The significance of WAAW and EAAD
Every year on the 18th to 24th November we celebrate the World Antimicrobial Awareness Week (WAAW). The theme for 2021 is: Spread awareness, stop resistance. As in previous years, the overarching WAAW slogan has continued to be 'Antimicrobials: Handle with Care'.
The first WAAW was launched by World Health Organisation (WHO) in November 2015 and was centred upon European Antibiotic Awareness Day (EAAD). The stated mission of WAAW was to raise awareness about AMR, to halt its emergence and spread, and to encourage best practice by professionals and the public.
Unfortunately, the despairing message is that this is a global crisis on antimicrobials and drug-resistance infections. It is too big an issue to ignore and has been described as a ‘slow motion’ pandemic. WHO outlines the problem as follows: “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, blood poisoning, gonorrhoea, and foodborne diseases – are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.”
The Era of Antimicrobials
Antimicrobials have been in use for thousands of years in a variety of formats; one of the oldest recognised and noted was from the Ebers Papyru, dating to circa 1550 BC, where the ancient Egyptians applied mouldy bread to infected wounds. Until the end of the 19th century most drugs were derived either from minerals or from plants.
The greatest contribution was from the German scientist, Paul Ehrlich. In 1910 he synthesised the first antimicrobial agent in the world, the discovery of salvarsan (today known as arsphenamine); this was a remedy for syphilis. He promoted the concept of a ‘magic bullet', where it must be possible to create substances that can kill certain bacteria selectively without harming other cells. This became the first modern antibiotic but had limitations in terms of safety and efficacy.
In 1928 Sir Alexander Fleming, by serendipity, discovered penicillin. He found that the growth of Staphylococcus aureus was inhibited in a zone surrounding a contaminated blue mold (a fungus from the Penicillium genus) in culture dishes. The discovery of penicillin in 1928 started the golden age of natural product antibiotic discovery. It wasn’t until 1945 when penicillin came into clinical use, Howard Florey and Ernest Chain published research papers on purifying the penicillin and scaling up the process. The mass production of penicillin saved the lives of many wounded soldiers during World War II and was named as a “wonder drug”.
During 1940 to 1962 most of the antibiotic classes we use as medicines today were discovered and introduced to the market. It was followed by other important antibiotics such as streptomycin, the tetracyclines, and the macrolides.
Antimicrobial Resistance – It’s Everyone’s Problem
At the point of discovery, Fleming also noted the dangers of antibiotic resistance by over-using or mis-using antibiotics, by the process of the bacteria evolving naturally via natural selection through random mutation. In 1948 penicillin-resistant staphylococcus became a global pandemic; in 1959 methicillin antibiotics were invented to combat penicillin-resistant staphylococcus; and in 1960 the first strain of methicillin-resistant staphylococcus aureus (MRSA) emerged.
Since 1984, there have been no new registered classes of antibiotics for human treatment developed and there are few antibiotics in the development pipeline. The main driving forces described by WHO has been the misuse of antimicrobials, together with over-prescription and self-medication practices over the last years. Poor diagnostic, prescribing practices and patients not following their treatment have also contributed towards the global AMR problem. It is now more important than ever that we use our existing antibiotics wisely and make sure these life-saving medicines continue to stay effective for us in the future.
Here is some practical Antimicrobial Resistance (AMR) advice from a Community Pharmacist (Farial Majid):
1. Take your health care professional advice
Antibiotics are important medicines and should only be taken when prescribed by a health professional. Antibiotics can have side effects as they upset the natural balance of bacteria potentially resulting in diarrhoea and/or thrush. The use of inappropriate antibiotics may also allow other more harmful bacteria to increase.
2. Take antibiotics as prescribed
Antibiotics should be taken as prescribed, never saved for later or shared with others; it is important we use antibiotics in the right way - the right drug, at the right dose, at the right time, for the right duration. Appropriate use of antibiotics will slow down the development of antibiotic resistance. It’s also crucial that you take the full course of antibiotics - even if you start to feel better before your course is complete. Your healthcare professional, including the pharmacy team, can counsel you on how to take antibiotics; common side effects; and potential interactions.
3. Dispose of unused or expired antibiotics properly
Never flush expired or unused medicine down the toilet, pour it down the sink or throw it in the waste disposal bins. If you do, the medicine enters the water system, which can make the problem of drug resistance much worse. Any unused or expired antibiotics can be disposed safely at your community pharmacy.
4. Make a pledge as an Antibiotic Guardian
Become an Antibiotic Guardian and protect yourself, your family and friends against the spread of antibiotic resistance at https://antibioticguardian.com/
5. Self-care
If you think you may have COVID-19 then please visit https://www.gov.uk/coronavirus or http://www.nhs.uk for the latest guidance and information.
Antibiotics do not work for ALL colds, or for most coughs, sore throats or earache. Your body can usually fight these infections on its own.
We can all do our part to keep antibiotics working - by washing your hands regularly, preparing food hygienically, avoiding close contact with sick people, practising safer sex, and keeping vaccinations up to date. You can also help the NHS prescribe fewer antibiotics by taking appropriate self-care steps. Community pharmacists are well placed to help provide advice on over-the-counter medicines to manage symptoms and help with self-care.
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For more information on antibiotics visit: http://www.nhs.uk/nhsengland/arc/pages/aboutarc.aspx.
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Useful Patient Information Leaflets for children are available: www.medicinesforchildren.org.uk
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Self-care leaflets such as 'How I can manage common infections for adults aged 16 years and over' can be found at: RCGP
- World Health Organisation: https://www.who.int/campaigns/world-antimicrobial-awareness-week/2021
- European Antibiotics Awareness Day: https://antibiotic.ecdc.europa.eu/en/get-informed/infographics
- History of antimicrobial agents and Resistant bacteria: https://www.med.or.jp/english/journal/pdf/2009_02/103_108.pdf
- History of Antimicrobial discovery: https://www.news-medical.net/life-sciences/History-of-Antimicrobial-Discovery.aspx
- TARGET antibiotics toolkit hub: https://elearning.rcgp.org.uk/course/view.php?id=553
- UKHSA World Antimicrobial Awareness Week and European Antibiotics Awareness Day: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1025912/waaw-eaad-resources-toolkit-healthcare-professionals-england.pdf