Infectious Disease

Yara Al-Shaer, PharmD

Antimicrobial resistance is now one of the biggest threats to global health—and it’s only set to worsen. According to research published in The Lancet on September 28, 2024, the global burden of bacterial antimicrobial resistance has skyrocketed from 1990 to 2021, with projections signaling a looming crisis by 2050 unless drastic interventions are made.

For instance, between 2019 and 2021, researchers noted a 12% increase in resistant infections in high-burden countries, particularly in regions such as South Asia and sub-Saharan Africa. The study authors forecast that 10 million deaths annually could be attributed to antimicrobial resistance by 2050, outpacing the mortality rates of cancer and diabetes combined.

Vulnerable populations in low- and middle-income countries are likely to experience the highest toll from antimicrobial resistance due to a lack of access to new antibiotics, poor health care infrastructure, and the widespread use of ineffective drugs, said the study authors.

They also pinpointed specific bacterial infections that are driving this crisis, such as MRSA, E. coli, and Klebsiella pneumoniae. Infections caused by these pathogens are becoming increasingly difficult to treat, with resistance rates rising by 30% in some countries. In sub-Saharan Africa alone, one in five deaths are now linked to resistant bacterial infections, underscoring the urgent need for targeted interventions in these regions.

Global antimicrobial resistance trends

Antimicrobial resistance poses a significant global health threat, leading to an estimated 1.27 million deaths in 2019 alone, noted the study authors. The burden is expected to disproportionately affect specific age groups, particularly children and older adults, who are at a higher risk of suffering from severe consequences, which can lead to prolonged illness, increased health care costs, and a higher risk of death. In other words, common infections—once easily treatable with antibiotics—are becoming more dangerous.

The study highlights how antimicrobial resistance has rapidly become a critical global health crisis, largely driven by the overprescription and misuse of antibiotics in health care and agriculture. For instance, in many countries, antibiotics are used not only to treat infections, but also as a preventive measure in livestock, contributing to the rise of drug-resistant bacteria.

The study’s findings make it clear that without concerted global efforts to combat antimicrobial resistance, the world is headed toward a future in which even minor infections could once again become deadly. The lack of investment in the development of new antibiotics is also exacerbating the problem. Many pharmaceutical companies have scaled back research into new drugs, as they are less profitable compared with other types of treatments.

Solutions

According to CDC, the rise in antimicrobial resistance during 2020 and 2021 can be partly attributed to the effects of COVID-19, which strained health care systems, public health departments, and communities. The pandemic led to longer hospitalizations for patients, particularly for patients with COVID-19; disrupted infection prevention and control efforts; and increased inappropriate antibiotic usage.

However, as the pandemic progressed, health care professionals and public health workers took actions to reduce infections and save lives, helping to lower antimicrobial resistance rates from their 2021 peak. CDC supported these efforts through American Rescue Plan funding, aiding Healthcare-Associated Infections and Antimicrobial Resistance programs, along with the Antimicrobial Resistance Laboratory Network across all U.S. states, major cities, and territories.

WHO has identified antimicrobial resistance as one of the top 10 global public health threats facing humanity. In response, CDC and WHO have developed guidelines to reduce the spread of antimicrobial resistance, including promoting better antibiotic stewardship programs, increased infection control measures, and research into new antibiotics.

What can pharmacists do?

As frontline health care providers, pharmacists play a vital role in addressing the rising threat of antimicrobial resistance. According to CDC, the Infectious Diseases Society of America, and WHO, there are several practical ways pharmacists can make a meaningful impact: leading antibiotic stewardship, educating patients about the responsible use of antibiotics, informing patients about potential adverse effects and interactions associated with antibiotic use, collaborating with health care providers to implement and enhance antimicrobial stewardship programs in hospitals and communities, and engaging in public health advocacy initiatives focused on antimicrobial resistance.

While the road to overcoming antimicrobial resistance is indeed long and challenging, the active involvement of pharmacists on the front lines can significantly mitigate this growing threat. By taking a proactive stance in antibiotic stewardship, patient education, and collaboration with other health care providers, pharmacists can help safeguard the effectiveness of antibiotics for future generations. ■