Antibiotic resistance: why antibiotics stop working and what helps

1. Introduction

Antibiotics are medicines that treat certain bacterial infections. Over time, some germs change so that these medicines no longer work well. This is called antimicrobial resistance, or AMR. The World Health Organization (WHO) defines it as bacteria, viruses, fungi and parasites no longer responding to the medicines designed to treat them, which makes infections harder or impossible to treat and raises the risk of spread, severe illness, disability and death ^[1]. This article uses WHO and US Centers for Disease Control and Prevention (CDC) information to explain the problem and what ordinary people can do.

2. How resistance develops and spreads

The CDC describes resistance as a natural process that speeds up when germs are exposed to antibiotics and antifungals. These medicines also kill helpful germs, while the surviving resistant germs multiply and spread. Resistance genes can pass between germs, including germs that have never met the medicine. Germs can resist in several ways, such as blocking the medicine from entering, pumping it out, breaking it down, or changing the target it acts on ^[2].

Resistant germs can spread in hospitals, farms, communities and the environment, and they can move between countries through trade and travel ^[2]. The CDC stresses that resistance means the germs have defeated the medicine. It does not mean your body has become resistant to antibiotics ^[2].

3. Why it matters

WHO reports that bacterial resistance was linked to more than 4.7 million deaths worldwide in 2021, and that about 1 in 6 laboratory-confirmed bacterial infections in 2023 resisted antibiotic treatment. Resistance was highest in the WHO South-East Asia and Eastern Mediterranean regions, where about 1 in 3 reported infections was resistant ^[1]. Resistant infections can mean more illness, fewer treatment options, longer hospital stays and higher risk during procedures such as surgery. The CDC adds that germs do not need to resist every medicine to be dangerous. Treatments used when the first choice fails can cause serious side effects, including organ failure, and recovery can take months. Many medical advances, such as joint replacements, organ transplants and cancer therapy, depend on antibiotics that work ^[2]. WHO notes that very young and very old people, and people in low-resource settings, are hit hardest ^[1].

4. What drives resistance

WHO lists these main drivers ^[1]:

• Misuse and overuse of antimicrobials, such as taking them when they are not needed or using the wrong type.
• Poor access to clean water, sanitation and hygiene.
• Weak infection prevention and control in homes, health facilities and farms.
• Limited access to vaccines, diagnostic tests and medicines.
• Too few new antibiotics being developed to replace those that stop working.

5. When antibiotics are and are not needed

The CDC explains that antibiotics treat certain bacterial infections, such as strep throat, whooping cough and urinary tract infections. Some bacterial infections, including many sinus infections and some ear infections, can clear up without antibiotics. Antibiotics do not work on viruses, so they do not help with colds, most sore throats other than strep, flu or most chest colds (bronchitis) ^[3].

Taking an antibiotic for a viral illness will not make you feel better, and its side effects can still cause harm. The CDC advises against pressuring a health professional to prescribe one and suggests asking how to feel better while your body fights the infection ^[3].

6. Using antibiotics safely

• If an antibiotic is prescribed, take it exactly as directed ^[3].
• Do not share antibiotics, save them for later or take someone else's prescription, because the wrong medicine can delay correct treatment and cause severe side effects ^[3].
• The FDA adds that antibiotics usually need to be finished even after symptoms go away, to stop the infection coming back in a more severe form, so ask your provider before stopping early ^[4].
• For leftover or expired medicine, use a take-back programme where available ^[3].

Antibiotics can cause side effects. Common ones include rash, dizziness, nausea, diarrhoea and yeast infections. Serious ones include a bowel infection called C. diff, life-threatening allergic reactions and resistant infections. When an antibiotic is prescribed by a professional, the benefits usually outweigh the risks ^[3].

7. Preventing infections

The CDC suggests washing hands with soap and water for at least 20 seconds or using a sanitiser with at least 60% alcohol, covering coughs and sneezes, staying home when sick, avoiding touching your eyes, nose and mouth with unwashed hands, keeping away from people who have colds, and getting recommended vaccines such as the flu vaccine ^[3]. Travellers should tell their provider if they recently travelled to or received care in another country ^[2].

8. When to see a doctor

See a doctor if an infection is not improving, if symptoms return after treatment, or if a child or adult has side effects from an antibiotic ^[3]. The CDC advises telling your doctor if you have three or more episodes of diarrhoea in 24 hours while taking these medicines ^[2].

In an emergency, call your local emergency number (112 in India, 911 in the United States). Seek urgent help for swelling of the face or throat, trouble breathing, a spreading rash with fever, or confusion.

9. Conclusion

Antibiotic resistance is a worldwide problem that affects every country. Protecting antibiotics means using them only when needed, taking them as directed, and preventing infection with hygiene and vaccines. Your doctor decides whether you need an antibiotic.