Antimicrobial Resistance

2019-07-18

Antimicrobial resistance (AMR) happens when microorganisms, such as bacteria, fungi, viruses and parasites, resist previously effective antimicrobials. It is considered one of the greatest threats to global health and economy.

Antibiotics are medications used for treating bacterial infection. When antibiotics wipe out disease-causing bacteria in our body, normal bacteria are also killed, thereby increasing the opportunity for resistant bacteria to grow and multiply. These resistant bacteria are sometimes referred to as ‘superbugs’. Some superbugs are capable of resisting more than one antibiotic and such infections are difficult to treat. Although there may be alternative antibiotics available, they may be less effective or cause more side effects. If the problem of AMR does not improve, there would be fewer effective treatment options.

In view of the threat of AMR to global public health, the Government announced in the 2016 Policy Address to set up a High Level Steering Committee on AMR (HLSC) to formulate strategies and implement actions. Chaired by the Secretary for Food and Health, HLSC comprises representatives from relevant Government departments, public and private hospitals, healthcare organisations, academia and relevant professional bodies. Under a One Health framework, the HLSC has considered the recommendations proposed by the Expert Committee on AMR and has taken human health, animal health and environment fronts into consideration in formulating the holistic Hong Kong Strategy and Action Plan on Antimicrobial Resistance (2017-2022) (Action Plan).

To address the issue, actions taken by the healthcare sector alone are not enough and concerted efforts from the general public are crucial.

What I can do to combat AMR?


Practise frequent hand hygiene, especially before eating and taking medicine, and after going to the toilet	Do not demand antibiotics from your doctor	Follow your doctor’s advice when taking antibiotics


Do not stop taking antibiotics by yourselves even if you are feeling better	Ensure that vaccinations of you and your family members are up-to-date	Maintain cough etiquette, wear a mask if you have respiratory symptoms

