AMR Bulletin 4.0

APRIL 2025
World Medical Association
Junior Doctors’ Network
www.wma.net/junior-doctors/
SPECIAL EDITION BULLETIN
(FORMERLY NEWSLETTER) ON
THE VIEWS AND OPINIONS EXPRESSED IN THIS NEWSLETTER ARE SOLELY THOSE OF THE
AUTHORS AND DO NOT NECESSARILY REFLECT THE OFFICIAL POSITIONS OR POLICIES OF
THE JUNIOR DOCTORS NETWORK (JDN) OR THE WORLD MEDICAL ASSOCIATION (WMA).
ANTIMICROBIAL RESISTANCE
Special Edition Bulletin on
Antimicrobial Resistance
April 2025
S.No. Contents Page No.
1 About WMA JDN 4
2 Meet the WMA JDN Leadership 5
3 Meet the Publications Team 6
4 Foreword by Chair 7
5 Foreword by Deputy Chair 8
6 Foreword by Secretary 9
7 Foreword by Publications Director 10
8 Foreword by Past Chair 11
9
Antimicrobial Resistance: Challenges and Solutions in Primary
Health Care
12
10 Empowering Youth in the Fight Against Antimicrobial Resistance 14
11 Building Effective Partnerships for AMR Strategy Implementation 16
12 One Health, One Fight: Junior Doctors in the Battle Against AMR 18
Table of Contents
www.wma.net/junior-doctors/
ISSN (PRINT) 2415-1122
ISSN (ONLINE) 2312-220X
Special Edition Bulletin on
Antimicrobial Resistance
April 2025
S.No. Contents Page No.
13
Indian Medical Association – Efforts in Combating Antimicrobial
Resistance and Junior Doctors’ Engagement
20
14
World AMR Awareness Week: A Talk on Antimicrobial Resistance at
My Workplace
22
15
Revolutionizing Antimicrobial Resistance Management with Digital
Health
24
16 Anti-Microbial Resistance: A Platonic Peer 26
17
Strengthening the Fight Against Antimicrobial Resistance by
Web-based Monitoring System
27
18
Antimicrobial Resistance in the Philippines: Perspectives from
Junior Doctors
29
19
Antimicrobial Resistance in Low and Middle – Income Countries: an
Established Global Health Crisis
32
20
A Global Threat: Antimicrobial Resistance through the One Health
Lens
34
22 Antimicrobial Resistance in Ophthalmology: A Global Perspective 36
23 How to become a WMA JDN Member? 38
www.wma.net/junior-doctors/
ISSN (PRINT) 2415-1122
ISSN (ONLINE) 2312-220X
Special Edition Bulletin on
Antimicrobial Resistance
April 2025
About Us
What is World Medical Association?
The World Medical Association (WMA) is an international organization representing physicians. It
was founded on 17 September 1947, when physicians from 27 different countries met at the First
General Assembly of the WMA in Paris. The organization was created to ensure the independence of
physicians, and to work for the highest possible standards of ethical behaviour and care by
physicians, at all times. This was particularly important to physicians after the Second World War,
and therefore the WMA has always been an independent confederation of free professional
associations. Funding has been by the annual contributions of its members, which has now grown to
115 National Medical Associations.
What is the Junior Doctors Network?
The Junior Doctors Network (JDN) serves as an international platform for junior doctors to facilitate
an open dialogue of global events and activities that are relevant to their postgraduate training and
the World Medical Association (WMA).
It was created at the 61st WMA General Assembly (October 2010) in Vancouver, Canada and the
inaugural JDN meeting was held at the 62nd WMA General Assembly (October 2011) in Montevideo,
Uruguay. The network, which started from a few motivated junior doctors, now has a total of over
900 members from more than 90 countries from all regions of the world. Junior doctors are defined
as physicians, within 10 years after their medical graduation or who are still in an ongoing
postgraduate medical education program.
What is the mission?
The purpose of the JDN is to empower young physicians to work together towards a healthier world
through advocacy, education, and international collaboration.
