Will we join hands for a tomorrow without antimicrobial resistance?

This article was exclusively written for The European Sting by Mr. Georgio Toumieh, a second year medical student at the American University of Beirut with a biology major and the national public health officer of the Lebanese Medical Students’ International Committee (LeMSIC). He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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The war against disease is with no doubt the greatest war that we humans have been collectively conducting for thousands of years, with antibiotics widely marketed as the weapons of choice to have a chance at winning. Such a statement is true, but like all weapons, antibiotics could end up harming us more than we would expect (1). Why does it matter if we use them correctly or not? The reason for that is that bacteria are actually smarter than we think they are. Whenever we administer an antibiotic regularly, randomly and without following clear instructions on how to use it, some of the microbes mutate genetically and gain the ability to resist its action (2). This is worsened even more when we use several types of antibiotics in such an erratic way that it leads to the development of superbugs resistant to most, if not all, antibiotics available on the market. Getting infected by one of those has proven to be deadly (3). Hence the importance of the role of medical and pharmaceutical professionals in raising awareness on the potential harms of antibiotic misuse and in making sure to prescribe them only when needed. However, the time has come to admit that antimicrobial resistance (AMR) has reached a stage where it cannot be mitigated through the management of direct antibiotic administration only. The huge problem of today can only be managed by the united effort of professionals from various backgrounds. In other terms, a One Health approach has to be implemented globally to be able to reach palpable results. In agriculture, antibiotics are being used for prophylaxis and for growth promotion in an erratic way and without following veterinarians’ advice for their proper use. One would think that once cattle is processed into food, antibiotics would disappear and no longer be present. However, it was found that actually there is a high dose of antibiotics that ends up in our plate because of this lack of responsibility (4). Moreover, the pollution of our environment is often taken for granted in the role it has in the dissemination of antibiotics. Indeed, reports have shown that pharmaceutical industries are dumping their wastes in such a careless way that the antibiotics contained in them end up in our surface water, which we so calmly drink (5). These three aspects of the OneHealth approach should be urgently addressed not only directly but also indirectly. The universities have a huge role in incorporating this perspective into their curriculums to make sure that the future generation can manage AMR efficiently. Additionally, research institutes should promote research on ways to manage AMR in a OneHealth approach as a supplement to their constant pursuit of new antibiotics (6). All of this however should be supported by governments around the world by following WHO’s recommendations for antibiotic use, by implementing vaccination programs, raising awareness on proper hygiene and assisting all concerned stakeholders in their war against AMR (7). Let us join hands in our battle against antimicrobial resistance and fight for a safer tomorrow. References (1) Chandel, Navdeep S, and G R Scott Budinger. “The good and the bad of antibiotics.” Science translational medicine vol. 5,192 (2013): 192fs25. doi:10.1126/scitranslmed.3006567 (2) Munita, Jose M, and Cesar A Arias. “Mechanisms of Antibiotic Resistance.” Microbiology spectrum vol. 4,2 (2016): 10.1128/microbiolspec.VMBF-0016-2015. doi:10.1128/microbiolspec.VMBF-0016-2015 (3) Aslam, Bilal et al. “Antibiotic resistance: a rundown of a global crisis.” Infection and drug resistance vol. 11 1645-1658. 10 Oct. 2018, doi:10.2147/IDR.S173867 (4) Hao, H., Cheng, G., Iqbal, Z., Ai, X., Hussain, H. I., Huang, L., … Yuan, Z. (2014). Benefits and risks of antimicrobial use in food-producing animals. Frontiers in microbiology, 5, 288. doi:10.3389/fmicb.2014.00288 (5) Ahmad, A., Patel, I., Khan, M. U., & Babar, Z. U. (2017). Pharmaceutical waste and antimicrobial resistance. The Lancet Infectious Diseases, 17(6), 578-579. doi:10.1016/s1473-3099(17)30268-2 (6) Mcewen, Scott A., and Peter J. Collignon. “Antimicrobial Resistance: a One Health Perspective.” Microbiology Spectrum, vol. 6, no. 2, May 2018, doi:10.1128/microbiolspec.arba-0009-2017. (7) Laura J. Shallcross, Sally C. Davies, The World Health Assembly resolution on antimicrobial resistance, Journal of Antimicrobial Chemotherapy, Volume 69, Issue 11, November 2014, Pages 2883–2885, https://doi.org/10.1093/jac/dku346 About the author Georgio Toumieh is a second year medical student at the American University of Beirut with a biology major and the national public health officer of the Lebanese Medical Students’ International Committee (LeMSIC). He considers himself as someone who is passionate about public health and its implications on our daily lives and about being involved in both pushing the leaders of today towards making the right decisions and building other medical students into fellow fighters for a better tomorrow. He also loves playing the piano, writing and relaxing on the beach!