Antimicrobial resistance

What is antimicrobial resistance (AMR)?

Antimicrobials is the collective term for medicines that are used to prevent and treat infections in humans, animals and plants. These medicines include antibiotics, antivirals, antifungals and antiparasitics for bacteria, viruses, fungi and parasites.

AMR develops when microorganisms, such as bacteria, fungi, viruses, and parasites are exposed to antimicrobials. In order to protect themselves against antimicrobials, they undergo changes that prevent these medicines from working effectively against them.

Poster by the Centers for Disease Control and Prevention

Why is AMR a concern?

As a result of developing resistance, antimicrobial-resistant microorganisms no longer respond to antimicrobial medicines. This makes infections harder to treat, increasing the risks of developing severe illness and death.

With new antimicrobial resistance mechanisms emerging and spreading globally, AMR threatens our ability to prevent and treat an ever-increasing range of infections.

Without effective antimicrobials for prevention and treatment of infections, medical procedures (from transplants, chemotherapy, to surgeries) can become life-threatening. Around the world, healthcare systems are increasingly being put at risk.

Infographic by the World Health Organization

When are antibiotics required?

Antibiotics kill or slow the growth of bacteria. They are used to treat bacterial infections such as:

• Strep throat;

• Whooping cough; or

• Tuberculosis.

When your doctor prescribes antibiotics to treat your bacterial infection, the benefits outweigh the risks. However, side effects may occur as antibiotics destroy both good and bad bacteria. Common side effects include:

• Nausea or vomiting;

• Diarrhoea;

• Bloating; or

• Loss of appetite.

Your doctor may then prescribe probiotics along with your antibiotics to maintain and restore good bacteria. If you start developing other symptoms like allergic skin rashes due to the antibiotics or/and your side effects become worrisome, you should consult a doctor immediately.

However, antibiotics DO NOT work on viruses that cause viral infections, such as:

• Flu (Influenza);

• Common cold;

• COVID-19; or

• HFMD (Hand Foot Mouth Disease).

Instead of taking antibiotics, when down with the common cold or flu, you should:

• Get plenty of rest;

• Stay hydrated;

• Practice good hygiene habits to prevent the infection from spreading; and

• Consult your doctor if you do not get better.

Viral symptoms usually go away with time and symptomatic relief.

What are the consequences of misusing antibiotics?

Overuse or misuse of antibiotics can lead to antibiotic resistance. This reduces the effectiveness of antibiotics in treating infections, which can lead to undesirable consequences, such as:

• Drug-resistant bugs: Bacteria become resistant to antibiotics designed to kill them.

• Increased medical costs: Complications caused by antibiotic-resistant bacteria can increase hospital stay lengths and medical care costs.

• Increased health risks: Without effective antibiotics, illnesses caused by antibiotic-resistant bacteria are harder or impossible to treat, which can lead to disability and death.

Left unchecked, AMR could cause as many as 10 million deaths worldwide by 2050 – higher than death attributed to diabetes (1.5 million) and cancer (8.2 million).

How can you protect yourself and your loved ones from infections?

An infection occurs when invading microorganisms overcome your body’s immune defences. Infections caused by antimicrobial-resistant microorganisms are harder to treat as the usual antimicrobials may not work. Instead, stronger antimicrobials must be used, which may be more expensive and lead to further resistance.

Protect yourself and loved ones against infections with these steps:

Practice good hygiene habits

Our hands are in contact with germs, and we use our hands in our daily routines such as eating. Germs can also be carried by animals which, upon contact, can cause sickness in humans and vice versa. Thus, regular hand washing with soap for at least 20 seconds, after touching animals or other daily activities, is one of the easiest and most effective ways to get rid of germs, prevent infection and prevent germs from spreading to others.

Reduce infection transmission

Stay home if you are unwell. This helps to prevent the spread of bacteria and viruses, and protect the community and our loved ones.

If you have respiratory symptoms such as a cough, wear a mask when you are around others. Remember to cover your mouth when you cough or sneeze.

If you have a wound or abrasion, make sure it is disinfected and covered to prevent infection.

Get vaccinated

Several infectious diseases are preventable. Vaccinations strengthen our immunity against these diseases.

Are your vaccinations up to date? Learn about the recommended vaccines for your age group here.

Take antibiotics responsibly

Not all illnesses require antibiotics. For instance, antibiotics do not treat viral infections such as the cold, flu, and most upper respiratory tract infections.

Follow your doctor's advice for medication:

• Do not demand antibiotics from your doctor;

• Only use antibiotics when prescribed by your doctor;

• Follow the recommended dosage and duration of treatment prescribed by your doctor;

• Never share antibiotics with others or use leftover antibiotics; and

• Never save antibiotics for later use.

Practice food safety

Proper food handling and cooking can reduce the risk of infection by harmful microorganisms. The risk of foodborne illnesses caused by bacteria can be mitigated by ensuring good hand hygiene, washing fruits and vegetables thoroughly before cooking or consuming, and cooking food thoroughly.

Learn more about food safety here.

Maintain good pet health

People and pets share lives and living spaces, and could also share resistant microorganisms. Keep your pet healthy through vaccination, regular parasite and deworming treatment, proper nutrition and exercise, regular health checks by a veterinarian and good hygiene practices.

Learn more about pet health here.

Singapore’s National Strategic Action Plan on AMR

The National Strategic Action Plan (NSAP) on AMR was jointly formulated in November 2017 by the former Agri-Food & Veterinary Authority of Singapore (AVA); the Ministry of Health (MOH); the National Environment Agency (NEA); and PUB, Singapore’s National Water Agency.

The plan provides a roadmap of existing gaps and priorities for intervention and sets a framework for a national response to AMR across the human, animal, food, and environment sectors. It builds on many years of work to combat AMR in Singapore and unifies existing initiatives mounted across sectors.

About the Antimicrobial Resistance Coordinating Office

The Antimicrobial Resistance Coordinating Office (AMRCO), under the Communicable Diseases Agency (CDA), was established in August 2018 to oversee the implementation, monitoring, and evaluation of the NSAP on AMR. It works with the human, animal, food, and environmental sectors and other key strategic partners to drive progress in reducing the emergence and prevent the spread of resistant organisms.

Singapore’s One Health framework

Learn more about the NSAP and AMRCO here.

Email amrco@cda.gov.sg to enquire about AMR.

Resources for the public

Importance of antibiotics and following doctor’s advice

Watch the video below to learn more about how to use antibiotics appropriately, the importance of following your doctor’s instructions on antibiotics and advice on the treatment if antibiotics are not required.

Antibiotics – A precious resource tale

Watch a snippet from "The Antibiotic Tales" comic book by Mr Sonny Liew and Associate Professor Hsu Li Yang to learn why antimicrobials are a precious resource and ways in which you can help to reduce the spread of antimicrobial resistance.