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Commentary: Our misuse, overuse of antibiotics comes with a huge cost
Infections can become resistant to the standard drugs used to treat them if we are not careful, say Dr Clarence Tam and Jane Lim from NUS Saw Swee Hock School of Public Health.
Ten pills of the antibiotic Amoxicillin at a pharmacy in Hanau, Germany, May 31, 2018. (File photo: REUTERS/Kai Pfaffenbach)
SINGAPORE: Globally, around 700,000 people die each year from infections resistant to the standard drugs used to treat them.
This number is projected to rise to 10 million deaths per year unless urgent, concerted action is taken to address antimicrobial resistance (AMR).
Statistics on this scale are hard for us to fathom. But behind each of these numbers lies a tragic story.
RESISTANCE TO ANTIBIOTICS FROM OVERUSE, MISUSE
The loss of effective antibiotics and other antimicrobial drugs to treat infections means more patients like Matthew Ames, an Australian father of four whose sore throat turned into a life-threatening, drug-resistant infection that led to his arms and legs being amputated.
Or the anonymous 65-year-old HIV patient in Singapore, who after extensive treatment for severe pneumonia was re-hospitalised with a multidrug-resistant Salmonella infection that required several weeks of treatment with multiple drugs, before finally responding to a third-line antibiotic.
Or Addie Rerecich, an 11-year-old American girl who contracted a drug-resistant infection that caused blood poisoning, pneumonia and blood clots in her lungs, and who required life support for three months, a double lung transplant and treatment costing US$6 million.
And these are the fortunate ones who survived to tell their story.
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As these patient stories show, the rapid spread of bacterial infections resistant to multiple antibiotics is a global concern.
A major factor in this rapid spread of resistance is the overuse and misuse of antibiotics in humans and animals. Strategies to encourage responsible use of antibiotics in both sectors are key to turning back the tide on antibiotic resistance.
TURNING BACK THE TIDE
Singapore’s National Strategic Action Plan on Antimicrobial Resistance highlights the importance of increasing public awareness about appropriate antibiotic use as one of five core strategies to address antibiotic resistance.
Creative platforms for education and raising awareness are important strategies in tackling any public health issue, and AMR is no exception.
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In 2017, the Japanese Ministry of Health, Labour and Welfare enlisted Gundam, a wide-reaching Japanese anime franchise, to increase awareness on AMR.
Amuro, a popular fictional universe Gundam character, was tasked with the challenge of protecting the public from AMR through education.
Accordingly, one of his well-known catchphrases “Amuro ikimasu!” (“Amuro is heading out!”) was repurposed to say “AMR taisaku ikimasu!” (“AMR countermeasures are heading out!”).
Closer to home, The Antibiotic Tales, a comic book by local graphic novelist, Sonny Liew, and infectious disease physician, Hsu Li Yang, was recently released to inform readers about antibiotic resistance.
Singapore’s Health Promotion Board has also created a campaign using an antibiotic pill to promote awareness among the general public about the futility of using antibiotics to recover from the common cold and flu, and steps that people can take to prevent the spread of antibiotic resistance.
But how exactly has Singapore been faring?
HOW SINGAPORE FARES ON NATIONAL AWARENESS OF ANTIBIOTICS
We conducted a survey among 735 Singaporean residents aged 21 and above to explore community knowledge and awareness about antibiotics and antibiotic resistance.
We found that most participants had heard of antibiotics (98 per cent) and antibiotic resistance (60 per cent). Eight out of 10 recognised antibiotics as medicine that could help them recover from bacterial infections.
Half of all participants went to a doctor when they experienced symptoms of the cold or flu, expecting information about the illness, advice for self-care, or medical certificates.
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Encouragingly, only 10 per cent of participants explicitly asked their doctor for antibiotics. The vast majority of respondents were aware they should not keep leftover antibiotics or share them with others; antibiotics should only be used as prescribed by a qualified healthcare professional.
MANY COMMON MISCONCEPTIONS REMAIN
There were, however, some common misconceptions. More than a third of respondents thought antibiotics could help them recover from the common cold and flu. These, however, are caused by viruses, against which antibiotics are not effective.
Many respondents also believed that antibiotic resistance occurs because antibiotics become less powerful so they do not work as well, or that our bodies become resistant to the antibiotics.
In fact, bacteria resistant to antibiotics exist naturally in the environment, in animals, and in our bodies. When we take antibiotics, we may kill useful bacteria that help keep the resistant ones in check, allowing these to thrive and multiply.
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If we use too many antibiotics, over time, most bacteria will become resistant. When they cause infections, our existing antibiotics will not work to treat them.
Additionally, about a third of survey respondents believed as long as they used antibiotics appropriately themselves, they did not have to worry about antibiotic resistant infections.
Unfortunately, antibiotic resistant bacteria can be spread between people, acquired through contaminated food products, and contracted from animals, so preventing antibiotic resistant infections requires that we all use antibiotics responsibly.
TACKLING AMR
Losing these life-saving medications to antimicrobial resistance is something that as a society we cannot afford.
Without effective antibiotics, we lose the ability to perform advanced medical procedures that rely on antibiotics to prevent and treat infections.
We also face the prospect of losing ever more people to infections that are increasingly becoming untreatable.
It helps to improve health messaging to address common misconceptions among the public; it is crucial that we all understand how we can act responsibly to ensure that antibiotics remain effective for everyone.
It is now time to deploy our most important AMR countermeasure – the public  Â
Dr Clarence Tam is Assistant Professor at the NUS Saw Swee Hock School of Public Health. Jane Lim is a PhD student at the same school.
