This article has been written by Ms. Abhipsa Tejasweta, a Second year student of Capital Law College, Odisha.

ABSTRACT

Antimicrobial resistance (AMR) has emerged as a critical global health threat, posing formidable challenges to the effective treatment of infectious diseases. This abstract explores the multifaceted dimensions of global antimicrobial resistance, delineating the complexities surrounding its rise and the subsequent risks it poses to public health. The paper elucidates the primary drivers of AMR, including the overuse and misuse of antibiotics in human and animal health, inadequate sanitation and hygiene practices, as well as the global interconnectedness facilitating the rapid spread of resistant strains.

The document also scrutinizes the socio-economic implications of antimicrobial resistance, emphasizing its potential to exacerbate health inequities and strain healthcare systems worldwide. Additionally, the abstract investigates the intricate interplay between antimicrobial resistance and other global challenges such as climate change, population growth, and the intensification of food production.

In response to these challenges, the abstract delineates a comprehensive set of mitigation strategies. These encompass enhanced global surveillance and monitoring systems, judicious use of antimicrobials in healthcare and agriculture, investment in research and development of new antibiotics, and the implementation of robust infection prevention and control measures. Furthermore, the abstract underscores the imperative of international collaboration and coordinated efforts to address AMR effectively, recognizing it as a shared responsibility requiring a unified global response.

As nations grapple with the intricate web of challenges posed by antimicrobial resistance, this abstract provides a succinct overview of the key issues and outlines a strategic framework for mitigating the impact of AMR on a global scale.

KEYWORDS- Antimicrobial stewardship, Drug-resistant infections, AMR surveillance, Overuse of antibiotics, Antifungal resistance, Antimicrobial misuse, and Superbugs.

INTRODUCTION

Antimicrobial resistance (AMR) occurs when microorganisms like bacteria, viruses, fungi, and parasites evolve and become less responsive to antimicrobial drugs. This can make infections harder to treat, increasing the risk of spread, severity, and mortality. It’s a growing global health concern, emphasizing the need for responsible antibiotic use and the development of new treatments. Imagine a battle between germs and the drugs we use to fight them. In the past, antibiotics and other antimicrobials were like powerful warriors, easily defeating the enemy germs. But over time, the germs have become stronger and developed ways to resist the drugs. Now, it’s like they’re wearing armor that makes the drugs ineffective. This is what antimicrobial resistance is all about. Overuse and misuse of antimicrobials is the main driver. When we take antibiotics for viral infections like colds or the flu, or when we don’t finish the full course of treatment, it gives resistant germs a chance to survive and multiply. Improper sanitation and hygiene can help germs spread, including resistant ones.

The development of new antibiotics is slow and expensive, and there are fewer new drugs being discovered now than in the past. Germs can naturally develop resistance over time, even without exposure to drugs. However, the overuse of antimicrobials speeds up this process. Human Healthcare is the main driver. When antibiotics are prescribed unnecessarily for viral infections or not completed for the full course, it gives resistant bacteria a chance to survive and multiply. Routine use of antibiotics in healthy animals to promote growth or prevent disease can also contribute to resistance. Antimicrobials used to control pests and diseases in crops and fish can also contribute to resistance development and spread. Bacteria and fungi naturally evolve and acquire mutations in their DNA that make them resistant to certain antimicrobials. This happens even without antibiotic use, but it’s accelerated with exposure. Resistant bacteria can share their resistance genes with other bacteria, even different species, through a process called horizontal gene transfer, further increasing the spread of resistance.

The pipeline for developing new antibiotics is slow and expensive, and fewer new drugs are being discovered compared to past decades. This means we rely on the same existing antibiotics, creating more pressure on them and accelerating resistance. Inadequate sanitation and hygiene practices, particularly in healthcare settings, can facilitate the spread of resistant bacteria. Lack of awareness among healthcare professionals, the public, and farmers about the dangers of antimicrobial resistance and the importance of proper use can contribute to its spread. In “Mandatory Reporting of AMR” many countries have implemented regulations requiring healthcare facilities and professionals to report cases of infections caused by multi-drug resistant (MDR) organisms. This data helps track the spread of resistance and inform public health interventions. In “Antibiotic Stewardship Programs” some jurisdictions have implemented legal frameworks requiring healthcare institutions to adopt antibiotic stewardship programs that promote the responsible use of antimicrobials.

These programs typically involve education for healthcare professionals, guidelines for prescribing practices, and infection control measures. Challenges like widespread use and inappropriate prescription of antimicrobials contribute to the development of resistance, infectious diseases and resistant strains can quickly spread globally, making coordinated efforts challenging, and few new antimicrobial drugs are being developed, limiting treatment options. The mitigation strategies that promote responsible use of antimicrobials in healthcare settings through stewardship programs, establish robust surveillance systems to monitor resistance patterns and detect outbreaks early, Raise awareness among healthcare professionals, policymakers, and the public about the importance of responsible antimicrobial use and Prioritize and expand vaccination programs to prevent infections and reduce the need for antibiotics.

