Antimicrobial resistance
that drug-resistant bacterial infections contributed to an estimated 4.95 million associated deaths in 2019, including 1.27 million deaths directly attributable to bacterial AMR,6 making AMR a leading cause of death globally. If action is not taken, AMR could result in at least 10 million extra deaths a year globally and a cost of £66 trillion by 2050.7 Recognising the need for urgent action, the
UK government has recently committed to containing and controlling AMR by 2040.8
This
plan acknowledges the need for a global and national effort to lower the burden of infection, optimise the use of antimicrobials, and to develop new diagnostics and treatments.
How can we prevent the spread of AMR? There are many facets to fighting AMR, whether it is trying to develop new antimicrobials, looking at environmental pollution, more effective use of data and surveillance, or the improved management and distribution of current antimicrobials. The most immediate action that can be taken is reduced usage through a multi- sectoral approach, the use of alternative drugs and through better diagnostics.
Reduction through a ‘One Health’ approach The ‘One Health’ approach is defined as a joint effort of various disciplines that come together to provide solutions for human, animal, and environmental health (Figure 1). AMR is linked to each of these three components due to the prolific use of antimicrobials in areas including human healthcare, livestock production, agriculture, and aquaculture. Antimicrobials are heavily used in these industries to prevent disease and maintain animal welfare and food security. However, this perpetuates the occurrence
and spread of AMR, threatening the food supply, human health, and veterinarian treatments. AMR
is a complex and global issue encompassing issues such as antimicrobial mismanagement, inadequate infection control, agricultural debris, contaminants in wastewater, and the movement of people and animals infected with resistant bacteria. As such, the management of antimicrobials
needs to be reduced and regulated across sectors including: l Farms and food industry premises. l Healthcare facilities. l Sewage treatment plants. l In the management of waste from antibiotic production.
Reduction through vaccines and alternative drugs As our current antimicrobials become less effective, it is important that we look for alternatives. We still need antimicrobials to treat infections in both animals and humans, to protect our crops, and to keep our hospitals, laboratories, and clinical spaces sterile. Despite our dependence on these compounds, the last time a new antibiotic class was discovered and brought to market was in 1987, meaning it has been over 30 years since a new class of antibiotics was produced (see Figure 2). 9,10 The continued lack of new antimicrobial
agents requires us to consider other alternatives that may be easier to develop or longer-lasting. One alternative measure to antibiotics is the use of vaccines. A new study published in 2023 has found that over half a million lives could be saved each year with the effective use of existing vaccines and the continued development of new vaccines to tackle priority pathogens.11
Vaccines play a
Fig 1. The One Health approach brings together many disciplines to provide solutions for human, animal, and environmental health.
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crucial role in decreasing rates of infections, which in turn reduces the need for antibiotics. For example, a highly effective tuberculosis (TB) vaccine could significantly cut back on cases of multidrug-resistant TB, which is the leading
cause of death related to AMR globally,12 but the
most readily available TB vaccine is still only effective in infants. Other alternative approaches to both
preventing and treating bacterial infections are also being researched, and could provide alternatives to antimicrobials in the future. Alternative treatments, including antimicrobial proteins, microbiome therapies, bacteriophages, probiotics, and plant-based substances, have the potential to delay or halt AMR development. However, many of these treatments are targeted at specific bacteria and may not lead to the full elimination of pathogenic bacterial infections.
Reduction through better diagnostics
As discussed, a significant cause of AMR is the excessive and improper use of antibiotics in both animals and people. It is common practice for antibiotics to be prescribed without clinical confirmation of bacterial presence. This means that many infections are treated with antibiotics even if they are viral in nature, making the treatment redundant. Diagnostic tests are the primary means
of identifying infectious disease in humans and animals and detecting resistance in microorganisms. However, traditional microbial detection methods tend to involve sending samples for laboratory testing, which is time- consuming and delays diagnosis, this in turn can lead to the further spread of infectious disease or the use of inappropriate medication. To close the gap between treatment and diagnosis, NHS England has recently published new guidance on integrating point-of-care testing (POCT) diagnostic technologies into urgent community response and virtual ward services, to ensure the best clinical outcomes.13 This guidance emphasises the importance and need of effective, fast, and low-cost diagnostic technologies for guiding the appropriate use
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