When antibiotics stop working: The growing threat of antimicrobial resistance

Imagine needing treatment for a simple infection, only to realise the medicine that once reliably treated the infection no longer works.

It sounds frightening, but this is the reality behind antimicrobial resistance (AMR), one of the biggest threats facing modern medicine. As bacteria and other microbes become resistant to the medicines used to treat them, infections can become harder – and sometimes impossible – to treat.

And one of the biggest drivers of this problem is something we can all influence: how antibiotics are used.

What is antimicrobial resistance?

“Put simply, antimicrobial is the umbrella term for medicines that act against different types of microorganisms,” says Andriette van Jaarsveld, Clinical Pharmacy Specialist at Mediclinic Southern Africa. “Antibiotics are one type of antimicrobial and specifically treat bacterial infections. As this article focuses mainly on bacterial infections and the responsible use of antibiotics, we say antibiotic resistance when discussing bacteria and antibiotics, and antimicrobial resistance (AMR) when referring to the broader global problem.”

AMR happens when microorganisms such as bacteria, viruses, fungi and parasites change over time and stop responding to medicines designed to kill or control them. This doesn’t mean your body becomes resistant to antibiotics. It means the bacteria causing an infection become harder to kill.

“Antibiotic resistance is a natural process, but inappropriate and excessive use of antibiotics accelerates it,” says Van Jaarsveld. “Every time antibiotics are used, susceptible bacteria can be killed while resistant bacteria may survive and multiply. Over time, resistant strains can become more common.”

Why should we care?

It’s easy to think of antibiotic resistance as something that affects hospitals or other people. But resistant infections can affect anyone.

A urinary tract infection that once responded easily to treatment may require a different, stronger or more complicated antibiotic. A bacterial infection following surgery may become more difficult to treat. In severe cases, infections can spread rapidly and become life-threatening.

In addition, many routine procedures rely on effective antibiotics to prevent or treat infections. Cancer treatment, organ transplantation, major surgery and intensive care can all involve patients who are particularly vulnerable to bacterial infections.

“If antibiotics stop working effectively, procedures that are currently considered relatively safe become much more challenging,” says Van Jaarsveld.

It’s not just about taking antibiotics unnecessarily

Antibiotic resistance is driven by several factors, including inappropriate prescribing by doctors, patients taking antibiotics when they are not needed, incorrect dosing and poor infection prevention and control.

One common misconception is that antibiotics are appropriate whenever you have an infection. “They aren’t,” says Van Jaarsveld. “Antibiotics treat bacterial infections – they do not work against viruses. Taking them for a viral illness such as a cold or flu will not make you recover faster, but it can contribute to antibiotic resistance and expose you to unnecessary side effects.”

There is also a danger in self-medicating with leftover antibiotics or taking medication prescribed for someone else. “The wrong antibiotic, dose or duration may not effectively treat an infection and can contribute to resistance,” she adds.

What can you do?

Protecting antibiotics is a shared responsibility, and small decisions matter.

1. Don’t demand antibiotics. If your doctor says an illness is viral and antibiotics aren’t appropriate, trust that recommendation.
2. Take antibiotics only when prescribed. Never use someone else’s medication or leftover antibiotics from a previous illness.
3. Follow your prescription carefully. Take the medicine at the dose and times recommended by your healthcare professional. If you have questions or experience side effects, speak to your doctor or pharmacist.
4. Prevent infections. Maintaining good hand hygiene, staying up to date with recommended vaccinations and practising food safety can reduce your risk of infection – and therefore your need for antibiotics.
5. Never share antibiotics. A medicine that is appropriate for one person’s infection may be completely wrong for another. Never self-medicate with antibiotics. Many upper respiratory tract infections are caused by viruses, so antibiotics will not help and may cause unnecessary harm.

Antibiotics remain one of medicine’s most valuable tools. But they are a resource we cannot afford to take for granted. “The goal isn’t to avoid antibiotics altogether,” says Van Jaarsveld. “It is to use them wisely, only when they are genuinely needed, so that they continue to work effectively when they are needed.”