Article on Strategies to Reduce Antibiotic Misuse and Address Antimicrobial Resistance
M3 India Newsdesk Apr 30, 2025
Antimicrobial resistance (AMR) is a rising global health threat, worsened by the COVID-19 pandemic. This article emphasises the need for coordinated efforts in prevention, responsible antimicrobial use, and innovative strategies to combat AMR.
Antimicrobial resistance (AMR) represents one of the most significant public health challenges of our time, characterised by the ability of microorganisms to withstand antimicrobial treatments. It has been gaining momentum globally, with experts referring to it as the "slow pandemic" due to its insidious progression and significant implications for healthcare systems worldwide.
The COVID-19 pandemic has further complicated this landscape, potentially accelerating AMR through changes in antimicrobial usage patterns, infection control practices, and healthcare delivery systems, etc.
Current estimates suggest that AMR causes approximately 700,000 deaths/year worldwide, with projections indicating this figure could rise to 10 million deaths/year by 2050.
Understanding Antimicrobial Resistance
Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites evolve to no longer respond to antimicrobial drugs. A microorganism is considered resistant when recommended doses of antimicrobial agents neither kill nor effectively inhibit its multiplication. This phenomenon represents a natural evolutionary process that has been immensely accelerated by human activities, particularly the inappropriate use of antimicrobials in healthcare and agriculture.
The causes of antibiotic misuse include:
- Overuse and Misuse of Antibiotics are often prescribed when not needed, such as in viral infections, contributing to resistance.
- Inappropriate Prescribing: Incorrect choice of antibiotic, duration, or dosage can lead to ineffective treatment and resistance.
- Lack of Adherence: Not completing the full course of antibiotics can promote resistance.
- Poor Hygiene and Infection Control: Inadequate hygiene practices increase the spread of resistant bacteria.
- Public Misconceptions: Misunderstandings about antibiotics' effectiveness for mild illnesses lead to overuse & misuse.
- Healthcare Access Issues: Limited access to diagnostic tools and healthcare facilities can exacerbate misuse.
- Self-medication involves using antibiotics without a prescription, leading to misuse and increased it’s resistance.
- OTC access to antibiotics facilitates self-medication, as individuals can easily purchase antibiotics without medical supervision.
- Agricultural misuse of antibiotics involves their overuse in animal husbandry to promote growth and prevent disease, but contributes significantly to antibiotic resistance.
Increased Antimicrobial Usage During the Pandemic
During the early waves of the COVID-19 pandemic, healthcare systems worldwide experienced unusual pressure, leading to changes in antimicrobial prescribing practices.
Millions of antibiotic prescriptions were inappropriately issued in the context of treating COVID-19 patients, despite COVID-19 being a viral infection not responsive to antibiotics. This extensive misuse has potentially contributed to the emergence of new resistance patterns globally.
Changes in Infection Prevention and Control Practices
The COVID-19 pandemic necessitated shifts in healthcare priorities, sometimes resulting in the reprioritisation of infection prevention and control (IPC) measures and antimicrobial stewardship programs (ASPs).
According to surveys by the Global Antimicrobial Resistance and Use Surveillance System (GLASS), while many infection control measures improved during the pandemic but breaches in adherence to standard practices were also reported. These inconsistencies may explain the differential impacts on resistance patterns across various pathogens.
Surveillance and Management Strategies
1. Infection Prevention and Control
The role of infection prevention and control (IPC) measures in combating AMR became particularly evident during the COVID-19 pandemic. According to international surveys, many IPC measures improved across countries during the pandemic, though adherence varied.
The relationship between enhanced IPC practices and AMR outcomes remains complex, with some studies finding no statistically significant differences in resistance rates between healthcare settings with and without enhanced IPC interventions.
2. Antimicrobial Stewardship Programs
Antimicrobial stewardship programs (ASPs) represent a critical strategy for addressing AMR through promoting appropriate antimicrobial use. Studies examining the impact of these programs during the pandemic have yielded mixed results, highlighting the need for continued emphasis on ASP as healthcare systems recover from the pandemic.
