Antimicrobial Resistance (AMR)

Antimicrobial Resistance (AMR)

What is AMR

Some bacteria, viruses, parasites, and other microbes, have adapted to medical treatments so effectively that commonly used drugs to prevent or eliminate them are no longer effective. These microbes lead to drug-resistant infections, a phenomenon known as antimicrobial resistance (AMR).  

Antimicrobial medications have saved millions of lives worldwide since the discovery of the first modern antimicrobials in the early 1900s, and they have become integral to medical care for people facing illness and disease. However, some bacteria, viruses, parasites, and other microbes, continually evolve to ensure their survival. In 2019, AMR was responsible for 1.27 million deaths, making it a leading global cause of mortality, with low-resource settings bearing the highest burdens.   

AMR is an urgent global public health threat. It can affect individuals at any stage of life, as well as the healthcare, veterinary, and agriculture industries. The direct consequences of infections caused by resistant microbes can be severe, resulting in increased morbidity, prolonged illnesses, extended hospital stays, higher costs, and increased mortality. If nothing is done to curb resistance, it could become the leading cause of mortality with an annual 10 million deaths globally by 2050. While MSF works to prevent and address AMR in the places where it works, it is a global challenge with long-term generational impact which requires cooperation and investments from different countries and sectors. All countries have a role to play in strengthening the global response to increasing rates of resistance. 

Facts About AMR

AMR infections are frequent in places where counterfeit or easily accessible antibiotics are common, or where antibiotics are overused and misused. Without proper diagnostics, healthcare providers may not know if a patient’s symptoms are those of a bacterial infection, and if they are, which bacteria is involved. This can result in unnecessary or wrong antibiotic prescriptions. In hospitals with poor hygiene, resistant bacteria can spread, affecting vulnerable patients who are already sick or have unhealed wounds.

Bacteria can become resistant to an antibiotic when they are exposed to it repeatedly, or to incomplete or sub-optimal doses. This can lead to the growth of mutant bacteria which the drug can no longer kill. Resistance to antimicrobials occurs in a wide range of disease-causing bacteria and can also be transmitted from one type of bacteria to another.

AMR infections often go unrecognized in their early stages, since they usually cause the same clinical symptoms as antibiotic-sensitive infections. Typically, they are identified only after the patient’s symptoms persist despite treatment with appropriate first-line antibiotics.

Prevention of infections is crucial in the fight against AMR. Having fewer infections means a reduced use of antibiotics, and therefore a reduced chance for that bacteria to develop resistance, or that already-resistant infections spread.

Infection prevention involves many different approaches, such as ensuring widescale population coverage with vaccines against infectious diseases, providing safe water and sanitation in communities, and establishing effective infection control measures in hospitals and health clinics.

When patients seek treatment for illnesses, doctors and health workers must avoid overusing antibiotics. They need access to microbiology laboratories that can accurately diagnose infections and point doctors to the correct prescription. Patients should be informed about the importance of taking antibiotics only when they are truly necessary. Antibiotics should be prescribed by a clinician and provided by a pharmacy. Patients must also be aware that  taking the prescribed dosage for the entire prescription period is of the utmost importance.

Strengthening laboratory capacity and hospital infection control practices is a key step which requires investment and good basic infrastructure, while other steps call for behavioral changes of the patients and medical staff alike. Some others demand decisive action from policymakers—for example, to end the over-the-counter and black-market antibiotic sale which is common in many countries.

Patients with an AMR infection, especially one resistant to multiple drugs, have fewer antibiotic treatment options. These options are generally more expensive, more complicated to administer (intravenously rather than orally) and often more toxic with numerous side effects.

For many types of highly resistant infections where no current antibiotics are effective, patients may be treated either with old antibiotics that were abandoned due to their potentially dangerous side effects, or with a combination of antibiotics that together might overcome the resistance. When no antibiotics work, and the infection is localized to a limb, amputation may be the only hope for saving the patient’s life.

AMR in Humanitarian Context

In a humanitarian context, such as during emergencies, conflicts, or natural disasters, the challenges associated with AMR become even more pronounced. Here’s how AMR is relevant in a humanitarian context.

How is MSF adressing AMR

MSF has made an institutional commitment to comprehensively address AMR in the humanitarian contexts where we operate, through a range of actions centered on providing quality care to patients, adapting to health system and community realities, and fostering countries’ engagement in policy change.

MSF employs a holistic approach to address AMR in humanitarian settings. The strategy includes three pillars: infection prevention and control, antimicrobial stewardship, and expanded access to diagnostic and surveillance. In addition, MSF approach encompass key transversal subjects: operational research, health promotion, learning and development, initiatives and innovations, analysis and advocacy, and prevention and vaccination.

Who has a role to play

Addressing AMR requires active involvement from healthcare professionals, individuals, policymakers, and the broader community to preserve antibiotic effectiveness. Healthcare providers ensure responsible use, individuals follow prescribed regimens, and policymakers implement regulations, support research, and promote public health campaigns.

What does it mean for patients

Patient’s life could take an unexpected turn when they contracted an infection. Initially, common antibiotics brought relief, but the infection returned relentlessly, and standard treatments proved futile due to antimicrobial resistance. Here is what happened with Riwa and Haydar.

Both struggle became more than physical; it was emotional and financial. Endless rounds of tests, consultations, and alternative medications drained both savings. The toll on both well-being was evident—constant pain, fatigue, and the looming uncertainty of effective treatment. The experience underscored the profound impact of AMR on an individual’s life. It wasn’t just a medical battle; it was a personal journey marked by setbacks, resilience, and the urgent need for innovative solutions to combat this silent threat.

What actions are needed on AMR

AMR is a global issue that requires cooperation from all countries. Similar to how the COVID-19 pandemic emphasized that infectious diseases anywhere can impact everyone globally, AMR poses the same risk.

Countries with greater resources should support those with less capacity, committing resources to three main actions:

1- Developing Infection Prevention and Control (IPC) and Stewardship Programs to halt infection spread and ensure proper antimicrobial use.

2- Establishing Quality Microbiology Laboratories and supporting innovations like mini-labs and Antibiogo.

3- Assisting in Access to Medicines by aiding low-resource settings with forecasting medical needs, ensuring transparent global distribution, promoting local production, supporting joint procurement of affordable medical tools, and providing funding for these activities. Furthermore, enhancing overall community health, including clean water, sanitation, and vaccinations, is vital in combating AMR. Many low-resource areas lack funds for these critical measures. A collective effort is essential to prepare for rising resistance rates and curb their global spread.

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