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The UNDERSTAND focus area of the toolbox provides information and tools for increased knowledge about bacteria, antibiotics and antibiotic resistance, and aims to explain why antibiotic resistance has become one of the major health challenges of our time. The focus area further discusses why it is important to take action against this negative development and gives an introduction to possible ways to do so.

The narrative text is accompanied by “Selected resources” for more in-depth information. Browse through then pick and choose what material is most helpful for you!

Antibiotics – cornerstones of medicine

The discovery and introduction of antibiotics to treat bacterial infections is one of the single most important advancements in human medicine. From treatment of pneumonia and gonorrhea to prevention and treatment of infections that can arise after major surgery or cancer chemotherapy, antibiotics have become indispensable. Likewise, antibiotics are crucial in food animal production, for treatment of sick animals and in turn securing productivity. Overall, antibiotics have greatly improved human health and animal welfare. They really are the cornerstones of modern medicine.

Unfortunately, the growing phenomenon of antibiotic resistance now threatens to leave us without effective treatment of bacterial infections. Over time, some bacteria have found means to avoid and survive the action of antibiotics. As resistance increases, antibiotics that were once effective stop working. Use and misuse of antibiotics in health care, food production and by people in the community has lead to the selection and proliferation of antibiotic resistant bacteria. These resistant bacteria can spread between people, animals and in the environment, facilitated by poor hygiene and sanitation practices, human travel and trade. At the same time, very few new antibiotics are under development.

Antibiotic resistance – the silent tsunami

Antibiotic resistance is already a severe problem worldwide, although data on the actual health and economic burden is still limited. Some available estimates on the number of deaths caused by antibiotic resistant bacteria each year are summarized in the table below:

Country and number of deaths
Thailand: More than 19,000
USA: 36,000
European Union: 33,000

And this is only the tip of the iceberg as only selected bacteria were included in these estimates. Antibiotic resistance has an especially devastating impact on people living in low- and middle-income countries, where for example treatment failure in pneumonia or blood stream infections among children results in large number of deaths. Studies from South Asia (India, Pakistan, Afghanistan, Nepal, Bangladesh) indicate that blood stream infections with resistant bacteria alone kill 98,000 newborns each year. This means that one child looses its life every five minutes because the available antibiotics are useless due to resistance! Many more have suffered from resistant infections but recovered.

The World Health Organization (WHO) has stated that bacterial resistance to antibiotics is a major global threat to public health, and warned that we are heading toward a post-antibiotic era where common bacterial infections that have been treatable will once again be associated with high mortality rates.

In this short movie, M.D. Otto Cars, founder of ReAct and Professor of infectious diseases at Uppsala university in Sweden shares his concern about the antibiotic resistance problem and briefly discusses what we should do to counteract this negative development.

A complex issue

The issue of antibiotic resistance is complex, and so are possible solutions to manage the situation. To halt the spread of resistance and reach sustainable solutions, multiple interventions are needed on many levels in society all around the globe. The only true way forward must involve global collective action applying a holistic perspective. This means that both the human and animal sector as well as environmental and financial consequences must be taken into consideration. All efforts are important, from decisions and actions by individuals to large-scale initiatives by governments.

Selected Resources

Resource Description
What do we do when antibiotics don’t work any more? Video. TED talk by Maryn McKenna on the consequences of antibiotic resistance and what may happen if we don’t start acting now (17 min).
The drugs don’t work Video. TEDx talk by Sally Davies on the reason why drugs don’t work and how to fight against it (10 min).
The coming crisis in antibiotics Video. TED talk by Ramanan Laxminarayan about the coming antibiotic resistance crisis (15 min).
What causes antibiotic resistance? Video. This TED-Ed animated video gives an overview of how antibiotics function, how bacteria evolve to resist their action and how selection of resistant bacteria works (5 min). Also available in Spanish.
Effective antibiotics – essential for children’s survival Fact sheet from ReAct providing key examples on how antibiotic resistance affects children around the world.
Successful cancer treatment relies on effective antibiotics Policy brief from ReAct explaining how and why antibiotic resistance affects cancer care and the treatment outcomes of cancer patients.
Centers for Disease Control and Prevention - CDC. Antibiotic Resistance Threats in the United States 2019. (2019).
ReAct - Action on antibiotic resistance. New fact sheet: Effective antibiotics - essential for childrens’ survival – 2020. ReAct (2020).
ReAct - Action on antibiotic resistance. New ReAct Policy Brief: Successful cancer treatment relies on effective antibiotics – 2020. ReAct (2020).
Lim, C. et al. Epidemiology and burden of multidrug-resistant bacterial infection in a developing country. eLife 5, (2016).
Cassini, A. et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. The Lancet Infectious Diseases 19, 56–66 (2019).
Davies, S. The drugs don’t work: Sally Davies at TEDxAlbertopolis.
Bhutta, Z. A. Millennium Development Goals and Child Survival: does Antimicrobial Resistance matter? (2010).
What do we do when antibiotics don’t work any more?
Ramanan Laxminarayan: The coming crisis in antibiotics. (TED, 2014).
World Health Organization - WHO. Antimicrobial resistance: global report on surveillance - Summary 2014. (2014).
ReAct. Misuse of antibiotics: the consequences. (2014).
What causes antibiotic resistance? - Kevin Wu. (2014).