What is antimicrobial resistance and why is it important?

When antibiotics no longer work to kill bacteria, this is called antibiotic or antimicrobial resistance. This means that infections caused by certain types of bacteria can become difficult or impossible to treat with the antibiotics we have now. For example, there is growing evidence that urinary tract infections are becoming increasingly resistant to the antibiotics that, for generations, easily and quickly cured them. As another example, some types of tuberculosis have become resistant to antibiotics and are becoming deadlier, just like they were before antibiotics were discovered.

In Canada, over a quarter of bacterial infections are now resistant to antibiotics that once cured them (1). In 2018, experts estimated that 15 Canadians died every day as a direct result of antimicrobial resistance (1). According to the World Health Organization, antimicrobial resistance is one of the ten most serious public health problems of our time (2). Antimicrobial resistance has been made worse because of a decline in the development of new antibiotics over the past decades, especially those that target the most resistant bacteria.

Why should older Canadians be concerned about antibiotic resistance?

Canadians aged 60 and over are prescribed antibiotics 1.5 times more often than any other age group (3). Older people may have weaker immune systems, making them more vulnerable to bacterial infections. Furthermore, older Canadians living in long-term care or assisted living facilities or who are admitted to hospitals may be more at risk of being exposed to “superbugs” like C. difficile. C. difficile can cause a life threatening diarrheal illness, especially among those who have compromised immune systems or who have recently used antibiotics. C. difficile is now resistant to most antibiotics.

What causes antibiotic resistance?

Using antibiotics when they are not needed or don’t work.
Antibiotics are often prescribed to treat illnesses not caused by bacteria. Colds and flu are caused by viruses and cannot be cured by antibiotics. Another example is when a lab test shows bacteria in the urine but there are no physical symptoms of a urinary tract infection, which is common in older adults. Giving antibiotics in this case can lead to overuse and antibiotic resistance.

Overusing broad spectrum antibiotics.
Broad-spectrum antibiotics are a type of antibiotic that kill many types of bacteria as opposed to only the specific bacteria causing the illness. For example, the overuse of broad-spectrum fluroquinolone antibiotics (drugs whose names end in “floxacin”, such as ciprofloxacin or Cipro®) contributes to antimicrobial resistance. Not to mention, fluroquinolones have a history of harmful side effects (4). Narrow-spectrum antibiotics, which focus on the specific bacteria causing the infection, should be used where possible. Sometimes, tests are needed to determine the type of bacteria involved.

Not using antibiotics as prescribed.
It is important to only use antibiotics that are prescribed for you and to take the dose as prescribed, even if the infection seems to be gone before the treatment is finished.

Global, poorly regulated antibiotic use.
Antibiotics are overused in agriculture as well as seafood and meat production. In some countries, they are available without a prescription, leading to overuse and contributing to resistance. Residue from human and animal antibiotic use contaminates our soil and water, another cause of antibiotic resistance.

What can you do to help reduce antibiotic resistance?

DON’T

Do not share or use leftover antibiotics.
Do not demand an antibiotic if your doctor, nurse, dentist or pharmacist says you don’t need one.

DO

Ask your doctor, nurse, dentist or pharmacist, “Do I really need an antibiotic?”
Follow your doctor, nurse, dentist or pharmacist’s advice if you are prescribed antibiotics.
Take all of the antibiotics as prescribed, even if you feel better before you are finished.
Avoid infections from bacteria:
- Wash your hands regularly, especially after you use the bathroom and before eating.
- Avoid close contact with sick people.
Keep your vaccines up to date.

Spread the word about the dangers of antibiotic resistance and how we must use antibiotics more wisely.

Always talk to your doctor, pharmacist or nurse before stopping or changing any medication.

References

1. Council of Canadian Academies. (2019). When Antibiotics Fail. The Expert Panel on the Potential Socio-Economic Impacts of Antimicrobial Resistance in Canada, Council of Canadian Academies. https://cca-reports.ca/wp-content/uploads/2018/10/When-Antibiotics-Fail-1.pdf

2. World Health Organization. (2021, November 17). Antimicrobial resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

3. Public Health Agency of Canada. (2018, April 3). Prescribe antibiotics wisely (Clinical points). Government of Canada. https://www.canada.ca/en/public-health/services/publications/drugs-health-products/prescribe-antibiotics-wisely.html

4. Health Canada. (2017, January 23). Summary Safety Review - Fluoroquinolones - Assessing the potential risk of persistent and disabling side effects. Government of Canada. https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/safety-reviews/summary-safety-review-fluoroquinolones-assessing-potential-risk-persistent-disabling-effects.html

The authors

Janet Currie is a social worker who has been involved with patient and medication safety issues for over 17 years. She is particularly concerned about the safety and efficacy of psychiatric drugs and their impacts on seniors. She is a member of the core Executive of the Canadian Deprescribing Network, the past co-chair of the Canadian Women’s Health Network and was a two-term member of Health Canada’s Expert Advisory Committee on the Vigilance of Health Products. She owns and manages a website on psychiatric drug safety and has frequently testified to the Canadian Senate and the Parliamentary Standing Committee on Health on prescription drug surveillance and adverse drug effects. She is completing a Ph.D. on medication safety and off-label prescribing at UBC. Janet is Chair of the Patient Awareness Committee of the Canadian Medication Appropriateness and Deprescribing Network.

Johanna Trimble is a patient safety advocate and member of the BC Patient Voices Network. She is a member of the Geriatrics and Palliative Care Subcommittee of the Council on Health Promotion for Doctors of BC. As an honourary lecturer, she co-teaches first-year medical students at UBC in Community Geriatrics as well as pharmacy students on medication issues in Long Term Care. Johanna is an active member of the Patient Awareness Committee of the Canadian Medication Appropriateness and Deprescribing Network.