What do we do?
Networking:
During the regular JDN meetings, members get to know each other, discuss global health issues,
share challenges, and start collaborations on global health issues. The JDN meets on several
occasions during the year, both in-person and via online teleconferences:
Biannual meetings in conjunction with the Council Meeting and the General Assembly of the
WMA (April & October).
Monthly general membership and management team teleconferences
Ad-hoc online and webinars organized by the JDN
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Special Edition Bulletin on
Antimicrobial Resistance
April 2025
Meet the WMA JDN Leadership 2024 – 2025
DR PABLO ESTRELLA PORTER
CHAIRPERSON
DR BALKISS ABDELMULA
DEPUTY CHAIRPERSON
DR SAZI NZAMA
SECRETARY
DR ADEEL RIAZ
SOCIO-MEDICAL AFFAIRS OFFICER
DR MERLINDA SHAZELLENNE
MEDICAL EDUCATION DIRECTOR
DR.SHIV JOSHI
MEDICAL ETHICS DIRECTOR
DR YUJIN SONG
MEMBERSHIP DIRECTOR
DR VENKATESH KARTHIKEYAN
PUBLICATIONS DIRECTOR
DR JEAZUL PONCE
COMMUNICATIONS DIRECTOR
DR MARIE-CLAIRE WANGARI
IMMEDIATE PAST CHAIR
5
Special Edition Bulletin on
Antimicrobial Resistance
April 2025
Meet the WMA JDN Publications Team – Special Edition
DR.ARENS JEAN RICARDO
MEDEUS
DR.FATIMA KHURSHID
DR.SHRAVAN R DAVE
DR.ENEJO EBOSHOGWE
REBECCA
DR.BONNKE ARUNGA DR. SREEJA A
DR.ARUNAGIRI G
DR TAMALE ELVIS
EDITOR
DR VENKATESH KARTHIKEYAN
EDITOR IN CHIEF
DR JEAZUL PONCE
ADVISOR
Address for Correspondence : Dr Venkatesh Karthikeyan, National Convenor – AMR, IMA House,
Indraprastha Marg, New Delhi, India – 110 002. Email : 4852012@gmail.com
6
DR. AQSA SHAFIQUE
DR PABLO ESTRELLA PORTER
ADVISOR
Special Edition Bulletin on
Antimicrobial Resistance
April 2025
Foreword by Chair
Dear Junior Doctors colleagues,
As the Chair of the Junior Doctors Network (JDN), it is an honor to contribute this foreword to our
WMA JDN Bulletin, focusing on antimicrobial resistance (AMR), a defining challenge of our time.
Antimicrobial drugs revolutionized medicine, saving countless lives. Yet, their misuse across
human, animal, and agricultural domains has driven a silent crisis: AMR. Recognized among the
top 10 global health threats, AMR caused nearly 1.14 million deaths in 2021 alone​
. The year 2024
has presented critical milestones such as the High-Level Meeting on AMR and the Fourth Global
Ministerial Conference in Jeddah that have spotlighted this issue. However, translating dialogue
into sustainable action remains crucial, particularly in Low- and Middle-Income Countries (LMICs),
where the burden is most acute.
JDN’s commitment to AMR advocacy through campaigns, policy engagement, and awareness
initiatives underscores our key role. Together, we must amplify the voices of junior doctors
worldwide, ensuring equitable access to antimicrobials, strengthening surveillance systems, and
promoting stewardship. The One Health approach is vital, integrating human, animal, and
environmental health to address this multidimensional threat.
I extend heartfelt gratitude to the Publications Team and contributing members for this special
edition. Your insights inspire us to confront AMR boldly, united in our vision for a healthier future.
Warm regards,
Dr Pablo Estrella Porter
Chair 2024-25,
Junior Doctors Network,
World Medical Association.
7
Special Edition Bulletin on
Antimicrobial Resistance
April 2025
Foreword by Deputy Chair
Dear Colleagues,
I am honored to address you in this special edition of our JDN Bulletin, dedicated to the urgent
issue of Antimicrobial Resistance (AMR). This publication wouldn’t have been possible without
the invaluable contributions of all our authors, whose dedication to advancing our
understanding of AMR and its implications for healthcare shines through in each article.
