Understanding the threat of antimicrobial resistance

Said to pose more of a threat than the COVID-19 pandemic, antimicrobial resistance occurs when germs like bacteria, viruses and fungi develop the ability to defeat the drugs designed to kill them. Yet there are ways to prevent its spread.

What is antimicrobial resistance?

When the germs that make you sick develop resistance to the medication designed to treat you, these germs are not killed and continue to grow and multiply. Through antimicrobial resistance, these germs defeat the drugs that are supposed to kill them and therefore continue to make you sick. 

“Resistant infections can be difficult, and sometimes impossible, to treat,” says Andriette van Jaarsveld, a clinical pharmacy specialist at Mediclinic Southern Africa. Spearheading antimicrobial stewardship programmes for the group aimed at fighting the spread of antimicrobial resistant organisms, van Jaarsveld oversees the appropriate use of antimicrobials.

“Antimicrobials is a collective term for antibiotics, that work against bacteria; antiviral medication, that works against illnesses like COVID-19; anti-parasites that work against diseases like malaria; and antifungal medication, that is used, for example, in the treatment of thrush,” she explains. “In a hospital setting, what we struggle with most is antibiotic and antifungal resistance which is what we mainly treat.”

Understanding the causes of antimicrobial resistance 

Antimicrobial resistance is in fact a naturally occurring process, van Jaarsveld explains. “It's natural for the bacteria and other germs to develop resistance to things that they get exposed to – in this instance medication. In nature, if something threatens you, you develop a mechanism to combat that threat.”

Yet your behaviour in terms of your frequency of antimicrobial use, also plays a role in the development of resistance. “Because we expose germs so often to these antibiotics, they develop the resistance so much quicker,” van Jaarsveld explains. “Broadly speaking, the problem is that we think antibiotics will help us to get better quicker, but they don't, because often they’re the wrong form of treatment for your underlying condition.” 

In the case of allergies and viral infections such as flu and Covid-19 where you can get extremely sick, antibiotics will not kill the virus – it’s the wrong drug for that specific illness. In such cases, an antibiotic won’t cure your illness but rather enable bacteria in your body to develop a resistance to it. “While any antimicrobial use drives the process, unnecessary use increases the development of resistance needlessly and we can do something about that,” van Jaarsveld stresses.

Who is at risk of antimicrobial resistance?

Those who are more frequently exposed to antibiotics also face a higher risk of developing antimicrobial resistance. As resistance bacteria in your body spread throughout the environment in which you find yourself, everyone is at risk of antimicrobial resistance – regardless of their age, although the risk of complications is higher in the elderly. “Antimicrobial resistance is driven by the combination of the germs exposed to the antibiotics and the spread of those germs,” van Jaarsveld explains.

“Vulnerable people such as those who are immunocompromised are more at risk than others because their bodies can’t fight the infection as well as others,” she continues. “They tend to get sicker quicker and tend to have antibiotics more readily prescribed to them, resulting in the organisms that cause their infections becoming very resistant very quickly. In South African hospitals, we already have patients that we can’t cure as infections caused by resistant germs are difficult – sometimes impossible to treat. They die of infections that we could have treated in 2008 and now we can’t because the antibiotics are not working.”

Preventing antimicrobial resistance

The good news is there are ways to lower the instance of antimicrobial resistance. According to van Jaarsveld these include:

• Not pressuring your doctor for an antibiotic, when he or she says you don’t need one.
• In cases where you are given antibiotics, use them exactly as prescribed.
• Don’t take someone else’s antibiotics – never take them if a doctor didn’t prescribe them to you. 
• Practice good hand hygiene to prevent contracting or spreading infections.
• Stay home when you’re unwell.
• Ask your healthcare professional if there are steps you can take to get symptomatic relief without using antibiotics.

“In most cases, you can get a long way without an antibiotic because your body can fight against the illness itself so don’t take them unless you absolutely need them,” says van Jaarsveld. Rest and symptomatic treatment are often equally effective. Many respiratory illnesses are viral, in which case antibiotics will not work. 

Worst-case scenario 

Failing to curb the incidence of antimicrobial resistance will be deadly, says van Jaarsveld. The problem is it’s not just you that becomes resistant to antimicrobials, it’s the bacteria in your body and those are the bacteria that you are spreading to everyone around you. “It’s a global threat because what each individual does, has an influence on the rest of the world.”

“If we look at the incidence of people who are dying of drug-resistant infections now, we think that by 2050, more people are going to die because of antimicrobial resistance than those who died per year from COVID-19,” she adds. 

Yet your actions in using antimicrobials appropriately and preventing the spread of infections can make a significant difference.