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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 chemotherapy, antibiotics have become indispensable. 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 then spread to other 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

Resistance has already reached a critical point for some major infections and the consequences can be seen worldwide. Data on the actual health and economic burden of antibiotic resistance is scarce. Some of the more reliable estimates on the number of deaths caused by antibiotic resistant bacteria each year and the costs for society are discouraging:

Country and number of deaths Societal costs
Thailand: More than 19,000 ~85-200 million USD direct, more than1.3 billion indirect
USA: 36,000 Up to 20 billion USD direct, up to 35 billion indirect (figure from 2013 report)
European Union: 33,000 ~1.5 billion Euros

And this is only the tip of the iceberg as only a few 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.
Antibiotic Resistance: An Ecological Perspective on an Old Problem Report that highlights the need of co-existence with resistance instead of fighting it. To be able to do this and save life, strategies can be developed to prevent new resistance from spreading, identify strains we need to protect against, manage reservoirs of antibiotic resistant strains in the environment and find effective treatment in patients infected with resistant bacteria. Also available in French.
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.
ReAct - Action on antibiotic resistance. New fact sheet: Effective antibiotics - essential for childrens’ survival – 2020 [Internet]. ReAct. 2020 [cited 2020 Oct 13]. Available from:
ReAct - Action on antibiotic resistance. New ReAct Policy Brief: Successful cancer treatment relies on effective antibiotics – 2020 [Internet]. ReAct. 2020 [cited 2020 Oct 13]. Available from:
Lim C, Takahashi E, Hongsuwan M, Wuthiekanun V, Thamlikitkul V, Hinjoy S, et al. Epidemiology and burden of multidrug-resistant bacterial infection in a developing country. eLife [Internet]. 2016 [cited 2016 Nov 21];5. Available from:
American Academy of Microbiology. Antibiotic Resistance: An Ecological Perspective on an Old Problem [Internet]. Washington, D.C; 2009 [cited 2016 May 20]. Available from:
Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, 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 [Internet]. 2019 [cited 2019 Feb 9];19(1):56–66. Available from:
European Centre for Disease Prevention and Control - ECDC, European Medicines Agency - EMEA. The bacterial challenge: time to react. A call to narrow the gap between multidrug-resistant bacteria in the EU and development of new antibacterial agents [Internet]. Luxembourg: EUR-OP; 2009. Available from:
Davies S. The drugs don’t work: Sally Davies at TEDxAlbertopolis [Internet]. [cited 2014 Oct 9]. Available from:
Bhutta ZA. Millennium Development Goals and Child Survival: does Antimicrobial Resistance matter? [Internet]. The Global Need for Effective Antibiotics - Moving towards Concerted Action; 2010 Sep 6 [cited 2015 Jan 24]; Uppsala, Sweden. Available from:
What do we do when antibiotics don’t work any more? [Internet]. [cited 2015 Jul 28]. Available from:
Ramanan Laxminarayan: The coming crisis in antibiotics [Internet]. TED; 2014 [cited 2015 May 7]. Available from:
World Health Organization - WHO. Antimicrobial resistance: global report on surveillance - Summary 2014 [Internet]. World Health Organization; 2014 [cited 2014 Oct 2]. Available from:
Centers for Disease Control and Prevention - CDC. Antibiotic resistance threats in the United States, 2013 [Internet]. CDC; [cited 2015 Jan 9]. Available from:
Phumart P, Phodha T, Thamlikitkul V, Riewpaiboon A, Prakongsai P, Limwattananon S. Health and Economic Impacts of Antimicrobial Resistant Infections in Thailand : A Preliminary Study. Journal of Health Systems Research [Internet]. 2012 Sep;6(3):352–60. Available from:
ReAct. Misuse of antibiotics: the consequences [Internet]. 2014 [cited 2014 Oct 2]. Available from:
What causes antibiotic resistance? - Kevin Wu [Internet]. 2014 [cited 2014 Oct 2]. Available from: