Originally written for Medics Academy.
With World Antimicrobial Awareness Week (WAAW) having passed, how many of us plan to act?
The reality for many is that we are too far removed from the situation. Most of us have strong immune systems, no experience of MRS infections and work/study in healthcare systems that have plenty of alternatives to common antimicrobials.
But when WAAW rolls around next year, could you honestly say you’ve actively done something to support the movement? Ultimately, antimicrobial resistance is a global health issue; just as we vilify anti-vaxxers, smokers and the pseudoscience community, should we put poor antimicrobial stewardship in this bracket?
Regardless of the strength of your stance, here are some tips to support the movement. To make a serious issue somewhat light-hearted, I’ve even given it the ironic acronym MRSA.
Tip 1: Be a Model
The controversial idea of “should HCPs be near-perfect” is a debate for another day, but it goes without saying that you are also a patient. Before we discuss any public or patient conversations, it’s important that you’re starting with yourself.
The basic tips around the individual might seem very basic, almost patronising, but it’s easy to get the “us and them” bias. Make sure you are looking after yourself and doing your best to pro-actively avoid getting ill in the first place. Looking after yourself includes sleep, diet and managing stress so yes, those expensive bath salts and candles count!
Exercising your antimicrobial stewardship can also give experiential knowledge that you can impart onto your patients. Think about the difference between “make sure you maintain good hygiene” and “one thing I did was buy a set of refillable soaps for home. I found XYZ brand was good for not drying your skin out. You can get them pretty cheap at…”
Tip 2: Review patients
This one is directly from the WAAW team, but I like it because it pokes us out of our comfort zone- especially as a student!
A large proportion of patients in hospital will be on antimicrobial therapy (one unfortunate outcome from the nosocomial infection problem). It’s worth taking a few seconds with these patients just to review their treatment. Are they on appropriate therapy? Do they still need it? Do we have any sensitivity analysis? Has someone spoken to the patient to check they are compliant?
As an example, some HIV patients can periodically disengage with their HAART, meaning they only have the longer half-life drugs in their system. This represents a sub-optimal dose, therefore predisposing to resistance. It’s important to speak to patients about current and historical compliance. As a medical student, this will be good practice for the realities of medicine!
Tip 3: Stewardship
The idea of antimicrobial stewardship is to promote responsible use and education. There are some very quick things you can do right now to promote this. In fact, if you’re reading this then take a break and go and do them now (although please come back).
- Pledge to become an antibiotic guardian at https://antibioticguardian.com/
- Like and follow relevant social media pages (some examples include the World Health Organisation, Students for Global Health and Polygeia)
- Flick through the BNF chapter (especially the useful links at the end!) at https://bnf.nice.org.uk/guidance/antimicrobial-stewardship.html
- Arrange to speak to someone who knows about antimicrobial resistance – usually one of the fantastic Microbiologists
If you’re especially interested in this, then there are more wide-reaching things you can do. For example, discussing with your current/ previous medical school to enhance the global health curriculum (both in general, because there is certainly a lack of emphasis, but also specifically for antimicrobial resistance) and supporting global health in general. After all, climate change, water shortages and poverty all affect how susceptible people are to infections.
Tip 4: Address your loved ones
As healthcare professionals, we are privileged (burdened?) with a juicy brain, bursting with facts and knowledge. I believe it is our duty to educate those with less scientific and medical literacy, especially when it comes to issues of global health.
It’s worth discussing this with your friends and family in a non-confrontational way. Are they aware of what resistance is and how it develops? Are they aware of viral versus bacterial infections, which ones require antibiotics and why they should be careful?
One fun exercise might be to educate the younger people in your family, particularly if they are interested in science. Discussing the mechanism of resistance can get super creative (drawing, modelling, baking, anything that can be put onto Instagram really) and there are plenty of resources already out there.
I’m by no means saying that addressing these four points will eradicate antimicrobial resistance. The issue is complex, wide-ranging (quite literally global) and will require the combined efforts of the whole population.
However, I firmly believe that we are at a critical point and it is up to us, as the informed, altruistic cohort, to drive the changes and push forward the narrative. We’ve seen the damage anti-science actions can do. Chances are many of you have seen resistant infections in hospital and the community. Ultimately, we need to do what we can to avoid a return to the pre-antibiotic era.
‘Tis but a scratch, but the reality is that scratch could soon be beyond our treatments. So remember your M.R.S.A!