AMR and the effective management of infections

Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites evolve over time and become unresponsive to medications that were once effective in treating those infections. This poses significant challenges in disease management, increasing the risk of disease transmission, severe illness, and even mortality.  

According to the World Health Organisation (WHO), AMR continues to be one of the top 10 global health concerns facing humanity, resulting in approximately 4.95 million deaths in 2019. A threat to the global economy is also predicted with AMR likely to impact international trade, healthcare costs and productivity. In the absence of preventive measures, AMR could cost the world’s economy US$100 trillion by 2050. 

There are several factors contributing to the rise in AMR. Antimicrobials are frequently employed in agriculture to enhance growth and prevent disease in livestock, according to Abdulrazaq S. Al-Jazari, Medical/Critical Pharmacy Department, division of pharmacy services at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.  

Related: Addressing antimicrobial resistance through One Health

However, this practice could lead to the development of resistant bacteria which can then spread to humans via the food chain. Inadequate infection prevention and control measures including improper hand hygiene, delay in administrating mandatory vaccinations and not caring for open wounds could lead to transmission and mutation of bacteria. Environmental factors also contribute to the rise, especially as they cause the spread of microbes from animals to humans through contaminated water or food.  

Certain bacteria possess inherent resistance to antimicrobials and can transfer their resistance genes to other bacteria, further aggravating the problem. “Bacteria is known to acquire resistance genes through horizontal gene transfer, where genes are exchanged between bacteria, or though mutation, which involves changed in the bacteria’s DNA. When bacteria acquire resistance genes, they become resistant to antimicrobials making infections caused by these bacteria more challenging to treat,” says Al-Jazari.  

Jay Purdy, Vice President and Therapeutic Area Lead Anti-infectives, Global Medical Affairs, Pfizer, strongly believes that the best antibiotics are the ones you do not need. The use of antibiotics promotes the growth of resistant bacteria in an individual’s gastrointestinal (GI) tract.  

Once the medication is administered, sensitive bacteria die off, leaving behind resistant ones that multiply and take over the GI tract. This disrupts the balance of bacteria in the gut leading to the development of bacteria such as C. difficile, which normally resides in the GI tract without causing trouble but can take over and cause difficult-to-treat gastrointestinal problems including diarrhoea.  

Physicians could benefit from using surveillance strategies and diagnostic testing that could help identify the pathogen that causes the infection. Once identified, the patient can be administered the right antibiotic that could help reduce antibacterial resistance and stop the infection.  

To address the crisis of AMR, Pfizer has developed four basic pillars. These include developing new antibiotics and vaccines that serve as a significant tool to prevent infections and therefore decrease the use of anti-infective drugs. Regional and global surveillance of antibiotic resistance patterns to assess the nature and scope of the problems and the effectiveness of their efforts to combat them.  

Related: Antimicrobial resistance: A global threat we can’t ignore

 Incorporating antimicrobial stewardship programmes to help reduce the spread of AMR by applying greater oversight of antibiotic usage and enabling more rational and judicious prescribing practices. The fourth pillar involves incentivising and introducing novel business models to support the development of additional anti-infectives and vaccines and encouraging more research of antibiotics.  

Purdy suggests that some of the most important antibiotics we have now and will have in the future are antibiotics that do not need new mechanisms of action but build upon those mechanisms that already exist and are understood in the industry.  

To address the global healthcare challenge of AMR it is imperative for doctors and physicians to administer antibiotics responsibly and only while treating bacterial infections. Educating the public about AMR and its preventive measures, raising awareness about the significance of good hygiene practices, and the importance of timely vaccinations are all essential to overcome the growing threat. 

This article appears in Omnia Health magazine. Read the full issue online today.

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