Antimicrobial resistance

Sanjeet Kumar

Antimicrobial resistance is resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive. Resistant organisms (they include bacteria, viruses and some parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist and may spread to others. It is a consequence of the use, particularly the misuse of antimicrobial medicines and develops when a microorganism mutates or acquires a resistance gene.

Why is antimicrobial resistance a global concern?

It kills

Infections caused by resistant microorganisms often fail to respond to the standard treatment, resulting in prolonged illness and greater risk of death.

It hampers the control of infectious diseases

AMR reduces the effectiveness of treatment because patients remain infectious for longer, thus potentially spreading resistant microorganisms to others.

It threatens a return to the pre-antibiotic era

Many infectious diseases risk becoming uncontrollable and could derail the progress made towards reaching the targets of the health-related United Nations Millennium Development Goals set for 2015.

It increases the costs of health care

When infections become resistant to first-line medicines, more expensive therapies must be used. The longer duration of illness and treatment, often in hospitals, increases health-care costs and the financial burden to families and societies.

It jeopardizes health-care gains to society

The achievements of modern medicine are put at risk by antimicrobial resistance . Without effective antimicrobials for care and prevention of infections, the success of treatments such as organ transplantation, cancer chemotherapy and major surgery would be compromised.

It threatens health security, and damages trade and economies

The growth of global trade and travel allows resistant microorganisms to be spread rapidly to distant countries and continents

What drives antimicrobial resistance?

Inappropriate and irrational use of medicines provides favourable conditions for resistant microorganisms to emerge and spread. For example, when patients do not take the full course of a prescribed antimicrobial or when poor quality antimicrobials are used, resistant microorganisms can emerge and spread.

Underlying factors that drive AMR include:

• inadequate national commitment to a comprehensive and coordinated response, ill-defined accountability and insufficient engagement of communities;
• weak or absent surveillance and monitoring systems;
• inadequate systems to ensure quality and uninterrupted supply of medicines
• inappropriate and irrational use of medicines, including in animal husbandry:
• poor infection prevention and control practices;
• depleted arsenals of diagnostics, medicines and vaccines as well as insufficient research and development on new products.

Combat drug resistance: no action today, no cure tomorrow

The emergence of antimicrobial resistance is a complex problem driven by many interconnected factors; single, isolated interventions have little impact. A global and national multi-sectoral response is urgently needed to combat the growing threat of it.

WHO's response

WHO is engaged in guiding the response to it through?

• Policy guidance, support for surveillance, technical assistance, knowledge generation and partnerships, including through disease prevention and control programmes
• Essential medicines quality, supply and rational use
• Infection prevention and control
• Patient safety
• Laboratory quality assurance.

WHO has selected combating antimicrobial resistance as the theme for World Health Day 2011. On this day, WHO issues an international call for concerted action to halt the spread of antimicrobial resistance and recommends a six-point policy package for governments.

WHO calls on all key stakeholders, including policy-makers and planners, the public and patients, practitioners and prescribers, pharmacists and dispensers, and the pharmaceutical industry, to act and take responsibility for combating antimicrobial resistance. The European Centre for Disease Prevention and Control estimates that antimicrobial resistance results each year in 25 000 deaths and related costs of over €1.5 billion in healthcare expenses and productivity losses. The situation is all the more serious because antimicrobials have become an essential tool for modern medicine. Many surgical operations could not be performed without them.

Action plan against antimicrobial resistance

The Commission's 2011 action plan against the rising threats from antimicrobial resistance contains 12 actions for implementation with EU member countries and identifies 7 areas where measures are most necessary:

• Making sure antimicrobials are used appropriately in both humans and animals
• Preventing microbial infections and their spread
• Developing new effective antimicrobials or alternatives for treatment
• Cooperating with international partners to contain the risks of AMR
• Improving monitoring and surveillance in human and animal medicine
• Promoting research and innovation
• Improving communication, education and training.

Source: WHO Report.