Overuse of antibiotics in human medicine, agriculture, and livestock has contributed to the emergence of antibiotic resistance. Inappropriate use stems from over-prescription by doctors, patients not completing treatment courses, and mass administration to farm animals. Lack of public knowledge about antibiotic use and resistance also drives unnecessary consumption. Weak infection control in hospitals and limited diagnostic testing further enable the spread of resistant bacteria. Addressing these interconnected factors through improved prescribing practices, public education, infection prevention, and testing is needed to curb the global rise of antibiotic resistance.

1. Factors Behind the
Emergence of Antibiotic
Resistance

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 antibiotics
 Despite understanding the long-term risks of resistance, doctors are often focused on
treating the potential infection in front of them, in their individual patient
 Long-term risks are not prioritized and the judicious use of antibiotics is not valued
 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 present
 In many lower and middle income countries antibiotics can be purchased without a
prescription
 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 health
 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 viruses

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 course
 Taking leftover antibiotics from previous treatment courses
 Sharing unused drugs with other people
 Close to one third (32%) of people surveyed believe they should
stop taking antibiotics when they feel better, rather than completing
the prescribed course of treatment.
 For some conditions, such as tuberculosis or osteomyelitis, and
other deep-seated infections, symptoms can improve even though
the bacteria might still be flourishing
 Many of these practices are common in both developed and
developing countries

5. Unnecessary use of
antibiotics in agriculture
and livestock
 Much of the use of antibiotics in animals is not therapeutic
 Significant volumes of antibiotics are used prophylactically amongst healthy
animals to:
 Stop the development of an infection within a flock or herd
 Promote growth, to speed up the pace at which animals gain weight
 Overuse presents the risk that drug-resistant strains are passed on through
direct contact between humans and animals (notably farmers)
 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 itself
 There is also a further indirect threat to human health as result of animal excretion
 Huge amounts of antibiotics are used for agriculture in some countries—up to
four-times the amount used in human medicine in some cases
https://agricultureproud.files.wordpress.com/2013/11/1452174_695477840471943_52921068_n1.jpg

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) infections
 Outbreaks caused by resistant pathogens
 Exacerbated by inherent problems: overcrowding and
insufficient equipment and trained personnel
 These resistant pathogens become a reservoir of
resistant genes
 Can also be spread to the community through unsafe water
and poor sanitation

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 viral
 Tests may help, however may help, however often
patients must wait some time for results
 Treatment is usually then given based on clinical
judgement – often influenced by the patient’s anxiety
and the doctor’s intolerance of risk
 Leads to overuse and overprescription

8. References
 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.
 WHO. WHO multi-country survey reveals widespread public
misunderstanding about antibiotic resistance. [News
Release]. 2015 16 NOVEMBER 2015.
 http://www.who.int/mediacentre/news/releases/2015/antibiotic-
resistance/en/
 Davies J, Davies D. Origins and evolution of antibiotic
resistance. Microbiology and Molecular Biology Reviews.
2010;74(3):417-433.