Details
	Strategic Framework The World Health Organization (WHO) and WHO Regional Office for Western Pacific issued the ‘Global Action Plan on AMR’ and the ‘Action Agenda for AMR in Western Pacific Region’ respectively in 2015. Both documents emphasized the importance of adopting the One Health framework in formulating and implementing strategies to combat AMR. The One Health concept stresses that the rising threat of AMR should be addressed by a comprehensive framework adopting a mutli-sectoral and whole-of-society approach. It calls for collaborative actions to be taken by different sectors, including human and veterinary medicine, agriculture, food, environment, pharmaceutical industry and consumers. In view of the threat of AMR to global public health, the Government announced in the 2016 Policy Address to set up a High Level Steering Committee on AMR (HLSC) to formulate strategies and implement actions. Chaired by the Secretary for Food and Health, HLSC comprises representatives from relevant Government departments, public and private hospitals, healthcare organisations, academia and relevant professional bodies. Under a One Health framework, the HLSC has considered the recommendations proposed by the Expert Committee on AMR and has taken human health, animal health and environment fronts into consideration in formulating the holistic Hong Kong Strategy and Action Plan on Antimicrobial Resistance (2017-2022) (Action Plan), which proposed recommendations in six key areas as follows: Strengthen knowledge through surveillance and research; Optimise use of antimicrobials in humans and animals; Reduce incidence of infection through effective sanitation, hygiene and preventive measures; Improve awareness and understanding of AMR through effective communication, education and training; Promote research on AMR; and Strengthen partnerships and foster engagement of relevant stakeholders.
	About Antimicrobial Resistance What are antimicrobial agents and antibiotics? There are many types of microorganism, such as bacteria, virus, fungi and parasites. Antimicrobial agents, including antibiotics, are drugs that can kill or suppress disease-causing microorganisms. Antibiotics are drugs for treating bacterial infections, either by killing the bacteria or stopping them from growing. There are different types of antibiotics for treating different bacterial infections. Antibiotics are not effective in curing viral infections such as common cold and influenza (flu) and cannot make recovery faster. What are antimicrobial resistance bacteria? ‘Antimicrobial resistance’ occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective. ‘Antibiotic resistance’ occurs when bacteria change in ways to become resistant to the antibiotics which they are previously sensitive to. These resistant bacteria are sometimes referred to as 'superbugs'. When the bacteria become resistant to most commonly used antibiotics, they are referred to as ‘multi-drug resistant organisms’ (or MDROs). When the medicines become ineffective and infections persist in the body, the risk of spread to others will also increase. What causes antimicrobial resistance? Antimicrobial resistance (AMR) occurs naturally over time, usually through genetic changes and can affect humans and animals. The emergence and dynamics of AMR genes in bacteria circulating among humans, the environment and animals are not entirely known. AMR develops when microorganisms adapt and grow in the presence of antimicrobials (including properly used antimicrobials). Resistance develops more rapidly through the misuse and overuse of antimicrobial medicines. Resistant bacteria are often acquired through ingestion or contact from colonised or infected animals, food or humans, or their contaminated environment. AMR has no respect for borders and direction and can be transmitted in a bi-directional manner from animals to humans and vice versa. Can antimicrobial resistance affect me? Yes. This is a major concern because infections due to resistant bacteria are more difficult to treat. It may even be fatal in severe cases. Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery become very risky. Infections caused by resistant bacteria can spread to people around you and impose huge threats to community and population health.
	For General Public What can I do to combat AMR? Practise frequent hand hygiene, especially before eating and taking medicine, and after going to the toilet Do not demand antibiotics from your doctor Follow your doctor’s advice when taking antibiotics Do not stop taking antibiotics by yourselves even if you are feeling better Ensure that vaccinations of you and your family members are up-to-date Maintain cough etiquette, wear a mask if you have respiratory symptoms Proper use of antibiotics Precaution when taking antibiotics Practise frequent hand hygiene Eat or drink only thoroughly cooked and boiled items Disinfect and cover all wounds Wear a surgical mask if you have respiratory symptoms like cough, sneeze, runny nose and sore throat Young children with symptoms of infections should minimise contact with other children Are antibiotics miracle drugs that cure all kinds of inflammation? No. Antibiotics are drugs for treating bacterial infections whereas anti-inflammatory drug is a general term referring to a group of drugs which can reduce inflammation and relieve pain, such as non-steroidal anti-inflammatory drugs like aspirin. Their actions are different from those of antibiotics. If you have questions about the drugs you are taking, you should consult your doctor. Are there any risks in taking antibitoics? Yes. Antibiotics, like any other drugs, may cause side effects and allergic reactions. While antibiotics wipe out the bacteria causing the disease, they also affect the normal bacteria living inside