Overuse of antibiotics in both human medicine and agriculture has contributed to the emergence of antibiotic resistance. In medicine, antibiotics are often prescribed unnecessarily due to pressure on doctors to treat potential infections and patient demand. Patients also frequently fail to complete antibiotic treatment courses. Agricultural use of antibiotics for growth promotion and disease prevention in healthy animals allows antibiotic resistant bacteria to spread to humans. Poor infection control and lack of rapid diagnostic tests have also facilitated the spread of resistant pathogens in healthcare settings. Addressing these factors through improved prescribing practices, public education, infection control, and testing can help slow the development of antibiotic resistance.

1. Factors Behind the
Emergence of Antibiotic
Resistance

2. https://content.govdelivery.com/accounts/USCDC/bulletins/136b8a2

3. Over-prescription and overuse
of antibiotics
 Medical culture can inadvertently promote and perpetuate unnecessary use of
antibiotics or overuse of the most potent, broad-spectrum antibiotics1
 Despite understanding the long-term risks of resistance, doctors are often focused on
treating the potential infection in front of them, in their individual patient1
 Long-term risks are not prioritized and the judicious use of antibiotics is not valued1
 Doctors are also commonly worried about the risk of not acting to prevent or treat the
infection, reporting an inability to accept the risk that avoiding prescribing the most potent
broad spectrum antibiotic might present1
 In many lower and middle income countries antibiotics can be purchased without a
prescription2
 The widespread unnecessary use of antibiotics (especially in lower and middle
income countries) is largely due to the general population’s lack of knowledge of
about how antibiotics work, and limited awareness of the consequences of
antibiotic resistance in public health2
 64% of 10 000 respondents over 5 developing countries believe antibiotics can be used to
treat colds and flu, despite the fact that antibiotics have no impact on viruses3

4. Patients not taking antibiotics
as prescribed
 Suboptimum patient compliance on use can contribute to resistance:
 Stopping taking antibiotics when feeling better when not finished
prescribed course3
 Taking leftover antibiotics from previous treatment courses3
 Sharing unused drugs with other people3
 Close to one third (32%) of people across 12 countries surveyed
believed they should stop taking antibiotics when they felt better,
rather than completing the prescribed course of treatment3
 For some deep-seated infections, such as tuberculosis or osteomyelitis,
symptoms can improve even though the bacteria might still be flourishing2
 Many of these practices are common in both developed and
developing countries3

5. Unnecessary use of
antibiotics in agriculture
and livestock
 Much of the use of antibiotics in animals is not therapeutic4
 Significant volumes of antibiotics are used prophylactically amongst healthy
animals to:
 Stop the development of an infection within a flock or herd4
 Promote growth, to speed up the pace at which animals gain weight4
 Overuse presents the risk that drug-resistant strains are passed on through
direct contact between humans and animals (notably farmers)4
 These drug-resistant strains can then be passed on to humans more generally
through the food chain, i.e. when consumers prepare or eat the meat itself4
 There is also a further indirect threat to human health as result of animal excretion4
 Huge amounts of antibiotics are used for agriculture in some countries—up to
four-times the amount used in human medicine in some cases4
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6. Poor infection control and
hand hygiene in hospitals and
clinics
 Insufficient infection control surveillance systems within
hospitals (especially in lower and middle income
countries) can lead to
 Spread of nosocomial (hospital acquired) infections2
 Outbreaks caused by resistant pathogens2
 Exacerbated by inherent problems: overcrowding and
insufficient equipment and trained personnel2
 These resistant pathogens become a reservoir of
resistant genes2
 Can also be spread to the community through unsafe water
and poor sanitation2

7. Lack of Rapid Laboratory
Tests
 It may not always be obvious whether an illnesses is
due to infection and whether it is bacterial (and might
need treatment) or viral2
 Tests may help, however may help, however often
patients must wait some time for results2
 Treatment is usually then given based on clinical
judgement – often influenced by the patient’s anxiety
and the doctor’s intolerance of risk2
 Leads to overuse and overprescription

8. References
1. Ingram P, Seet J, Budgeon C, Murray R. Point‐prevalence study of inappropriate
antibiotic use at a tertiary Australian hospital. Internal medicine journal. 2012;42(6):719-
721.
2. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al.
Antibiotic resistance—the need for global solutions. The Lancet infectious diseases.
2013;13(12):1057-1098.
3. Antibiotic resistance: Multi-country public awareness survey [Internet]. Geneva: The
World Health Organization; 2015 [cited 2016 Apr 3]. Available from:
http://apps.who.int/iris/bitstream/10665/194460/1/9789241509817_eng.pdf?ua=1
4. O’Neill. Antimicrobials in agriculture and the environment: reducing unnecessary use
and waste the review on antimicrobial resistance [Internet]. UK Department of Health
Commission [cited 2016 March 18]. Available from: http://amr-
review.org/sites/default/files/Antimicrobials%20in%20agriculture%20and%20the%20en
vironment%20-%20Reducing%20unnecessary%20use%20and%20waste.pdf