Antimicrobial resistance

Antimicrobial resistance arises as bacteria come to withstand the antibiotics used against them, and it is met by measuring and reducing antibiotic use and by developing new antibiotics. This branch covers that problem, and its parts divide by the side of it a question is about: why bacteria in a biofilm withstand treatment, how antibiotics are used in people, animals and the environment and how stewardship reduces that use, how the antimicrobials sold and used in animals are counted and set against resistance, and why new antibiotics are scarce. It leaves sepsis and the drugs that act against a virus to their own parts of infection, immunity and allergy, human, animal and environmental health as one subject to One Health and planetary health, and what drug residues and manufacturing waste do to ecosystems to pharmaceuticals in the environment.

• Why a biofilm infection resists treatment — what a biofilm is and where it grows, the infections biofilms cause in hospitals, why antibiotics fail against them, how they are treated, and how far biofilm research has reached patients
• Antibiotic use and stewardship in people, animals and the environment — overprescribing for influenza, the share of antibiotics used in animal farming and the resistance residues breed in the environment, the measures that reduce use in food-producing animals, prescribing on New Zealand dairy farms with its traffic-light guidance and antibiogram, the regulation and trends of farm use, and companion-animal prescribing against stewardship guidance
• Counting antimicrobial sales and use in animals — how Europe counts the antimicrobials sold for and used in animals: the voluntary ESVAC project and the sales trends its reports showed, mandatory reporting of sales and use, the first EU-wide report on both, and the joint analyses that set consumption against resistance in animals and people
• Why the antibiotic pipeline is thin — the commercial, scientific and regulatory reasons new antibiotics are scarce, the incentives and adjusted approval requirements offered for antibiotics against multi-resistant bacteria, early dialogue with antimicrobial developers, and the shift from single medicines to regimens in tuberculosis