For the last 2 years, 18–24 November has been marked as World Antimicrobial Awareness Week (previously named World Antibacterial Awareness Week) by the Antimicrobial Resistance Tripartite, which consists of the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE) and the World Health Organization (WHO). The theme for the 2021 campaign is ‘Spread Awareness, Stop Resistance’, with the aim of encouraging healthcare providers and the public to adopt best practices in the treatment of infection in order to combat antimicrobial resistance (AMR). 
An antimicrobial is any medicine used in the treatment of infection, including antibiotics, antifungals, antivirals or antiprotozoals. Currently, there are around 700,000 AMR-related deaths globally each year, but it is estimated that this number will exceed 10 million per year by 2050 if the problem is not adequately addressed.  In line with this, the WHO has declared AMR as one of the top ten global public health threats facing humanity. 
Since the discovery of penicillin in 1928, each time a novel antimicrobial is introduced for widespread use, AMR occurs within a few years.  Resistance to antimicrobials occurs when an organism evolves to survive a treatment it was previously susceptible to.  Although this is a natural phenomenon, every organism evolves to overcome survival obstacles and the development of AMR is being accelerated by a variety of factors. 
One of the key drivers of AMR is the overuse and misuse of antimicrobials in humans, livestock and agriculture. Half of antibiotic treatments in primary care are prescribed for respiratory tract infections due to viruses, meaning that they are largely ineffective.  Approximately 66% of antibiotics produced worldwide are used in the rearing of livestock,  destroying susceptible bacteria while also allowing more resistant strains to propagate. Lack of access to clean water is another factor driving AMR as resistant pathogens can develop in dirty water containing antimicrobials and circulate among the human population, thus increasing rates of AMR.  Additionally, inadequate access to healthcare facilities (e.g. vaccines and diagnostic tools) generally result in more infections, which encourages AMR.  Finally, a more recent development in AMR is the vastly changing healthcare landscape resulting from the COVID-19 pandemic,  which is discussed in the following section of the article.
AMR and COVID-19
The prevalence and severity of the COVID-19 pandemic has forced rapid adaptations across the entirety of global healthcare, which have in turn contributed to the development of AMR. In a recent meta-analysis that included 154 studies and over 35,000 patients, it was found that, despite concomitant bacterial infection only being found in 6%–8% of patients with COVID-19, nearly 75% of patients received broad-spectrum antibiotics in the first 6 months of the pandemic,  which may have increased rates of AMR considerably.
The logistical challenges due to the global pandemic may have also contributed to AMR. For example, global manufacturing and supply chain disruptions caused by the pandemic have resulted in shortages of some antimicrobial agents, leading to use of suboptimal alternatives. In addition, the vast number of hospitalisations arising from COVID-19 has placed a huge burden on healthcare systems, resulting in the disruption of many management programs for other infectious diseases, including HIV, tuberculosis and malaria.  These disruptions may lead to increasing time to diagnosis and the subsequent rise in the number of infections that will ultimately require treatment with antimicrobial agents.
However, it’s not all bad news. Several positive aspects of the pandemic have likely contributed to a reduction in AMR, mainly surrounding the area of initial infection prevention. Global travel restrictions led to a significant reduction in the transmission of infectious diseases as peoples’ ability to socialise face-to-face was severely limited.  Furthermore, stronger awareness of hygiene measures and widespread adoption of facemasks are also likely to have contributed to a reduced incidence of transmission. Less infections means less chance for microbes to genetically evolve resistances to antimicrobial treatments, thus limiting the development of AMR. 
What can we do?
One of the best ways to reduce AMR is to prevent infection from occurring in the first place. Preventing a case of infection removes the need for antimicrobials and therefore lowers the risk of AMR developing. The primary measures we can all take to prevent infection include following good hygiene practices, keeping up to date with vaccinations, and practicing safe sex.  Furthermore, it is essential that antimicrobial medications are only used when prescribed and that patients complete the full course of treatment, even if they feel better before it ends. 
AMR is not a new phenomenon, but it is only in the last few years that AMR has gathered widespread attention as a massive global issue. We can all help to spread awareness of AMR by engaging with the World Antimicrobial Awareness Week campaign. A great place to start is by educating yourself about the use of antimicrobials and the measures we all take to prevent infection, while encouraging others to do the same. Use the hashtags #WAAW, #AMR, #AntimicrobialResistance, and #HandleWithCare on social media to support the global awareness week.
Other ways to support the campaign include wearing blue clothing to be a part of the “Go Blue” colour campaign, as well as taking the opportunity to inform friends, family and colleagues about the significance of AMR. Please visit the WAAW campaign guidance page to learn more about what you can do get involved. 
The information in this article is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content is for general information purposes only. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding the health or medical condition of yourself / another individual.
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Author: Matthew Wilcox: Porterhouse Pathfinders Intern