; new research has discovered antibiotic-resistant strains of this bacteria are rapidly spreading throughout hospitals in Europe. Certain strains are already resistant to last-resort carbapenem antibiotics, meaning these strains are considered to be extremely drug-resistant (XDR) (Nature Microbiology, 2019).

A recent study from the Centre for Genomic Pathogen Surveillance, based at the Wellcome Sanger Institute, considered patients in 244 hospitals from 32 European countries. In their survey of the Enterobacteriaceae family of bacteria, researchers were able to analyse the genomes of roughly 2,000 K. pneumoniae samples (Nature Microbiology, 2019).

In some regions, more antimicrobials are used in animals than in humans which presents a great threat for resistance in human medicine. Although data on the exact amounts of antimicrobials used in global food production is deficient or completely absent in certain areas, the data we do have paint a serious picture. In the US for example, more than 70% of antibiotics considered to be medically critical for human health are used in livestock (AMR Review, 2015).

Colistin is used very sparingly in humans as it can cause kidney failure; however, when no other antibiotics have been effective, colistin is an important last resort (AMR Review, 2016). Widespread use of colistin in animals has led to resistance in animal pathogens which has concerning implications for human health. A recent study in China has shown the discovery of transferable colistin resistance in bacteria in both humans and animals (Yi-Yun Liu et al., 2016).

Animal-based products are not the only food sources that may be contaminated with antimicrobial resistant bacteria and/or antimicrobial resistance genes; ingredients added during food processing can also be vehicles for resistance spread. These ingredients can range from things such as starter cultures, probiotics, and bioconserving microorganisms. When raw food is mixed with other ingredients, cross contamination increases the likelihood that bacteria will spread. While cooking can often kill resistant bacteria, consumption of raw food products creates a substantial risk of transferring antimicrobial resistance to humans. (Verraes et al., 2013).

Inappropriate Disposal of Antimicrobials

Pharmaceutical pollution of the environment contributes to AMR and can occur at all stages of pharmaceuticals’ life cycle: during their production, use, and disposal phases.

China and India currently supply almost 90% of all active pharmaceutical ingredients (APIs) used globally. Industrial pollution of unmonitored antibiotic APIs in Asia is a large contributor to growing numbers of resistant bacteria in the region. This does not affect just local populations, but the entire world due to travel and trade (SumOfUs, 2015).

The inappropriate disposal of unused or expired antimicrobial drugs (i.e., by flushing them in the toilet or sink, or disposing them in household rubbish) can also contribute to the spread of AMR (Ashbolt et al., 2013).

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How can I stay safe while travelling?

No matter where you travel to, there are several general guidelines you should follow. For more specific advice and information visit our travel advice page.

  • Make sure all vaccines are up to date
  • Ask your health care professional if you could benefit from any vaccines specific to your destination country
  • Always use safe sexual practices
  • Maintain good hygiene; wash your hands often and especially prior to eating
  • Learn about ways to treat and prevent common travel-associated illnesses such as travelers’ diarrhea
  • Drink only bottled water
  • Avoid eating street food, particularly meat; use your judgement; if a restaurant or food vendor looks unclean your safest option is to eat packaged foods or stick to restaurants that have clear health and safety standards
  • Avoid eating meat in countries where antibiotics are still used incorrectly in animal husbandry
  • If you become sick while on vacation or after returning home, make sure you seek medical attention and let your healthcare provider know what countries you have been travelling in

Which common illnesses are often wrongly treated with antibiotics?

A series of mostly viral infections are incorrectly treated with antibiotics:

  • common cold – it comes with sneezing, running or stuffy nose, cough, and sore throat. In most cases it is caused by rhinoviruses and antibiotics won’t work (CDC);
  • sore throat – smoking, allergies, the viruses that cause colds or flu, or a bacteria group called A Streptococcus (i.e., Streptococcus pyogenes) are among the causes of this type of illness. Only the infection caused by Streptococcus needs antibiotic therapy, the rest do not(CDC);
  • flu (Influenza) – is caused by influenza viruses and can infect the nose, throat and the lungs sometimes. Common symptoms include: fever and/or chills, cough, sore throat, running or stuffy nose, headaches, tiredness, muscle and/or body pains. Antibiotic therapy is not needed (CDC);
  • acute bronchitis or chest cold – this disease is manifested by cough due to the mucus produced in the lungs by the swelling of the lungs’ airways. Besides coughing (with or without mucus), you can also feel soreness in the chest, tiredness (fatigue), mild headache, mild body aches or sore throat. In most cases it is a viral infection whose recovery takes up to three weeks (CDC).

What should I do with the unused/expired antibiotics that I have at home?

  • Never dispose of unused drugs in the toilet or sink.
  • Be informed on the safe, recommended methods for disposing or returning unused antimicrobial drugs.
  • For more information on safely disposing drugs and the risk associated with the presence of antimicrobials in the environment, check the Safer Pharma Campaign
  • If you live in Europe, you can find out more on the national collection schemes for drugs on medsdisposal.eu.
  • If you live in the US you can find information on safely disposing medication with the EPA.

If AMR has already been an emerging issue for a long time, why are governments taking so long to act?

There are a number of reasons why governments are slow to react to AMR. For one, AMR is a very complex issue due to its global and multisectoral nature and simple national policy cannot have a strong effect on it. Furthermore, even if there is political will, the public has yet to seize the AMR issue wholeheartedly and demand concrete action from their governments. (Wellcome Trust Fund, 2019).

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