How the misuse of antibiotics has led to a silent pandemic

Antimicrobial resistance, which is responsible for more than a million deaths globally each year, could undermine a century of medical progress. Tackling this crisis will require buy-in from doctors, vets, policy-makers and citizens.

Microbes are everywhere: in our food, air, soil and water; in our bodies; and on high-touch surfaces like cellphones and doorknobs. But before you go dousing your keyboard in bleach, consider that these tiny living organisms, which include bacteria, viruses, fungi, algae and parasites, are often harmless and can even be beneficial. The problem lies with pathogens, the microbes that cause infection, and their growing and alarming resistance to drugs. Antimicrobial resistance — colloquially known as AMR — is responsible for nearly 1.3 million deaths globally each year; the annual death toll is projected to be 1.9 million by 2050.

The issue isn’t simply that microbes evolve to resist the substances that threaten their existence — that is a natural and expected phenomenon. The current crisis has to do with the overzealous and improper use of antimicrobials to treat diseases in humans, animals and plants, which is supercharging resistance. As the medicines we normally rely on become less effective, we are finding that infections are increasingly hard to treat, new illnesses are on the rise and diseases we thought we had eradicated are returning.

International collaboration is crucial to address this silent pandemic, which is why global experts are pushing for the adoption of more responsible antibiotic use, preventative health measures and better infrastructure. Here’s the low-down on what’s at stake, what large-scale solutions are in play and what you can do to help protect your health and the health of all the creatures around you.

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How worried should I be?

Low- and middle-income nations are the ones most heavily impacted by AMR, but no country is safe — including wealthy ones in the global north, such as Canada. “Antimicrobial resistance could unwind 100 years of medical progress, making infections that are easily treatable today a death sentence,” said Dr. Tedros Adhanom Ghebreyesus, the director general of the World Health Organization, while addressing the United Nations in 2024. He is just one of many infectious disease experts who believe that AMR has become a global health crisis as urgent as climate action. Buy-in from everyone, including policy-makers, health practitioners, animal agricultural workers and even domestic pet owners, is required. A “One Health” approach recognizes that human, animal and environmental well-being are all intrinsically linked and must be addressed in tandem.

When and how should I be using antibiotics?

Knowing when to employ antibiotics is key to fighting AMR. For example, these medications are required to treat common bacterial infections such as UTIs, tuberculosis and gonorrhea, and they should be taken by patients with vulnerable immune systems post-chemotherapy. They are not effective for viral infections, such as the cold and flu; and over-the-counter fever and pain relief meds are often all that is needed to mitigate symptoms for mild cases of bronchitis and ear infections in otherwise healthy patients. When antibiotics are prescribed, it is important to complete the full course of treatment — stopping too early makes it less likely that all the bad bacteria will be wiped out, and more likely that the more resistant microbes that remain will multiply. As well, bringing any leftover medication to a pharmacy or veterinary office where it can be safely disposed of is a key step in curbing AMR.

Why is AMR getting worse?

Over-prescription is a significant contributor to AMR, but it’s not the only one. Climate change is a major driver: rising temperatures promote bacteria growth, more flooding propagates more disease and increased contact between humans and wildlife due to habitat loss facilitates the transmission of resistant microbes. Another factor is the multitude of options for those in search of treatment. Human patients without primary-care physicians may head to emergency departments, others will seek advice from pharmacists and others still will access family doctors. Traditionally, the lack of universal standards across these different entry points has contributed to inconsistent treatment and the further proliferation of disease. There is no magic bullet to addressing AMR, but setting up, then adapting international guidelines, can go a long way.

How do guidelines fit into the larger solution? There is a larger solution, right?

In 2022, the WHO published The Who AWaRe (Access, Watch, Reserve) Antibiotic Book, a resource to help health professionals select the best antibiotics for their patients and determine the appropriate dosage, route of administration and duration of treatment. The WHO then partnered with Firstline, a Canadian startup that has developed a free mobile app and health technology platform, to deliver this crucial AMR-related information to primary-care clinics and hospitals around the world.

Michael Long, the chief clinical officer at Firstline, acknowledges that prescribing antimicrobials and treating infections is extraordinarily complex. Evidence-based guidelines can simplify matters by equipping care providers with expert insights and reducing dangerous guesswork. Even so, says Long, those guidelines are just a starting point. “Due to clinical and environmental factors, the most appropriate prescription for any given infection may vary from place to place,” he explains. To address this one-size-does-not-fit-all conundrum, the company collaborates with infectious disease specialists around the world to develop locally tailored standards that are accessible at the point of care, regardless of the setting, Long notes.

In keeping with the “One Health” philosophy, Firstline doesn’t just promote responsible use in human medicine — it’s also teamed up with the Canadian Veterinary Medical Association and Dr. Scott Weese at Ontario Veterinary College to tackle this issue in agriculture and veterinary medicine. Weese, a leading infectious disease expert, is working on VetAWaRe, an animal version of AWaRe that employs a similar framework for animals in different contexts. Like his colleagues in human healthcare, Weese is calling for better antibiotic management and the widespread adoption of preventative measures to reduce dependence on antibiotics in the first place. “One of the biggest things we could do internationally would be to build better barns, make sure farmers everywhere have access to veterinary care, and improve education and access to vaccines,” he says.

I’m not a vet, a doctor or a policymaker. What can I do to curb AMR?

For one, you can believe your care provider or veterinarian when they say you don’t need antibiotics. While these medications aren’t required in many cases, and may cause side effects, many patients continue to see them as a panacea and will apply pressure to obtain a prescription. “Patients need to trust that their healthcare provider is making a decision based on the best available evidence,” says Firstline’s Long. “And expert guidelines can help make that case.”

Find out more about how experts are working to fight the threat of AMR on the MaRS podcast Solve for X: Innovations to Change the World.

Photo illustration: Stephen Gregory / Photos: Unsplash