Tackling Barriers to Support for Antibiotic Use and Resistant Infections

View from the Ground, by Dee Grant

Antimicrobial resistance (AMR) arises when microbes such as viruses, bacteria, fungi, and protozoa develop mechanisms to withstand the action of the drugs designed to destroy them.¹ Although AMR can occur naturally, the misuse and overuse of antimicrobial agents in both human and animal populations has accelerated this process to the point where it has become a major global health threat.^1,2 A recent systematic analysis published in The Lancet found that AMR was responsible for an estimated 1.27 million deaths globally in 2019, and played a role in a further 3.68 million deaths in the same period.³

Treatment failure due to AMR is already compromising the management of more common microbial infections (including urinary tract, lower respiratory tract, and sexually transmitted infections), giving rise to serious and/or prolonged illnesses that require longer hospital stays and are more difficult and expensive to treat.⁴ This is associated with significant health and socioeconomic burdens at the individual and societal levels. For example, AMR can negatively affect an individual’s ability to fully resume normal activities of daily living, as well as their ability to work or participate in education.^4,5 The associated loss of physical and/or financial independence may have a significant negative impact on close relationships, leading to feelings of isolation, reduced self-esteem, and low mood.

Antibiotic Research UK was originally set up in 2014 to tackle antibiotic resistance through research, but it soon identified a need for better information, support, and advocacy for those living with resistant bacterial infections —this led to the establishment of the Patient Support Service (PSS) in 2019. The service plays a unique and invaluable role in supporting patients living with some of the consequences of antibiotic resistance, and its staff spend much of their time responding to requests for advice from people struggling to cope with the physical and emotional effects of resistant infections. The priority is to help these patients to feel heard and supported throughout their healthcare journey and, above all, that they will always have somewhere to turn. Patients can also participate in online patient support groups, and the service is looking at options for providing ongoing peer support for those who may benefit.⁶

In addition to sharing information with the public about antibiotic use and resistance, the service aims to widen participation by making its resources more relevant and accessible to everyone. This is vital because the determinants of health are complex and multifactorial. For example, a person’s risk of infection and exposure to antibiotic overuse is often negatively influenced by certain individual or environmental characteristics,⁷ such as being an older person or from a minority ethnic community, having a long-term condition, living in area of deprivation, or experiencing street homelessness. This means that the people at greatest risk of acquiring a drug-resistant infection are also the most at risk of exclusion and may otherwise struggle to access support.⁷ If we truly want to tackle AMR, we need to remove as many barriers to support as possible (for example, cultural, linguistic, and physical barriers), and do more to highlight antibiotic resistance—not just as a medical issue, but as a major social problem that must be tackled from this wider perspective. 

Health and social care providers play a key role in limiting the growth of AMR through policies and practice, and are central to the ambitions outlined in the UK 5-year action plan for antimicrobial resistance 2019 to 2024.⁸ Primary care is often the first point of contact between patients and the wider health system, and around 70% of antibiotic prescriptions are generated by this sector.⁹ The PSS would like to work more closely with the health service, as it has enormous potential to act as a source of important information for busy clinicians—for example, by helping them to optimise the prescribing process or navigate some of the challenges associated with promoting antibiotic stewardship and managing resistant infections. Partnering up with clinicians in this way may even help to alleviate some of the pressure on their services.

There are a lot of other ways in which Antibiotic Research UK can work with healthcare professionals and, ultimately, the best way for us to identify these opportunities will be to start building connections with a broad range of clinicians from across the health sector.