The European Center for Disease Prevention and Control (ECDC) and European Medicines Agency (EMEA) jointly estimated that in 2009, the overall annual healthcare expenditure and productivity losses were over €1.5 billion because of the additional cost to AMR infectious disease management. In the United States of America (USA), the healthcare cost related to AMR was $55 billion per year in 2013, and every year more than 2 million of the US population are infected with resistant infections, which claim over 23,000 deaths ( 16). As a result, AMR creates a progressively grave risk for global public health in the last two decades and has now been appraised as the highest health endangerment in the 21st centenary ( 14, 15). Consistent expansion of AMR has stunted both the prevention and treatment of infections caused by bacteria, parasites, viruses, and fungi ( 14). Although antimicrobial resistance (AMR) is a natural phenomenon, the process has been much enhanced because of the overuse, underuse, and misuse of antimicrobials both in humans and animals ( 10– 13). Thereafter, the fight against pathogens has been a losing battle despite relentless attempts by scientists to develop new and more effective agents against the micro-organisms. Unfortunately, within 50–60 years, these successes of medical science were starting to fade as micro-organisms began to develop resistance toward antibiotics ( 10– 12). The discovery of antibiotics reduced the death rate by 25–30% for both community-acquired and healthcare-associated pneumonia, 75% for endocarditis, 60% for meningeal or cerebral infections, and 11% for cellulitis ( 8, 9). The discovery of penicillin by Sir Alexander Fleming in 1928, completely transformed medical practice., It still ranks as the most effective life-saving intervention in medicine, saving millions of lives in the years to follow ( 6, 7). Until relatively recently, the average life span was limited to 4 or 5 decades, in part because minor infectious diseases often progressed to septicemia and death ( 3– 5). were widespread all over the globe ( 1), and infectious diseases were the primary cause of morbidity and mortality ( 2). In the pre-antibiotic era, contagious microbial diseases such as smallpox, cholera, diphtheria, pneumonia, typhoid fever, plague, tuberculosis, typhus, syphilis, etc. We conclude with suggestions on how to address this public health threat, including recommendations on training medical students about antibiotics, and strategies to overcome the problems of irrational antibiotic prescribing and AMR. A fundamental problem is the knowledge, attitude, and practice (KAP) regarding antibiotics among medical practitioners, and we explore this aspect in some depth, including a discussion on the KAP among medical students. Among the factors discussed is the low level of development of new antimicrobials and the irrational prescribing of antibiotics in developed and developing countries. This paper sets AMR in context, starting with the history of antibiotics, including the discovery of penicillin and the golden era of antibiotics, before exploring the problems and challenges we now face due to AMR. AMR is a public health challenge with extensive health, economic, and societal implications. There is global concern about the rise in antimicrobial resistance (AMR), which affects both developed and developing countries. However, infectious diseases remain the leading cause of death in the world. 10The Unit of Pharmacology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, MalaysiaĪntibiotics changed medical practice by significantly decreasing the morbidity and mortality associated with bacterial infection.9Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh.8UChicago Research Bangladesh, Dhaka, Bangladesh.7The Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Malaysia.6Department of General and Emergency Surgery, Macerata Hospital, Macerata, Italy.5Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom.4Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.3Warwick Medical School, University of Warwick, Coventry, United Kingdom.2Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia.1School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St.Rahman 2 † Ed Peile 3 † Motiur Rahman 4,5 † Massimo Sartelli 6 † Mohamed Azmi Hassali 7 † Tariqul Islam 8 † Salequl Islam 9 Mainul Haque 10 * †
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