Recent research has revealed some frightening data on the ubiquity of antimicrobial resistance (AMR). In a layman’s understanding, AMR is defined as the ability of a microorganism, such as bacteria, viruses, fungi, or parasites, to withstand the effects of an antimicrobial agent that was previously effective for treating infections caused by that organism.
In simpler terms, AMR occurs when microbes evolve or acquire mechanisms that render drugs like antibiotics, antivirals, antifungals, and antiparasitics ineffective, making standard treatments fail, infections persist, and the risk of spread, complications, and death increase. While it may sound like a slow-burning crisis, AMR is projected to cause 10 million deaths annually by 2050, surpassing cancer as a leading cause of death (Antimicrobial Resistance Collaborators, 2022). The urgency could not be more critical.
On Monday, July 10, 2023, while I resumed duty from my annual leave, in a certain hospital at Abuja, where I worked, one of our Consultants, Dr. Kemi, an infectious disease Specialist, recalls a harrowing case they had while I was away. A 4-year-old child, once vibrant and full of life, battled a bloodstream infection for weeks. Despite aggressive therapy with broad-spectrum antibiotics, the child succumbed. Postmortem analysis revealed an extensively drug-resistant strain of Klebsiella pneumoniae — a reminder that we are waging war against a microbial enemy that’s evolving faster than our medicines. AMR is no longer a distant threat; it is a pressing global health emergency.
The emergence of antimicrobial resistance is a classic example of natural selection. Microorganisms mutate, and under the selective pressure of antibiotics, resistant strains survive and multiply. Some of these resistance mechanisms include:
Enzymatic degradation of antibiotics (e.g., beta-lactamase production)
Alteration of drug targets (e.g., mutation of penicillin-binding proteins)
Efflux pumps that expel antibiotics from the cell
Biofilm formation, which shields bacteria from immune attack and antibiotics
Nine years ago, a famous research Journal — Microbiology Spectrum — reported that horizontal gene transfer allows bacteria to share resistance genes like gossip at a marketplace, swiftly and widely (Munita & Arias, 2016). This is particularly concerning in hospital settings, where high antibiotic use and vulnerable patients create a fertile breeding ground for resistant organisms.
To complicate the situation, in many African countries, antibiotics are accessible over the counter, often without prescription or proper diagnosis. The informal sector thrives; pharmacists and drug vendors dispense antibiotics for viral illnesses like colds, coughs, and even malaria. A study by Tadesse et al. (2022) revealed that over 60% of antibiotics in sub-Saharan Africa are used inappropriately (some as prophylaxis), mostly in outpatient settings where diagnostic support is limited.
This misuse is not limited to human health. In livestock farming, antibiotics are used not only to treat infections but also to promote growth, a practice, like the prophylactic purposes, that accelerates resistance. With limited veterinary regulation, resistant bacteria easily leap from animals to humans through the food chain or direct contact (Van Boeckel et al., 2019).
The diagnostic gap further deepens the crisis. In many primary healthcare facilities across Africa, there are no microbiology Labs to guide antibiotic therapy. Most Clinicians prescribe empirically, often defaulting to broad-spectrum antibiotics to “cover all bases” — a strategy that inadvertently drives resistance.
While AMR is daunting, it is not insurmountable. The core strategy lies in antimicrobial stewardship (AMS) — a coordinated program that promotes the appropriate use of antimicrobials to improve patient outcomes and reduce resistance.
Globally, several efforts are underway. For instance, the WHO’s Global Action Plan on AMR, adopted in 2015, urges countries to improve surveillance, regulate antibiotic use, and promote research. Also, the Global Antimicrobial Resistance and Use Surveillance System (GLASS) is helping to build a global picture of resistance trends.
In Africa, progress is mixed. Nigeria, for instance, launched its National Action Plan (NAP) on AMR (2017–2022) and has begun implementing stewardship programs in selected tertiary hospitals (Federal Ministry of Health, Nigeria, 2021). However, sustainability and scale-up remain critical challenges.
The prevalence is gradually becoming a pandemic that kills silently but steadily. If left unchecked, routine surgeries could become life-threatening, cancer chemotherapy could be halted, and organ transplants could be rendered impossible.
Medical professionals, policymakers, researchers, and communities must act now. We need not just new drugs, but new thinking. Preserving the efficacy of our existing antibiotics is as crucial as discovering new ones. It begins with responsibility, prescribing antibiotics only when needed, educating the public, and strengthening our health systems.
As Dr. Kemi (in the opening paragraphs of this piece) reflects on the child lost to resistance, her resolve grows firmer. “Each prescription we write is a vote for resistance or for survival,” she says. Indeed, in this war, every choice counts.
✍️Jude Eze
References:
Antimicrobial Resistance Collaborators. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, 399(10325), 629–655. https://doi.org/10.1016/S0140-6736(21)02724-0
Federal Ministry of Health, Nigeria. (2021). Nigeria National Action Plan for Antimicrobial Resistance 2017–2022: Progress and Gaps. Abuja: FMoH.
Munita, J. M., & Arias, C. A. (2016). Mechanisms of antibiotic resistance. Microbiology spectrum, 4(2). https://doi.org/10.1128/microbiolspec.VMBF-0016-2015
Tadesse, B. T., Ashley, E. A., Ongarello, S., Havumaki, J., Wijegoonewardena, M., González, I. J., & Dittrich, S. (2022). Antimicrobial resistance in Africa: a systematic review. BMC Infectious Diseases, 22, 21. https://doi.org/10.1186/s12879-021-07079-0
Van Boeckel, T. P., Pires, J., Silvester, R., Zhao, C., Song, J., Criscuolo, N. G., … & Laxminarayan, R. (2019). Global trends in antimicrobial resistance in animals in low- and middle-income countries. Science, 365(6459). https://doi.org/10.1126/science.aaw1944
WHO. (2022). Antimicrobial resistance. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
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