In this edition, we explore the complex issues surrounding AMR, a growing global threat to
public health. We examine the scientific, clinical, and policy challenges that we, as junior
doctors, encounter in our day-to-day practice while dealing with resistant infections. We also
discuss the significance of responsible antibiotic use, infection prevention measures, and the
role of surveillance in fighting AMR at both local and global levels.
As caretakers of human lives, we are entrusted with the responsibility and privilege of
providing the best care possible to our patients while also safeguarding the effectiveness of
antibiotics. Tackling AMR is not only a professional duty but also an ethical imperative. Staying
informed about resistance trends, treatment alternatives, and the latest public health
strategies is essential to ensure we are equipped to combat this growing issue.
As junior doctors, we are at the frontline of this challenge, and the choices we make today will
have lasting impacts on the future of medicine. By approaching our practice with awareness,
responsibility, and ethical commitment, we not only honor the profession we have chosen but
also contribute to the global effort to preserve the efficacy of antibiotics for generations to
come.
Once again, I would like to express my sincere gratitude to the
authors of this edition for their exceptional contributions, and to
the JDN Publications Director for coordinating this important
project. I am confident that our JDN members will continue to
show unwavering commitment to combating AMR through our
AMR Working Group advocacy efforts.
Best regards,
Dr. Balkiss Abdelmoula, MD. MPH.
Deputy Chairperson 2024-2025
Junior Doctors Network
World Medical Association
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Special Edition Bulletin on
Antimicrobial Resistance
April 2025
Through the thoughts and experiences of junior doctors world-wide, we have been able to gain
insight into the evolution of medicine in varying degrees across the different fields of medical
practice. Through this, individual thought processes have broadened, further developed and in
some instances, aided in an individual’s ability to innovate and generate ideas that positively
impact their practice of medicine.
The Junior Doctors Network (JDN) provides a platform for young physicians to share and acquire
insights by fellow colleagues from across the world. This news bulletin focuses on a topic that has
over the years, garnered much attention in the medical community for its far-reaching effects not
only on humans, but animals and the environment as well : Antimicrobial Resistance.
The World Medical Association (WMA) echoed the thoughts of many physicians in their Statement
on Antimicrobial Resistance; “Addressing the threat of antimicrobial resistance is a fundamental
global health priority, and the responsibility of all countries.” Showcasing the Multi-sectoral
approach utilized in India, seeing AMR through the eyes of Junior doctors in the Philippines and
even briefly spotlights the importance and benefits of integrating digital health in antimicrobial
stewardship & patient care.
It is my hope that this publication provides you with interesting viewpoints, highlights strategies
that may aid in developing or advancing your practice of medicine and inspires you to continue or
join in combatting antimicrobial resistance.
I look forward to interacting with you all at the upcoming JDN Spring Meeting in Montevideo,
ahead of the WMA’s 229th Council Session.
Happy Reading!
Dr Sazi Z Nzama MBChB(UKZN)
Secretary
Junior Doctors Network
World Medical Association
Foreword by Secretary
9
Special Edition Bulletin on
Antimicrobial Resistance
April 2025
Foreword by Publications Director
Dear Junior Doctors,
It is with great pride and enthusiasm that I present to you the Special Edition of the WMA Junior
Doctors’ Network (JDN) “Bulletin”—formerly known as the “Newsletter”—marking a significant
evolution in how we engage with scientific discourse. This transformation reflects our
commitment to upholding international publication standards, ensuring that our work not only
informs but also inspires action on pressing global health challenges.
Underscoring the significance of Antimicrobial Resistance (AMR), this Special Edition brings
together diverse perspectives from junior doctors across the world. AMR is not just a clinical issue
—it is a multifaceted crisis threatening the very foundation of modern medicine. As young
physicians, we stand at the frontline, witnessing firsthand the devastating consequences of
resistant infections. This Bulletin serves as both a call to action and a repository of knowledge,
highlighting innovative approaches, policy insights, and grassroots efforts aimed at tackling this
silent pandemic.