Here are some alarming statistics that highlight the severity of the AMR threat:

1.27 million deaths in 2019 were directly attributable to bacterial AMR, while it contributed to an estimated 4.95 million deaths overall. (WHO) 50 million additional deaths are projected by 2050 if no action is taken. (Review on Antimicrobial Resistance) Antibiotic-resistant infections cause at least 2 million illnesses and 23,000 deaths in the United States alone each year. (CDC) Methicillin-resistant Staphylococcus aureus (MRSA), a drug-resistant staph infection, causes an estimated 112,851 infections and 20,744 deaths in the U.S. annually. (CDC) Klebsiella pneumoniae, a type of bacteria that can cause pneumonia and bloodstream infections, is becoming increasingly resistant to carbapenem antibiotics, considered a last-resort treatment. Candida albicans, a fungus that can cause thrush and other infections, is also exhibiting resistance to antifungal drugs. The global economic cost of AMR is estimated to be $1 trillion per year by 2050. (Review on Antimicrobial Resistance). In the U.S., antibiotic-resistant infections add an estimated $35.8 billion to annual healthcare costs. (CDC)  Overuse and misuse of antibiotics is the primary driver of AMR. Taking antibiotics for viral infections or not completing the prescribed course creates a breeding ground for resistant bacteria. Inadequate sanitation and hygiene, poor hygiene practices can facilitate the spread of resistant germs. Lack of new antibiotics development of new antibiotics is slow and expensive, while existing ones become less effective due to overuse.

Effective antimicrobial stewardship strategies include:

1. Guidelines and Protocols: Establishing evidence-based guidelines for antimicrobial use to guide healthcare professionals.
2. Education: Providing ongoing education for healthcare professionals and patients to promote understanding of proper antibiotic use.
3. Diagnostic Support: Encouraging the use of diagnostic tests to identify the specific pathogen causing an infection, allowing for targeted treatment.
4. Restricted Access: Implementing restrictions on certain high-priority antibiotics to prevent overuse and misuse.
5. Monitoring and Surveillance: Regularly monitoring antibiotic use and resistance patterns to identify trends and address emerging issues.
6. Feedback and Audit: Providing feedback to healthcare providers on their prescribing practices, fostering continuous improvement.
7. Multidisciplinary Approach: Involving a team of healthcare professionals, including pharmacists and infectious disease specialists, in decision-making regarding antibiotic use.
8. Promotion of Vaccination: Encouraging vaccination to prevent infections and reduce the need for antibiotics.
9. Patient Engagement: Educating patients about the importance of completing prescribed courses of antibiotics and discouraging self-medication.
10. Research and Development: Investing in the development of new antimicrobial agents to expand treatment options and combat resistance.

CONCLUSION:

Global antimicrobial resistance poses a significant threat to public health, requiring urgent and coordinated efforts. Addressing this challenge demands a multifaceted approach, including promoting responsible antimicrobial use, enhancing surveillance systems, fostering international collaboration, investing in research and development, and embracing a One Health perspective. By implementing these strategies, we can work towards mitigating antimicrobial resistance, preserving the efficacy of existing treatments, and safeguarding the well-being of individuals and communities worldwide.

References-

• This article was originally published on World Health Organization, Link of which is given underhttps://www.who.int/news/item/07-11-2017-stop-using-antibiotics-in-healthy-animals-to-prevent-the-spread-of-antibiotic-resistance#:~:text=Many%20countries%20have%20already%20taken,of%20antibiotics%20for%20growth%20promotion.
• This article was originally published on Centers for Disease Control and Prevention, Link of which is given under https://www.cdc.gov/antibiotic-use/antibiotic-resistance.html#:~:text=Antimicrobial%20resistance%20jeopardizes%20advancements%20in,effective%20antibiotics%20are%20not%20available.
• This article was originally published on Council of the European Union, Link of which is given under https://www.consilium.europa.eu/en/infographics/antimicrobial-resistance/#:~:text=Overuse%20and%20misuse%20of%20antimicrobials,in%20humans%2C%20animals%20or%20plants.&text=On%2013%20June%202023%2C%20the,a%20recommendation%20to%20fight%20AMR.
• This article was originally published on hopkinsmedicine.org, Link of which is given under https://www.hopkinsmedicine.org/health/wellness-and-prevention/antibiotics#:~:text=A%20common%20misconception%20is%20that,of%20developing%20medicine%2Dresistant%20bacteria.
• This article was originally published on fao.org, Link of which is given under https://www.fao.org/antimicrobial-resistance/background/what-is-it/en/#:~:text=Beside%20their%20direct%20negative%20impact,the%20effectiveness%20of%20veterinary%20medicines.
• This article was originally published on clevelandclinic.org, Link of which is given under https://my.clevelandclinic.org/health/articles/21655-antibiotic-resistance#:~:text=Spontaneous%20resistance.,fight%20off%20the%20medicine’s%20effects