Antimicrobials are used for the prevention, control and treatment of infectious diseases caused by bacteria, viruses, parasites and fungi. One of the more common types of antimicrobials, antibiotics are used to treat bacterial infections and have saved countless lives when prescribed and taken correctly. However, when overused and misused, antimicrobial drug resistance becomes a major concern and a public health threat worldwide1.

There is a global rise and spread of increasingly antibiotic-resistant organisms, such as methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae2. Infections caused by these antibiotic-resistant organisms are harder to treat, can result in longer hospital stays and even deaths2.

Misuse of antibiotics puts you at risk

Antibiotics, like all medications, can have side effects. When antibiotics are prescribed to treat an infection, the benefits outweigh the risks. Unnecessary or inappropriate use of antibiotics increases the risks of acquiring and spreading antibiotic-resistant infections. These include:

  • Consuming antibiotics prescribed for someone else – taking antibiotics that are not appropriate for a person’s condition can delay correct treatment.
  • Not completing the full course of antibiotics as prescribed – stopping antibiotics too soon can result in some bacteria surviving, which has the potential to cause a re-infection. As the surviving bacteria may have developed resistance to the antibiotic, stronger antibiotics (which may have more side effects) may be needed to treat the new infection. The antibiotic-resistant bacteria can also spread in the community.
  • Consuming antibiotics for viral infections, such as COVID-19, the common cold or flu – antibiotics are used to treat bacterial infections and are not effective against viral infections such as the common cold, most sore throats and the flu. When antibiotics are not needed, they will not help your illness. Instead, the side effects may cause harm.

Limit antibiotics to where they are useful

The appropriate use of antibiotics is critical to preserve antibiotic effectiveness and minimise the impact of bacterial resistance for future generations. This requires a collective effort. It includes prescribers limiting prescription of antibiotics to infections where they are useful, and patients using antibiotics exactly as prescribed for specific conditions. Antibiotics are not necessary for viral infections such as COVID-19, the common cold or the flu.

Stay healthy and keep others healthy

Preventing infection can reduce the use of antibiotics. Good basic hygiene is one of the most effective ways to reduce the risk of infection. This includes washing your hands properly, covering coughs, staying home when you are sick, and keeping your vaccinations – such as the flu vaccine – up to date.

Public health resources:

Practice tips for healthcare professionals:

Adapted from print material on careful antibiotic use from the Centers for Disease Control and Prevention, United States, the national public health institute.

KKH Antimicrobial Stewardship Programme

Hospital antimicrobial stewardship programmes (ASPs) promote the judicious use of antimicrobials through optimal usage5. These programmes have proven to be effective in improving antimicrobial use and patient outcomes, as well as contributing significantly towards reducing the rates of antimicrobial-resistant organisms and healthcare-associated costs6,7.

The KK Women’s and Children’s Hospital Antimicrobial Stewardship Programme (KKH ASP) facilitates optimal therapy for patients requiring antimicrobial treatment. The team comprises infectious disease physicians and antimicrobial stewardship pharmacists, who work to promote the judicious use of antimicrobials in babies, children and women with obstetric and gynaecological conditions.

The KKH ASP employs a prospective-intervention-and-feedback strategy5, performing daily reviews of selected antibiotics, in particular broad spectrum antibiotics of the carbapenem class, during clinical rounds. Recommendations are provided to the medical teams to reserve the use of broad-spectrum antibiotics for medical conditions where they are absolutely necessary, and reduce the risk of antibiotic-resistance development.

The team also works collaboratively to develop evidence-based guidelines for the use of antimicrobials in specific infections and various conditions, to reinforce the provision of safe care to patients in the hospital.

One such effort is the National Surgical Antibiotic Prophylaxis (SAP) Guideline (Singapore)8, which provides evidence-based recommendations for the rational use of antibiotic prophylaxis, to reduce the rate of surgical site infections and adverse events from prolonged duration of surgical prophylaxis. The Guideline is a multidisciplinary collaborative effort by the members of the National Antimicrobial Stewardship Expert Panel (NASEP) of the National SAP Guideline Development Workgroup.

​
 ​Dr Seah Xue Fen, Specialist Pharmacist, Pharmacy Department, KK Women’s and Children’s Hospital

Dr Valerie Seah Xue Fen is a paediatric specialist pharmacist and member of the National Antimicrobial Stewardship Expert Panel. Her clinical interests include antimicrobial stewardship and paediatric infectious diseases. Dr Seah has a Doctor of Pharmacy from the National University of Singapore.


​References:
  1. Antimicrobial Resistance, National Centre for Infectious Diseases (Singapore), https://www.ncid.sg/Health-Professionals/Pages/Antimicrobial-Resistance.aspx
  2. Tzouvelekis LS, Markogiannakis A, Psichogiou M et al. Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clin Microbiol Rev 2012; 25: 682-707
  3. Antimicrobial Resistance: What You Need to Know’ - HealthHub (Singapore). 2022. https://www.healthhub.sg/live-healthy/1970/Antimicrobial-Resistance-All-You-Need-to-Know
  4. Use Antibiotics Right – HealthHub (Singapore). 2022. https://www.healthhub.sg/programmes/146/use-antibiotics-right
  5. Dellit TH, Owens RC, McGowan JE et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007; 44: 159-177
  6. Nowak MA, Nelson RE, Breidenbach JL et al. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health-Syst Pharm 2012; 69: 1500-1508
  7. Schuts EC, Hulscher MEJL, Mouton JW et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis. 2016 Jul;16(7):847-856
  8. National Surgical Antibiotic Prophylaxis Guideline (Singapore). 2022. https://www.ncid.sg/Health-Professionals/Documents/NationalSAPGuidelineSingapore.pdf