A growing threat to the health of millions of people worldwide, antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi, and parasites change over time and become less or unresponsive to antimicrobial drugs.
The growing incidence of AMR is the result of excessive use of antimicrobial drugs, often rendering them ineffective and making it harder to treat infections while increasing patients' risk of severe illness and death. According to the World Health Organization (WHO), bacterial resistance to antibiotics kills between 1.25 to five million people every year*, with experts within healthcare describing AMR as ‘the quiet pandemic.’
Today, many patients are being prescribed antimicrobials before proper diagnosis. Due to the risk of infection when admitting a patient, it is not uncommon for medical professionals to face pressure to use more broad-spectrum antibiotics, usually in combination. This eventually leads to the development of more aggressive and resistant organisms, resulting in a vicious circle requiring the prescription of even more antibiotics.
At its peak, the COVID-19 pandemic had increased hospital and ICU admissions to compound the AMR threat further. The increased use of antibiotics has resulted from an increase in the number of mechanically ventilated patients, the use of medical devices needed by patients, including urinary and dialysis catheters, and longer hospital stays.
While AMR is a global threat, the risk is magnified in the region (particularly the UAE) as it hosts large events and becomes a tourism and aviation hub, with many millions of annual visitors. The growing incidence of AMR, however, can be effectively reduced if we carefully manage antibiotic use to make them more effective at killing bacteria. Critical to achieving this outcome is the role of healthcare professionals, who should support the correct use of antibiotics.
Dr. Ashraf Elhoufi
Medical providers and institutions can further support efforts to reduce AMR by applying antimicrobial stewardship best practices. A coordinated effort to measure and improve how antibiotics are prescribed by clinicians and used by patients can help to encourage evidence-based prescribing, which reduces the chances of AMR. And finally, healthcare authorities also have an essential role to play.
In the UAE, for example, training and awareness programs are continuously and consistently conducted and supported by the country’s various health authorities in both the public and the private sectors.
Medical professionals must adhere to the following guidelines to stop antibiotics' incorrect use. Moreover, patients should be similarly aware of the correct use of antibiotics. These should only be used to treat an infection. Accordingly, it is imperative that physicians properly and correctly diagnose an infection before prescribing antibiotics.
To properly diagnose an infection, relevant samples, such as blood, urine, and sputum, should be taken before starting antibiotics. Antibiotics should be stopped immediately if a course of antibiotics is prescribed on the suspicion of infection, but follow-up investigations show no evidence of an infection.
The prescription of antibiotics should be evidence-based and consistent with the recognised local, regional, and international guidelines. Based on culture and sensitivity results, antibiotics should be reviewed and adjusted within 48-72 hours (or even earlier if rapid diagnostics are used)
Through dosing and administration, antibiotic courses should be optimised based on the nature of the infection, severity of illness, the patient’s body weight and body organ functions. Antibiotics courses should be short but sufficient to avoid the continuous harmful pressure on microbial ecology.
In summary, we cannot be immune to the threat of AMR, and run the risk turning back the clock on more than a hundred years of scientific progress. But if we do not pay closer attention to how we are prescribing antibiotics, they will lose their effectiveness, and we would be left unable to treat infections and control public health threats. Healthcare practitioners, patients and health authorities must work together to reduce the threat of AMR and ensure our future health.
--
Dr. Ashraf ElHoufi is the Chairman of the Infection Control Committee and the Consultant and Head of ICU at Dubai Hospital, an examiner for the Royal College of Physicians of the UK, and a Professor of Medicine at Dubai Medical College.
