GM Antimicrobial Prescribing Guidance

Antimicrobial resistance (AMR)

Antimicrobial resistance (AMR) has been identified as one of the most pressing global challenges we face this century. In fact, the World Health Organisation (WHO) has declared AMR as one of the top 10 global public health threats, and AMR is listed on the UK Government’s National Risk Register. In 2019 there were 4.95 million deaths associated with bacterial AMR across 204 countries, and 1.27 million of those were directly attributed, leading the WHO to declare it a top global public health threat.

What is antimicrobial resistance?

AMR occurs when the microorganisms which cause disease (including bacteria, viruses, fungi and parasites) are no longer affected by antimicrobial medicines such as antibiotics, antivirals, antifungals and antiparasitics that we use to kill them, prevent and treat the disease.

While resistance is a natural phenomenon and not just a health issue, from a human healthcare perspective it is accelerated by:

inappropriate use of antimicrobial drugs
poor infection prevention and control practices
a lack of new antimicrobial drugs being developed
insufficient global surveillance of infection rates.

(Diagram from Antimicrobial resistance (AMR): applying All Our Health - GOV.UK)

How important is it that we tackle resistance?

We rely on antibiotics, antifungals, and antiparasitics to treat the microorganisms that cause many common diseases, such as tuberculosis (TB), HIV / AIDS, malaria, sexually transmitted infections, urinary tract infections, chest infections, bloodstream infections and food poisoning. These microorganisms, however, can already resist a wide range of antimicrobial medicines.

This isn’t just a problem in treating illness; routine surgical procedures and cancer treatment – such as caesarean sections, hip and knee replacements, cardiac surgery and chemotherapy – also rely on these antimicrobial medicines prior to carrying out surgical procedures to prevent infections.

There are few replacement antibiotics or alternative products in development, and even fewer which target specific super resistant bacterium, virus, or other microorganisms. This is partly due to how new drug development is funded.

As resistance continues to increase, more people will suffer for longer as infections become more difficult to treat – resulting in longer hospital admissions, routine surgical procedures becoming more dangerous to perform, and higher death rates. The impact of AMR therefore has a detrimental effect on the working of modern medicine and can and will affect each and every one of us.

What is needed from a healthcare perspective to tackle resistance?

early prevention of infections
- speak to your staff, residents, clients and visitors about the benefits of good hygiene including handwashing, hydration, vaccination and preventative measures available to reduce risk of getting infections
- promote health and wellbeing as a good immunity will benefit from a healthy lifestyle
- promote vaccination and immunisation programmes including seasonal flu and COVID-19 vaccines as well as shingles, RSV and pneumococcal vaccine programmes.
timely, accurate diagnosis
- understand and identify the signs and symptoms associated with infection and particularly sepsis
effective management of infections
- appropriate prescribing and use of antimicrobials only when there is an infection for which they are the most appropriate treatment
- familiarise yourself with the keep antibiotics working campaigns, Antibiotic Guardian programmes and Health Matters to help you have an overview of the subject
- become an Antibiotic Guardian
- familiarise yourself with key AMR and IPC messages and understand where to access trusted advice for your patients – for this we recommend NHS Choices antibiotics page
- follow local and national guidelines on Infection prevention and control in adult social care settings - GOV.UK

AMR national action plan

The UK Government has developed a new AMR 5 year national action plan, ‘Confronting antimicrobial resistance 2024 to 2029’, which builds on the achievements and lessons from the first national action plan.

Its overall aims are to: