How you may be contributing to antimicrobial resistance

SINGAPORE: Whenever you use antibiotics to treat bacterial infections such as a sinus infection or urinary tract infection, you may contribute to the risk of antibiotic resistance developing, said Professor Teo Yik Ying, the vice dean of research and dean-designate for the National University Singapore’s Saw Swee Hock School of Public Health.

Antibiotic resistance is a subset of antimicrobial resistance (AMR), which includes the resistance to drugs to treat infections caused by other microbes such as parasites (for example, malaria), viruses (for example, HIV) and fungi (for example, candida), according to the World Health Organization (WHO).

Antibiotic resistance is an expected consequence of natural selection. “While the antibiotic is designed to kill or inhibit the growth of microbes, the microbes are similarly evolving to ensure their survival,” said Prof Teo.

What has tipped the scale in favour of today’s microbes to evolve successfully is the widespread abuse of antibiotics, be it “in human health care, in raising animals, in waste water”, said Professor Keiji Fukuda, director for the School of Public Health at The University of Hong Kong.

According to the WHO, this has led to a growing list of infections such as pneumonia, tuberculosis, blood poisoning and gonorrhoea becoming harder, and sometimes impossible, to treat as antibiotics become less effective. Drug resistance is also starting to complicate the fight against HIV and malaria.

There are further repercussions. Without effective antibiotics, the success of major surgery and cancer chemotherapy would be compromised. Antibiotics resistance can also lead to longer hospital stays, higher medical costs and increased mortality, said the WHO.


In Singapore, patients’ perceptions towards antibiotics may have contributed to AMR. “There is an entire generation of people who are led to believe that antibiotics helps to hasten the treatment of coughs and colds. These people shop around for doctors who will prescribe them antibiotics, regardless of whether the medical condition actually calls for it,” he said.

“When patients demand that a doctor gives them antibiotics for illnesses that don’t require such medicines, they contribute [to AMR],” said Prof Fukuda. “When people obtain antibiotics without going to a doctor for a proper diagnosis and take them unnecessarily, they contribute [to AMR].”

Playing doctor by deciding to stop an antibiotics course or take someone’s antibiotics is a no-no. Similarly, you should not self-administer antibiotics. “Increasingly, people are storing unused antibiotics or even purchasing antibiotics overseas or online, so they can self-prescribe when they fall ill,” said Prof Teo.


Doing your part to stymie AMS can be as simple as seeking the appropriate healthcare, said Prof Teo. For minor ailments, for instance, visit a general practitioner or polyclinic rather than a specialist clinic or hospital, he said. Getting the requisite vaccinations for both children and adults, especially the influenza vaccination, is also recommended.


If you are concerned about AMR when shopping at the market or dining in a restaurant, ask about whether the meat being sold or served was raised without antibiotics, said Prof Fukuda. “When you are cooking food, and especially meat, follow good hygienic food preparation practices to avoid potentially contaminating yourself or others with bacteria.”

Good hygiene such as washing your hands after visiting the toilet and before handling food is another way to keep AMR in check, said Prof Teo.

Read about the Singapore’s plan to tackle antimicrobial resistance here.

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