Tackling Antimicrobial Resistance: How to fight back against the rise in tough cases

Antimicrobial resistance (AMR) is one of the most pressing public health threats of our time, making once-treatable infections harder—or even impossible—to cure.

Understanding Antimicrobial Resistance

What is AMR?

Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi, and parasites adapt and evolve to withstand the medications designed to eliminate them. As a result, infections that were once easily treatable with antibiotics or antifungals become increasingly difficult—or even impossible—to cure. This resistance develops naturally over time, but human activities, particularly the overuse and misuse of antimicrobials, have accelerated the process.

The consequences of AMR are severe: routine infections become life-threatening, medical procedures like surgeries and chemotherapy become riskier due to the lack of effective antibiotics, and the spread of resistant pathogens leads to prolonged hospital stays and increased mortality rates.

The Global Scope of the Crisis

AMR is not just a localized issue—it is a worldwide public health crisis. According to the World Health Organization (WHO), drug-resistant infections are responsible for approximately 1.27 million deaths per year globally, with millions more experiencing complications due to resistant pathogens. If left unaddressed, this number is expected to surpass 10 million deaths annually by 2050, making AMR a more significant killer than cancer.

Beyond human health, the economic and healthcare burden of AMR is staggering. A report from the Centers for Disease Control and Prevention (CDC) highlights that resistant infections cost the U.S. healthcare system more than $4.6 billion annually due to prolonged hospital stays, additional treatments, and lost productivity. The global economy is also at risk, with projections estimating trillions of dollars in lost GDP if AMR remains unchecked.

Causes of AMR

The rapid rise of antimicrobial resistance can be attributed to several key factors:

• Overuse and Misuse of Antibiotics:
  One of the primary drivers of AMR is inappropriate antibiotic use in both healthcare and agriculture. In clinical settings, antibiotics are frequently prescribed for viral infections where they offer no benefit, or they are given in incorrect dosages and durations. In agriculture, antibiotics are routinely used to promote growth in livestock, contributing to the development of resistant bacteria that can be transmitted to humans through food and the environment.
• Lack of New Antibiotic Development:
  Despite the growing need for new antibiotics, pharmaceutical companies have largely abandoned antibiotic research due to the high costs and low financial incentives associated with developing these drugs. Unlike chronic disease medications, which are used long-term and generate consistent revenue, antibiotics are prescribed for short courses, making them less profitable. As a result, the pipeline for novel antibiotics has dwindled, leaving clinicians with limited treatment options for drug-resistant infections.
• Inadequate Infection Prevention and Control:
  Poor hygiene, insufficient sanitation, and gaps in infection control practices allow resistant pathogens to spread rapidly in hospitals and communities. Without strong surveillance systems, proper hand hygiene protocols, and robust hospital infection control measures, AMR will continue to escalate.

Understanding the root causes of AMR is the first step in combating this crisis. Healthcare providers, policymakers, and the public must work together to improve antibiotic stewardship, encourage the development of new treatments, and implement stronger infection prevention strategies to slow the spread of resistance and safeguard the future of modern medicine.

The Role of Antibiotic Stewardship

What is Antibiotic Stewardship?

Antibiotic stewardship refers to a coordinated, evidence-based approach to optimizing the use of antimicrobial medications. The goal is to ensure that antibiotics are prescribed only when necessary, at the right dose, and for the appropriate duration, ultimately slowing the spread of antimicrobial resistance (AMR). By implementing stewardship strategies, healthcare providers can improve patient outcomes, reduce the incidence of resistant infections, and preserve the effectiveness of existing antibiotics for future generations.

Effective antibiotic stewardship is not just a responsibility of infectious disease specialists—it requires collaboration among physicians, pharmacists, nurses, hospital administrators, and even patients to create a culture of responsible antibiotic use.