I extend my heartfelt gratitude to all contributors, peer reviewers, the Management Team and the
Publications Team for their unwavering dedication to this issue. The overwhelming support from
junior doctors worldwide is a testament to our collective resolve in addressing AMR through
advocacy, education, and multidisciplinary collaboration.
As we embark on this new phase of our publication journey, I invite
you all to actively engage with the Bulletin, contribute your insights,
and champion the fight against AMR. Together, we can drive
meaningful change and safeguard the future of antimicrobial
stewardship.
Regards,
Dr. Venkatesh Karthikeyan MD (AIIMS), FRSPH (London),
Publications Director,
Junior Doctors Network,
World Medical Association.
10
Special Edition Bulletin on
Antimicrobial Resistance
April 2025
Foreword by Past Chair
As the immediate past Chair of the Junior Doctors Network (JDN), it is my privilege to introduce
this edition of our newsletter, which focuses on a pressing global health challenge: Antimicrobial
Resistance (AMR). This issue transcends borders, disciplines, and specialities, threatening to
undo decades of progress in medicine and public health. For junior doctors, it represents both an
enormous challenge and an unparalleled opportunity to lead change.
AMR arises when microorganisms such as bacteria, viruses, and fungi evolve to resist the drugs
designed to kill them. As frontline health workers, junior doctors frequently witness the human
cost of treatment failures, longer hospital stays, and the devastating loss of lives due to drug-
resistant infections. The World Health Organization (WHO) has identified AMR as one of the top
ten global public health threats. For us, this is a call to action.
In this edition, we spotlight innovations in AMR stewardship, stories from junior doctors
advocating for better prescribing practices, and insights on how to bridge the gap between
policy and practice. As custodians of future healthcare systems, we must embrace multi-
sectoral collaboration, advocate for robust health policies, and integrate AMR awareness into
daily clinical practice.
The fight against AMR demands resilience, innovation, and commitment. I hope the articles in
this newsletter inspire you to champion change in your communities and beyond. Together, we
can turn the tide against AMR and secure a healthier, safer world for generations to come.
Dr. Marie-Claire Wangari
Immediate Past Chair,
Junior Doctors Network,
World Medical Association.
11
Eleleta Surafel Abay
Co-chair, Primary Healthcare
Working Group, WMA-JDN
Ethiopia
eleletasabay@gmail.com
Marie-Claire Wangari
Graduate student in Global
Health, Liverpool School of
Tropical Medicine, Liverpool,
United Kingdom
Independent Global Health
Consultant
Immediate Past Chair
(2024/2025), WMA-JDN
Kenya
mcwangari.wm@gmail.com
Mehr Muhammad Adeel Riaz
Co-chair, Primary Healthcare
Working Group, WMA-JDN
Socio-medical Affairs
Officer, WMA-JDN
Chair, Pre-World Health
Assembly Organizing
Committee 2025, WMA-JDN
Pakistan
adeelriaz369@gmail.com
Antimicrobial Resistance: Challenges and Solutions in
Primary Health Care
1
Eleleta Surafel Abay, MD , Marie-Claire Wangari, MBChB , Mehr Muhammad Adeel
Riaz, MBBS ,Saksham Mehra, MBBS ,Osundara Tope, MBBS ,Wunna Tun, MBBS, MD.
Antimicrobial resistance (AMR) poses a
growing global health threat, undermining
decades of medical progress. The misuse
and overuse of antibiotics, particularly in
low- and middle-income countries (LMICs),
are key drivers of this crisis (1). Contributing
factors include unregulated access to
medications, insufficient healthcare
infrastructure, inadequate training for
healthcare providers, and weak regulatory
frameworks. Addressing AMR demands a
comprehensive, multi-pronged approach,
with primary healthcare (PHC) at the
forefront as the first point of contact for
many communities (2).
