A new sanitizing area with bright wide open hallways, soft contrasting colours, wood accents at the Patient Care Centre in the Royal Jubilee Hospital provide elderly patients with a much better stay in Victoria,BC.Chad Hipolito/The Globe and Mail
From kindergarten to Grade 3, children in British Columbia and Alberta are being taught what they can do to save the endangered antibiotics of the world.
They learn that handwashing can prevent infections. They learn not to expect an antibiotic when they're sick and to trust their doctor if no antibiotic has been prescribed. They even get to play online games that teach them how to defend properly against bugs. "Use antibiotics wisely," instructs the program, called Do Bugs Need Drugs? "You can make a difference."
Children will not singlehandedly save antibiotics from the overuse by parents, doctors and pharmacists. But the program is a harbinger of a massive effort, in Canada, in other wealthy countries, in the developing world and in global health organizations, to save modern medicine from itself. It is exactly the sort of urgency that the world needs more of.
Antimicrobial resistance is the new climate change. The phrase will soon be on the lips of the world – even schoolchildren. The antibiotic footprint is of the moment. And the effort needed to reduce that footprint will need to be of the same scale as that needed to tackle climate change.
That begins with a vast information-gathering program. We need to know the size of the "footprint" – how often antibiotics are being prescribed, in Canada and elsewhere, and why; how many people acquire drug-resistant infections, and what their risk factors are. "We have some rudimentary systems in place but we should be doing a much better job," says microbiologist Andrew Simor of Sunnybrook Health Sciences Centre in Toronto. The European Union shares antibiotic usage information across national borders much more easily than Canada does across provinces, observers say.
And modern medicine needs to correct its ways. Wealthy countries need to change the conversation between patients and doctors. In rich countries like Canada, an estimated 50 per cent of antibiotics prescriptions are given inappropriately. But it is not a problem that can fixed by "just saying no."
"It's astonishingly more difficult to change than you think," says Lynora Saxinger, a professor in the infectious diseases division of the University of Alberta department of medicine.
Why? Because sometimes, the consequences of not taking an antibiotic may be serious, and individuals naturally wish to protect against the worst (whether it's an actual risk or not) to themselves or their children. And individuals pursuing what they conceive of as their own interests, and doctors trying to help them, are bringing about a calamity.
The struggle is between the individual's short-term good and the community good, which will inevitably affect the individual. But many people have only a hazy knowledge of what is at stake, and many doctors, too, have lax or permissive practices around the giving out of antibiotics.
"If you take an antibiotic," Dr. Saxinger says, "you have changed your own bacteria, and you can spread resistant bacteria to other people. Our antibiotic use can change the ecology of resistance for our kids and grandkids. And so there's a lot more to think about when you're prescribing antibiotics."
Do Bugs Need Drugs? also offers programs to doctors, nurses, pharmacists, teachers and others. It runs ads on buses and trains, in newspapers and on radio and the Internet. And similar programs are being tried in the United Kingdom (Stemming the Tide of Antibiotic Resistance (STAR) Educational Program) and the United States (Get Smart), which tells families "Snort. Sniffle. Sneeze. No antibiotics, please." Similar programs are spreading in the developing world, too, in places such as Thailand and Vietnam.
The problem is often worse in developing nations, because people often rely on antibiotics purchased over the counter to make up for an absence of easily available medical advice. Low- or middle-income countries need to improve their health infrastructure before proper prescribing can happen.
Agriculture, too, will need to become much more vigilant about the use of antibiotics in animal feed, through better regulation and a reduction of antibiotic use in healthy animals.
Hospitals need to be part of the answer. In Canada, they have begun to rein in antibiotic use with "stewardship" programs – audits, education, and a team approach with infection-control leaders. Accreditation of hospitals in Canada is building in a requirement for those programs.
Infection controls need to be much more stringent. The challenge is compounded "when hospitals have a 105-per-cent occupancy rate," Dr. Simor says. Perhaps, but there is far too much sloppy practice.
As climate change has become a household phrase, so will the subject of antibiotic resistance soon be commonplace, even among children – if the world is lucky, and smart about it.