Best Practices in Antibiotic Stewardship

1. Prescribing Antibiotics Only When Necessary:
   • A significant contributor to AMR is the overuse and misuse of antibiotics, particularly for viral infections like the flu or common cold, where antibiotics are ineffective.
   • Clinicians should use diagnostic tests and clinical guidelines to determine whether an antibiotic is truly warranted.
   • When prescribing, selecting the narrowest-spectrum antibiotic that effectively treats the infection minimizes disruption to the patient’s microbiome and reduces selective pressure for resistance.
2. Optimizing Drug Selection, Dosage, and Duration:
   • Tailoring antibiotic regimens to the specific pathogen, infection site, and patient characteristics prevents unnecessary exposure to broad-spectrum antibiotics.
   • Shorter courses of antibiotics, when appropriate, have been shown to be just as effective as longer treatments while reducing the risk of resistance.
3. Educating Patients on Proper Antibiotic Use:
   • Many patients still believe that antibiotics work for all infections, leading to unnecessary demands for prescriptions.
   • Healthcare providers should educate patients on completing their full course of prescribed antibiotics, avoiding self-medication, and not sharing antibiotics with others.
   • Clear communication can help manage patient expectations and reduce pressure on clinicians to prescribe antibiotics unnecessarily.
4. Preventing Infections Before They Occur:
   • Reducing the need for antibiotics starts with effective infection prevention strategies, including:
     • Vaccination programs (e.g., flu, pneumococcal, and COVID-19 vaccines) to lower the risk of secondary bacterial infections.
     • Strict hand hygiene and sanitation protocols in healthcare settings to reduce the spread of resistant bacteria.
     • Hospital infection control measures, such as the isolation of patients with resistant infections and the judicious use of antibiotics in surgical prophylaxis.

Challenges in Implementing Stewardship Programs

While antibiotic stewardship is essential, several challenges hinder its widespread implementation:

• Overprescription Due to Patient Expectations and Diagnostic Uncertainty:
  • In many cases, patients expect antibiotics, even for viral illnesses. Clinicians may feel pressured to prescribe antibiotics to satisfy patient demands, even when unnecessary.
  • Rapid, reliable point-of-care diagnostic tests are still lacking in many settings, making it difficult to distinguish bacterial from viral infections, leading to precautionary antibiotic use.
• Limited Resources and Training for Healthcare Providers:
  • Not all hospitals and clinics have dedicated antimicrobial stewardship teams to oversee antibiotic prescribing practices.
  • In resource-limited settings, access to infectious disease specialists, microbiological testing, and surveillance programs is often inadequate.
  • Continued medical education and integration of clinical decision support tools are needed to empower clinicians with real-time guidance on appropriate antibiotic use.

By addressing these challenges and promoting stronger stewardship practices, healthcare providers can play a critical role in curbing AMR, reducing antibiotic misuse, and ensuring that future generations still have access to effective antimicrobial treatments.

How Clinical Decision Support Tools Aid in Combating AMR

What Are Clinical Decision Support (CDS) Tools?

Clinical Decision Support (CDS) tools are technology-driven solutions designed to assist healthcare providers in making evidence-based, real-time treatment decisions. These systems integrate with electronic health records (EHRs) or function as standalone platforms, offering instant access to medical guidelines, patient data, and best practices for diagnosing and treating infections.

CDS tools play a crucial role in enhancing antibiotic stewardship efforts by ensuring that clinicians have the most current information available at the point of care. In the fight against antimicrobial resistance (AMR), leveraging CDS can help reduce unnecessary antibiotic prescriptions, optimize dosing strategies, and minimize the risk of resistance development.

How CDS Tools Improve Antibiotic Stewardship

1. Providing Real-Time Guidance on Appropriate Antibiotic Selection:
   • One of the biggest challenges in antibiotic stewardship is ensuring that clinicians prescribe the right antibiotic for the right infection.
   • CDS tools automate the process of matching infections with the most effective and least resistance-prone antibiotics, reducing reliance on broad-spectrum treatments when a narrower option is available.
   • By referencing local antibiograms and resistance patterns, CDS can provide customized recommendations tailored to a patient’s region and healthcare setting.
2. Alerting Prescribers to Potential Drug-Drug Interactions and Resistance Risks:
   • Many patients, especially those with chronic conditions, take multiple medications. CDS tools can automatically flag potential drug-drug interactions that could compromise the effectiveness of antibiotics or cause adverse effects.
   • Advanced CDS systems can also warn prescribers when an antibiotic is known to have high resistance rates or when a patient’s prior microbiology reports suggest resistance concerns.
3. Offering Up-to-Date, Evidence-Based Recommendations for Infectious Disease Management:
   • Medical guidelines are constantly evolving, and staying current with the latest research and recommendations is challenging for busy clinicians.
   • CDS tools provide instant access to updated treatment protocols from trusted sources such as the Infectious Diseases Society of America (IDSA), World Health Organization (WHO), and Centers for Disease Control and Prevention (CDC).
   • By integrating these recommendations directly into the prescribing workflow, CDS helps ensure that treatment decisions align with the best available scientific evidence.

