Antimicrobial Resistance: Cause for Concern and Optimism?
Kenneth Lawrence, PharmD, discusses the global problem and the need for a layered, multifaceted approach to antimicrobial resistance (AMR) and some of the ongoing inroads and progress being made to address the medical issue.
World Antimicrobial Resistance Awareness Week (WAAW) is being observed this week. It is commemorated annually from November 18–24, and it is “a global campaign to raise awareness and understanding of AMR and promote best practices among One Health stakeholders to reduce the emergence and spread of drug-resistant infections,” according to the World Health Organization’s (WHO) website. This year’s theme is Educate. Advocate. Act now. 1
Within this awareness campaign is the concept of One Health. According to WHO, “One Health is an integrated, unifying approach to balance and optimize the health of people, animals and the environment. It is particularly important to prevent, predict, detect, and respond to global health threats such as the COVID-19 pandemic. The approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together. This way, new and better ideas are developed that address root causes and create long-term, sustainable solutions. One Health involves the public health, veterinary, public health and environmental sectors.”2
The scope of AMR globally is enormous and AMR-associate mortality is expected to increase for years to come. A study published earlier this year in The Lancet looked at AMR-associate mortality from this year up to 2050 and the number of deaths in that time period. This was a modeling analysis that predicted that more than 39 million people could die from AMR globally in that time period.3
According to the study’s investigators, more than 1 million people died each year as a result of AMR between 1990 and 2021. The study also estimates 1.91 million people could potentially die as a direct result of AMR in 2050, an increase of almost 70% per year compared to 2022. Over the same period, the number of deaths in which AMR bacteria play a role will increase by almost 75% from 4.71 million to 8.22 million per year (Table).3
This table captures the estimated and predicted figures for AMR-related deaths, showing how the number of deaths is expected to grow over time.
Table credit: ChatGPT
Although the medical community and public health officials are both fully aware of AMR’s impact; this is not something that is commonly discussed with the public. “This is what many people refer to as a silent pandemic,” said Kenneth Lawrence, PharmD, member of the Peggy Lillis Foundation's board of directors. “Many people, if you were to talk to them, know somebody that may have been impacted by AMR. So I think this topic is something that really does need to come more into the forefront.”
One of the more promising developments, according to Lawrence, was that the United Nations came together this past summer during a General Assembly where all nations attend the meeting and discussed AMR.
“At that meeting, there were not only a number of important stakeholders, most importantly for me and I think others, there were also several patients and patient advocates there who spoke directly to those members of the General Assembly,” Lawrence said. “And fortunately, what came out of that is some political declarations that there would be political will targets directed towards reducing the number of deaths due to AMR by an appreciable number by 2030.”
The 2030 number is symbolic and significant as the WHO often uses this year as a landmark to see progress across several health initiatives.
Stewardship Includes Patient Safety
One area Lawrence believes can make a significant impact is antimicrobial stewardship. He says he and stakeholders within the Peggy Lillis Foundation are trying to focus on the appropriate use of antibiotics. “We know, based on current studies, that about 30% of those antibiotics prescribed, whether they're for adults or pediatrics, are unnecessary,” Lawrence said. “And the most common infections where we see those are viral infections due to upper respiratory tract infections.”
Education is another key in employing stewardship says Lawrence.
“It really starts with education, not only of those junior physicians, but also the patients, helping them understand that antibiotics may not always be necessary.”
He says it’s about working with clinicians to ensure that patients are receiving the right medication. “It's not always the broadest spectrum antibiotic that's necessary and making sure that it's the appropriate duration of treatment.”
“We're now learning with very good studies that long courses of antibiotics may not be necessary for a number of the common infectious disease syndromes. There was some literature that came out about shorter treatment of bloodstream infections of less than 10 days." Additionally he says the utilization of newer diagnostics to get to a more accurate diagnosis in a timely manner is also part of the stewardship equation.
“When we can get patients out of the hospital to switch them to oral medication, those are all things that can help reduce the overall use of antibiotics—to tailor the antibiotic use, and over the long run, reduce the risk of of antibiotic resistance, and, more importantly, improve patient safety. I can't underscore enough that antimicrobial stewardship focuses on patient safety.”
For more news and information on AMR, check out our coverage from the World AMR Congress.