your body and increase the risk of acquiring resistant bacteria which make treatment and control of subsequent infections difficult. Therefore, your doctor will consider your condition and balance the treatment benefits against risks before making a prescription. To protect your health, follow your doctor’s instructions when taking antibiotics. What are the side effects of taking antibiotics? Each antibiotic has its own specific side effects. In general, some people may experience side effects such as nausea, vomiting, constipation or diarrhoea, and headache when they are taking antibiotics. If the side effects persist or worsen, you should consult your doctor. Some people may also develop allergic reactions such as rash, itchiness or breathlessness after taking antibiotics. If this should occur, consult your doctor immediately. If drug allergy is confirmed, you should tell the doctor about your history of drug allergy in your future consultations. Some antibiotics may decrease the efficacy of oral contraceptives, or cause harm to the foetus or infant. Therefore, women should inform their doctors of their contraceptive, pregnancy or breastfeeding status so that appropriate prescriptions could be given. Personal hygiene Self-care tips for minor illness Do I always need antibiotics if I have cold or flu? 90% of upper respiratory tract infections (URTI) do not require antibiotic treatment (URTI such as common cold and influenza that are of viral origin). If you have a cold or flu, adopt the following measures: Have adequate rest and drink plenty of water. If symptoms persist, consult your doctor Follow your doctor’s advice on the use of drugs Do not push your doctor to prescribe antibiotics Do not self-medicate antibiotics If I am having a cold or flu and my nasal discharge changes to yellow or green, do I need antibiotics? It is quite common for the discharge to become thick and change to yellow or green during a cold or flu. Therefore, changes in the appearance of nasal discharge alone do not justify the use of antibiotics. Always consult your doctor for the use of antibiotics. Do I always need antibiotics if I have fever? No. Fever is a common presenting symptom of infection which may or may not be caused by bacterial infections. You should follow your doctor’s advice for the use of antibiotics. For the sake of your own health, you should neither push your doctor to prescribe nor self-medicate antibiotics. Keep vaccination up-to-date The World Health Organization emphasized that vaccination is a key element in preventing infections, alongside with other factors such as improved sanitation and infection control. Pneumococcal vaccine has been shown by studies to be effective in reducing overall antibiotic prescription. Another vaccine in focus is seasonal flu vaccine. The role of seasonal flu vaccination in fighting AMR is two-fold. It is not uncommon for people with flu symptoms to take antibiotics unnecessarily. According to the survey on Hong Kong general public's knowledge, attitude and practice on antimicrobial resistance, 54% of respondents have mistaken that cold and flu are treatable by antibiotics. Seasonal flu vaccination can therefore not only prevent the inappropriate primary use of antibiotics for seasonal influenza, but also their use for secondary bacterial infections. This translates into fewer opportunities for resistance to occur. "I-pledge" certificate for responsible use of antibiotics
	For Healthcare Workers What can health care workers do to combat AMR? Only prescribe antibiotics when they are needed Perform good infection control measures, practise frequent hand hygiene Remind patients to take antibiotics at the right time and with the right dose Remind patients to maintain personal hygiene Receive seasonal influenza vaccine Guidelines and Resources Reducing bacterial resistance with IMPACT, 5th edition, Hong Kong Infection Control Corner Antibiotic Stewardship Programme in Primary Care "I-pledge" certificate for responsible use of antibiotics
	Publications Hong Kong Strategy and Action Plan on Antimicrobial Resistance (2017 – 2022) General Public's Knowledge, Attitude and Practice Survey on Antimicrobial Resistance 2016/17 Wholesale Supply Data of Antibiotics in Hong Kong Wholesale Supply Data of Antibiotics in Hong Kong (2014 – 2017) Past Report Wholesale Supply Data of Antibiotics in Hong Kong (2014 – 2016)
	Press Releases
	Activities to Combat AMR Regional Symposium on Antimicrobial Resistance World Antibiotic Awareness Week World Hand Hygiene Day
	Health Education Materials TV Announcement Safe Use of Antibiotics Radio Announcement of Public Interest Safe Use of Antibiotics Transcript Videos Fight AMR – Together we can do it (full version) Fight AMR – Together we can do it (short version) Safe Use of Antibiotics Transcript Safe Use of Antibiotics Animation Transcript Clean Your Hands Frequently To Keep The Germs Away Pamphlets Prevent Antimicrobial Resistance Ask the right questions Use antibiotics smartly Beware of Antibiotic Resistance Use Antibiotics Properly Posters (Chinese version only) Never take antibiotics without a prescription Consult your doctor first (PDF) Ask the right questions Use antibiotics smartly (JPG) Doctor Chinese version only (PDF) Dentist Chinese version only (PDF) Drug Store Chinese version only (PDF) Vet Chinese version only (PDF) Safe use of antibiotics Doctors and Patients together Chinese version only (JPG) Infographics Prevent Antibiotic Resistance (PDF) Prevent Antibiotic Resistance - Parents and Children (PDF) Prevent Antibiotic Resistance - Patients (PDF) Prevent Antibiotic Resistance - Health Care Workers (PDF) Precaution when taking antibiotic (PDF) FAQs Antimicrobial Resistance (PDF) Links WHO Antimicrobial Resistance Global Antimicrobial Resistance Surveillance System (GLASS)