3. International Monitoring Approaches
The complex and global nature of AMR necessitates coordinated international monitoring efforts. Organisations like the Global Antimicrobial Resistance and Use Surveillance System (GLASS) have played important roles in tracking resistance patterns during and after the COVID-19 pandemic [1]. These surveillance networks provide valuable data for understanding AMR trends and informing policy responses.
4. Education and Awareness
Educating patients and healthcare professionals about appropriate antibiotic use and the risks of resistance is important.
5. Regulation in Agriculture & Animal Husbandry
Like the FAO, it supports reducing antimicrobial use through good agricultural practices and prudent use, with initiatives like RENOFARM aimed at transforming agrifood systems.[2]
6. Development of new antibiotics and alternatives
Explore novel antibiotics from unexplored bacteria, and use anti-virulence agents, nano-antibiotics, and antibiotic adjuvants to improve efficacy and reduce resistance.
7. One Health approach
Integrate human, animal, and environmental health efforts to prevent zoonotic resistant infections and promote organic farming. Ex. In Sikkim(India), 100% organic farming is practised.
8. Host immunomodulation
Use vaccines, probiotics, prebiotics, monoclonal antibodies, and microbiome transplantation to reduce infection severity and antibiotic need.
9. Use of technology and AI
Employ artificial intelligence(AI) for drug design, prediction of resistance, and novel treatment strategies.
10. Plasmid curing and anti-plasmid strategies
Target genetic elements that spread resistance to reduce AMR gene prevalence.
Together, these strategies form a comprehensive framework to combat AMR globally by reducing misuse, preventing infections, innovating treatments, and monitoring resistance.
The benefits of using traditional medicinal practices to combat AMR include
- Cost-effectiveness and Accessibility: Traditional medicines, often based on medicinal plants, provide affordable alternatives to expensive modern antibiotics, especially in developing & poor countries.
- Diverse Bioactive Compounds: Medicinal plants contain multiple bioactive compounds that can kill pathogens, reducing the chance of resistance development compared to single-target antibiotics.
- Synergistic Effects: Combining traditional plant extracts with standard antibiotics can enhance antimicrobial efficacy, expand the spectrum, prevent resistance emergence, and lower toxicity.[3]
- Immune System Support: Some traditional remedies act as bio-enhancers by boosting the immune system and improving drug absorption and metabolism, aiding infection control.
- Sustainability and Reduced Antibiotic Use: Ethno-veterinary practices and organic farming reduce antibiotic residues in food products and lower antibiotic dependence, supporting One Health goals.
- Lower Side Effects: Herbal medicines generally have fewer adverse effects than synthetic drugs, improving patients' quality of life.
- Preservation of Traditional Knowledge: Utilising and researching traditional medicine helps retain valuable generational wisdom that may lead to novel antimicrobial discoveries.
Conclusion
AMR represents a significant and growing threat to global public health, characterised by complex mechanisms and patterns that vary across different types of microorganisms. The COVID-19 pandemic has influenced AMR dynamics in multiple ways, though the relationship is not straightforward and varies by pathogen and context.
While some pathogens, particularly certain Gram-negative bacteria, have shown concerning increases in resistance rates, others have demonstrated more stable patterns. The COVID-19 pandemic's impact on healthcare practices, antimicrobial use, and infection control measures has created a complex landscape that continues to evolve.
Moving forward, addressing AMR will require integrated approaches across national boundaries, with a strong emphasis on rational, personalised, and regulated use of antimicrobials. Enhanced surveillance systems, robust infection prevention and control practices, and effective antimicrobial stewardship programs(ASPS) will be essential components of this response. As we navigate the post-pandemic era, maintaining vigilance against this "slow pandemic" of antimicrobial resistance must remain a global health priority.
Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.
About the author of this article: Dr Jyoti Biswas is a General Practitioner and Medical Writer from Kolkata.
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