Do bugs need drugs?

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Winnipeg Health Region
Wave, March / April 2017

In 2016, Dr. Margaret Chan, Director General of the World Health Organization, described the issue of antimicrobial resistance as a “global crisis” and a “cross-border, slow moving tsunami.”

That same year, the United Kingdom’s Review on Antimicrobial Resistance projected that antimicrobial resistance could be responsible for 10 million deaths annually by 2050, and an economic global cost of two to 3.5 per cent GDP, representing a productivity loss of US $100 trillion.

In 2015, the WHO and the United States respectively released their global and national action plans to combat this growing problem.

So what is antimicrobial resistance (AMR)?

The term refers to bacteria that develop mutations after being exposed to antibiotics. These mutations change the bacteria so that antibiotics can no longer treat the infections caused by the now “resistant” bacteria.

For many years, concern about AMR and not having effective antibiotics to fight infections has been increasing internationally among doctors and scientists. This concern increased again recently when a bacterial mutation for a last-resort antibiotic was discovered, increasing the risk that we are closer to an era where antibiotics will no longer work. This means a return to a time when we were unable to treat a wide range of infections, from common bladder, ear and throat infections, to infections like tuberculosis that has caused death and disease around the world for centuries.

There are several causes of AMR. One important cause is the large use of antibiotics as growth promoters in livestock production. Another cause is inappropriate use in treating people. Every year, over 23 million antimicrobial prescriptions are written for human consumption in Canada, of which 30 to 50 per cent have been estimated to be unnecessary.

Canada has been slower than some other countries in responding to AMR, but more recently has begun to ramp up its efforts. In November 2016, HealthCareCAN and the Winnipeg-based National Collaborating Centre for Infectious Diseases, supported by the Public Health Agency of Canada, released “A National Action Plan on Antimicrobial Stewardship” following a consultation process that included experts from across Canada.

What was discovered through this consultation process was that there are many initiatives underway in Canada (in particular at larger urban tertiary hospital centres) to support appropriate antibiotic prescribing, but that much more needs to happen to have a truly significant impact on antibiotic use and the development of AMR. Better surveillance of antibiotic use, audits of prescribing, and stronger leadership within health-care systems to support evidence-based use of antibiotics are examples of some of the areas that need to be addressed.

The recent addition by Accreditation Canada, the organization that accredits health-care organizations such as hospitals and regional health authorities, of a requirement for antimicrobial stewardship is helping to stimulate these types of activities.  

One Canadian initiative, developed in British Columbia and Alberta, which was created to help promote appropriate and evidence-based use of antibiotics, is called “Do Bugs Need Drugs?”

DBND provides information and resources for health-care professionals and the public on when and why it’s better not to use antibiotics. The website “” has been specifically developed to provide information for the public on evidence-based antibiotic use. 

Which brings us to your role. In surveys on AMR and antibiotic prescribing, one of the most common reasons doctors provide for overuse of antibiotics is patient expectations.

In my own experience as a community-based family doctor, I often got the sense (and other times heard directly!) from patients that they felt I was under-treating them when I didn’t prescribe an antibiotic for an infection, even though most community-acquired infections are caused by viruses. And it almost always took longer to explain why I wasn’t giving an antibiotic than to write a prescription for one.

So the next time you are at your doctor’s office wondering about an infection for you or a family member, feel free to ask if the infection needs an antibiotic. And if your doctor says no, don’t take that as a bad sign – it’s probably best for you and best for everyone!

Dr. Michael Routledge is Medical Officer of Health for Southern Health-Santé Sud. He previously served as Manitoba’s Chief Provincial Public Health Officer.

Wave: January / February, 2017

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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