A commentary. Dr. David Patrick is the director of research and the medical epidemiology lead for antimicrobial resistance at the B.C. Centre for Disease Control (BCCDC) and an infectious disease specialist with the UBC School of Population and Public Health. Dr. Tracy Monk is a family physician in Burnaby and the physician lead for the provincial Pathways system, an online resource that provides physicians and their teams quick access to current and accurate resources.
While the COVID-19 pandemic has overwhelmed our lives and health-care system, it certainly underscored the devastating impacts of living in a world where we can neither prevent nor treat a lethal infectious disease. We are all pandemic-weary, and yet the World Health Organization and United Nations have made an urgent call to action to slow the threat of antibiotic resistance.
It’s a race against time to avert a future where antibiotics may no longer work against some infections. National research shows that if global antibiotic resistance trends continue to 2050, up to 40 per cent of simple infections may become untreatable by many antibiotics.
A community effort is needed to tackle the growing problem of resistance to antibiotics. So what can patients, physicians, health researchers and authorities do, or do better?
As patients, there are actions each of us can take to reduce the threat of drug-resistant infections. They include properly disposing of antibiotics instead of holding onto them or sharing with others. Taking that expired penicillin tablet in your cabinet when you’re feeling unwell may seem convenient, but are you willing to face the greater consequences of consuming that antibiotic on your overall health and the health of those around you?
You can also combat antibiotic misuse and overuse by becoming more informed about how antibiotics work, and sharing that information with family and friends. Not all illnesses require or even respond to antibiotics (hint: they don’t work against viral illnesses such as colds, flu or COVID-19).
In recent years, you’ve probably noticed your doctor or nurse practitioner prescribing antibiotics less often, for shorter duration or asking you to wait a day or two before filling the prescription. Many dentists are prescribing less after dental surgery, opting to use antibiotics only during the procedure itself.
As practising physicians and health researchers in B.C., we’re seeing an overall decline in patients coming to ask for antibiotics, but a continued increase in antibiotic resistance across all ages that is worrying.
In some cases, a patient with allergies or medication sensitivities may need to try several different antibiotics to treat something as simple as a skin infection. Up to a quarter of urinary tract infections already cannot be treated with drugs that were once standard, leading to a wholesale change in treatment guidance.
At the provincial level, some improvements are already in place. The Pathways system — created by Divisions of Family Practice and used by physicians, nurse practitioners and primary care teams in B.C. — provides quick search by infection. Clinicians can also use Pathways to email information to their patients from the Do Bugs Need Drugs? and Choosing Wisely educational programs.
With funding support from the Ministry of Health, the B.C. Centre for Disease Control is working to share educational resources more widely across the province, as part of the Community Antimicrobial Stewardship program. This spring, it will launch a continuation of its AntibioticWise.ca campaign, providing educational resources for those looking to better understand how antibiotics work. Adults over the age of 65 are front and centre in the campaign because they are more likely to have an infection, and they are prescribed 1.5 times more antibiotics than the average Canadian.
Health researchers across the province are also mobilizing by tracking trends to get ahead of emerging infections. After all, prevention of infections is a key part of the solution. Fewer infections mean less chance for antibiotics misuse. Each time we avoid using an antibiotic is an opportunity to prevent antibiotic resistance and reduce the strain on a health system already overwhelmed by the impact of COVID-19.
The COVID-19 pandemic taught us that there are not only life and death impacts of untreatable infections, there are also social and economic disruptions, even to those not infected. We must act now to stem the rising tide of antibiotic resistance and protect the health-care system. We all have a role to play to prevent misuse of antibiotics. The alternative, a world without antibiotics, isn’t an option we want to experience.