Research underscores that neglecting
treatment guidelines, particularly in
managing infectious diseases, amplifies
AMR prevalence (1). Tackling this issue
requires increased use and analysis of
antimicrobial consumption data, the
adoption of stricter prescription-only access
laws, enhanced practitioner training in
evidence-based care, and active public
engagement in medication stewardship (2).
1
12
Open access Editorial
In many LMICs, community pharmacies and
patent medicine stores dispense antibiotics
without requiring prescriptions, bypassing
regulatory oversight (3, 4). Patients often
prefer these unregulated outlets due to high
costs, long waiting times, and bureaucratic
hurdles at hospitals. The absence of proper
investigations before dispensing antibiotics
is a common practice, further fueling
inappropriate usage, including incomplete
courses (3, 4).
Challenges in PHC
Primary healthcare plays a pivotal role in
delivering essential care and disease
prevention at the community level,
especially in LMICs. However, numerous
challenges hinder its ability to combat AMR
effectively.
Workforce Constraints
In rural areas, the shortage of physicians
often forces reliance on integrated health
workers (nurses and community health
workers), who provide consultations and
prescribe medications (2). While this
strategy increases access to care, many of
these health workers lack comprehensive
training in the proper use of antibiotics
Unregulated Medication Access
2
3 4 5 6
2
3
and without adequate knowledge, they
inadvertently contribute to antibiotic
misuse. Addressing this gap through
targeted education is critical for equipping
this strata of healthcare workers to tackle
AMR effectively (2).
Affordability is a significant concern in
LMICs, where many patients cannot bear
the financial burden of healthcare services
in formal settings (4). This highlights the
urgent need for Universal Health Coverage
(UHC) to ensure equitable access to
affordable healthcare and reduce
dependence on unregulated medication
sources (4).
Economic Barriers
Weak Regulatory and Training
Frameworks
The lack of robust guidelines and
enforcement mechanisms exacerbates AMR
in LMICs. Weak regulations enable PHC
pharmacies to dispense antibiotics
irresponsibly. Strengthening these
frameworks and engaging pharmacy
attendants in antimicrobial stewardship
campaigns are essential for reducing
Saksham Mehra
External Affairs Chair,
Trinidad and Tobago Medical
Association
Member, Primary Healthcare
Working Group, WMA-JDN
Member, Pre-World Health
Assembly Organizing
Committee 2025, WMA-JDN
Trinidad and Tobago
mehrasaksham1@gmail.co
m
Osundara Tope
President, Nigerian
Association of Resident
Doctors
Member, Primary Healthcare
Working Group, WMA-JDN
Nigeria
topezenith@gmail.com
Wunna Tun
Past Secretary, WMA-JDN
Myanmar
onlinewunna@gmail.com
4
5
6
WMA JDN Special Edition Bulletin on AMR
13
Open access Editorial
inappropriate dispensing practices (3, 4).
With disease outbreaks, climate challenges and political
instability further destabilizing the PHC systems of LMICs,
there is a critical need for continuous training of
healthcare workers and the integration of AMR education
into undergraduate and ongoing professional
development programs to ensure practices appropriately
cater to dynamic global health needs (4).
Limitations in Diagnostics and Digital Health
Integrating advanced diagnostic tools and digital health
technologies into PHC systems offers significant potential
for combating AMR. Early disease detection and
surveillance reduce unnecessary antibiotic prescriptions,
with advanced diagnostic tools playing key roles in
infection management and targeted interventions.
However, these innovations face barriers such as high
costs, limited infrastructure, and a lack of trained
personnel in LMICs (5).
Digital health technologies showcased their
transformative power during the COVID-19 pandemic,
particularly in sub-Saharan Africa, where they
streamlined surveillance, telehealth services, and
logistics. Despite these successes, challenges like poor
internet connectivity and inadequate funding hinder
broader adoption (6).
Scaling up investments in accessible, affordable
diagnostic tools and integrating them into PHC settings
remains essential to improve and strengthen PHC
response to mitigate AMR.