Choosing the Right CDS Tool: Why PEPID is the Best Choice

For healthcare providers looking to streamline antibiotic stewardship efforts and combat AMR effectively, PEPID stands out as the go-to CDS tool. PEPID’s clinical decision support platform offers instant access to evidence-based treatment guidelines, antimicrobial prescribing recommendations, and drug interaction checks, ensuring clinicians make the safest, most effective choices for their patients.

PEPID empowers healthcare providers to make informed prescribing decisions while reducing the risk of antibiotic misuse. As AMR continues to pose a global health threat, utilizing advanced tools like PEPID is essential in preserving the efficacy of life-saving antibiotics for future generations.

The Path Forward: Strengthening the Fight Against AMR

Antimicrobial resistance (AMR) poses one of the greatest public health threats of our time, making it increasingly difficult to treat common infections and putting patients at higher risk of severe complications. The overuse and misuse of antibiotics have accelerated this crisis, turning once-treatable infections into potentially life-threatening conditions. Without immediate intervention, the rise of resistant pathogens will continue to compromise modern medicine, making routine surgeries, cancer treatments, and critical care more dangerous.

Healthcare providers play a pivotal role in curbing the spread of AMR through antibiotic stewardship. By prescribing antibiotics only when truly necessary, following evidence-based guidelines, and educating patients on proper antibiotic use, clinicians can slow the progression of resistance and protect the efficacy of existing treatments. Prevention strategies such as infection control measures, vaccination programs, and improved public awareness further enhance efforts to limit the spread of resistant bacteria.

To take antibiotic stewardship to the next level, leveraging clinical decision support (CDS) tools is essential. Platforms like PEPID provide real-time, evidence-based recommendations that help clinicians select the right antibiotic, minimize unnecessary prescriptions, and identify resistance risks before they become critical issues. By integrating these tools into everyday practice, healthcare providers can make informed decisions that align with global efforts to combat AMR.

The fight against AMR is far from over, but with thoughtful prescribing, ongoing education, and innovative solutions like PEPID, we can work toward a future where antibiotics remain effective, patients receive the safest treatments, and public health is preserved for generations to come. Now more than ever, it’s time to act decisively, embrace responsible antibiotic use, and ensure that the medical advances we rely on today remain viable for years to come.

References

Centers for Disease Control and Prevention. (n.d.). Antimicrobial resistance. National Antimicrobial Resistance Monitoring System (NARMS). Retrieved March 7, 2024, from https://www.cdc.gov/narms/resistance/index.html

Centers for Disease Control and Prevention. (n.d.). Partner estimates of global antimicrobial resistance burden. CDC. Retrieved March 7, 2024, from https://www.cdc.gov/antimicrobial-resistance/stories/partner-estimates.html

World Health Organization. (n.d.). Antimicrobial resistance. WHO. Retrieved March 7, 2024, from https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

Salam, M. A., Al-Amin, M. Y., Salam, M. T., Pawar, J. S., Akhter, N., Rabaan, A. A., & Alqumber, M. A. A. (2023). Antimicrobial resistance: A growing serious threat for global public health. Healthcare (Basel, Switzerland), 11(13), 1946. https://doi.org/10.3390/healthcare11131946

Shrestha, J., Zahra, F., & Cannady, P., Jr. (2023). Antimicrobial resistance. StatPearls. National Center for Biotechnology Information (NCBI). Retrieved March 7, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK572068/

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digital Medicine, 3, 17. Retrieved March 7, 2024, from https://doi.org/10.1038/s41746-020-0221-y