Antibiotic resistance is rising to dangerously high levels in all parts of the world. New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases. A growing list of infections – such as pneumonia, tuberculosis, food poisoning and gonorrhoea – are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.

Where antibiotics can be bought for human or animal use without a prescription, the emergence and spread of resistance is made worse. Similarly, in countries without standard treatment guidelines, antibiotics are often over-prescribed by health workers and veterinarians and over-used by the public.

Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill.

Antibiotic resistance is accelerated by the misuse and overuse of antibiotics, as well as poor infection prevention and control. Steps can be taken at all levels of society to reduce the impact and limit the spread of resistance.

To prevent and control the spread of antibiotic resistance, individuals can:

• Only use antibiotics when prescribed by a certified health professional.
• Never demand antibiotics if your health worker says you don’t need them
• Always follow your health worker’s advice when using antibiotics.
• Never share or use leftover antibiotics.
• Prevent infections by regularly washing hands, preparing food hygienically, practicing safer sex, and keeping vaccinations up to date.

To prevent and control the spread of antibiotic resistance, policy makers can:

• Ensure a robust national action plan to tackle antibiotic resistance is in place.
• Improve surveillance of antibiotic-resistant infections.
• Strengthen policies, programmes, and implementation of infection prevention and control measures.
• Regulate and promote the appropriate use and disposal of quality medicines.
• Make information available on the impact of antibiotic resistance.

To prevent and control the spread of antibiotic resistance, health professionals can:

• Prevent infections by ensuring your hands, instruments, and environment is clean.
• Only prescribe and dispense antibiotics when they are needed, according to current guidelines.
• Report antibiotic-resistant infections to surveillance teams.
• Talk to patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
• Talk to your patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).

To prevent and control the spread of antibiotic resistance, the health industry can:

• Invest in research and development of new antibiotics, vaccines, diagnostics and other tools.

To prevent and control the spread of antibiotic resistance, the agriculture sector can:

• Only give antibiotics to animals under veterinary supervision.
• Not use antibiotics for growth promotion.
• Vaccinate animals to reduce the need for antibiotics and use alternatives to antibiotics when available.
• Promote good practices at all steps of production and processing of foods from animal & plant sources.
• Improve biosecurity on farms and prevent infections through improved hygiene and animal welfare.

We are trying to address it in a variety of projects: everything from our neonatal unit in Pakistan; to our burns unit in Haiti; to our surgical programs in the Middle East, including the Amman project.

The use of antibiotics is a cornerstone of management in burns patients, particularly those patients in whom we are worried about invasive infections or bloodstream infections. Typically, because they’ve lost their normal skin defenses and must spend weeks in hospital undergoing multiple invasive procedures, and receiving a lot of antibiotics, burns patients are more likely to develop infections from multi-drug resistant bacteria.

The Peshawar project in Pakistan focuses on neonates—babies less than 28 days old. These are newborn babies who, in theory, have had very limited exposure to antibiotics and when they become unwell, they are becoming unwell with multi-drug resistant bacterial infections. The hypothesis is that the babies have acquired these infections from their mothers during the birth process. And it’s also likely that some of them have gotten the infections in hospital.

In these projects and in others, we are working to address some key issues:

• Improving, particularly for in-patient settings, infection prevention and control;
•  Improving access to reliable microbiology labs in order to improve surveillance and thus know the rates and types of antibiotic resistance in certain countries;
• Educating health workers and prescribers about antibiotic use and encouraging rational prescribing practices and infection control;
• And we’re also trying to do operational research and advocacy around this issue.

Moving forward, MSF needs to work in collaboration with ministries of health and local governments to restrict the over-the-counter availability of broad-spectrum antibiotics while still ensuring that people who need antibiotics can receive them in a timely manner. Another collaboration should be the expansion of vaccine use as a strategy to prevent the burden of bacterial diseases that need antibiotics.

Finally, research and development for new vaccines, diagnostic tools, and treatments is critically needed, as is the funding for the R&D. MSF will continue to advocate for that.

Within MSF, we appreciate that this issue is not going to go away, and that to address it will be a long-term and enormous undertaking. But it’s a challenge that we are already working on and will continue to in the coming years.