The Path Forward
To effectively address AMR, LMICs must prioritize the
following actions:
1.Strengthening regulations that strictly enforce
prescription-only access to antibiotics and enhance
guidelines to curb misuse.
2.Education and training programs that empower PHC
workers, including integrated health workers and
pharmacy attendants, with evidence-based knowledge
on antimicrobial stewardship.
3.Enhancing diagnostics and investing in accessible
diagnostic and surveillance tools in PHC to reduce
unnecessary antibiotic prescriptions.
4.Advancing UHC to ensure that financial barriers
do not force patients to seek unregulated care.
With PHC serving as the cornerstone of
community healthcare, strengthening its
capacity to address AMR is essential. Through
robust regulations, improved diagnostics and
surveillance, and enhanced training for
healthcare providers, LMICs can play a vital role
in mitigating the AMR crisis at the grassroots
level of healthcare delivery.
REFERENCES
Iwamoto, K., Pedersen, H. B., Tello, J. E., Lo Fo Wong, D., &
Robertson, J. (2019). Cross-programmatic consultation on the
role of primary care in the responsible use of medicines and
the reduction of antimicrobial resistance. Expert review of
anti-infective therapy, 17(2), 75–78.
https://doi.org/10.1080/14787210.2018.1563482
1.
Sulis G., Adam P., Nafade V., Gore G., Daniels B., Daftary A.,
Das J., Gandra S., Pai M. Antibiotic prescription practices in
primary care in low- and middle-income countries: A
systematic review and meta-analysis. PLoS Med.
2020;16:e1003139. doi: 10.1371/journal.pmed.1003139.
2.
Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect
of antibiotic prescribing in primary care on antimicrobial
resistance in individual patients: systematic review and meta-
analysis. BMJ [Internet]. 2010 May 18;340 (May 18
2):c2096–6. Available from:
https://www.bmj.com/content/340/bmj.c2096
3.
(2018) Antimicrobial resistance and Primary Health Care.
Available at:
https://iris.who.int/bitstream/handle/10665/326454/WHO-
HIS-SDS-2018.56-eng.pdf.
4.
Nafade, Vaidehi et al. The value of diagnostic imaging for
enhancing primary care in low- and middle-income countries.
eClinicalMedicine, Volume 0, Issue 0, 102899.
https://www.thelancet.com/journals/eclinm/article/PIIS2589-
5370(24)00478-4/fulltext
5.
Yidnekachew Girma Mogessie et al. Digital health and
COVID-19: challenges of use and implementation in sub-
Saharan Africa. Pan African Medical Journal. 2021;38(240).
10.11604/pamj.2021.38.240.27948
6.
WMA JDN Special Edition Bulletin on AMR
Pablo Estrella Porter
Chair
World Medical
Association – Junior
Doctors’ Network.
pestrellaporter@gmail.com
14
Open access Editorial
Empowering Youth in the Fight Against Antimicrobial
Resistance
Pablo Estrella Porter
1.Youth Manifesto Launch and Advocacy:
In May 2024, we launched the Youth AMR
Manifesto alongside the Quadripartite’s
multi-stakeholder hearings. This has served
as a vital tool to articulate the priorities and
Antimicrobial resistance (AMR) is a silent
yet escalating global health crisis. Its
impact is disproportionately felt in Low- and
Middle-Income Countries (LMICs), where
access to resources and healthcare is often
limited. In response, the Quadripartite,
comprising the World Health Organization
(WHO), Food and Agriculture Organization
(FAO), United Nations Environment
Programme (UNEP), and World Organization
for Animal Health (WOAH), launched the
Youth Engagement for AMR Working Group
back in October 2023. This initiative
underscores the transformative power of
youth in tackling one of the most pressing
challenges of our era with the support of 14
representatives from youth-led and youth-
serving organizations​
​
, including the
representation of the Junior Doctors
Network (JDN) (1).
As of November 2024, I have the privilege
of chairing this dynamic working group.
Over the past year, our collective efforts
have amplified youth voices and solidified
their role in shaping global AMR strategies.
A cornerstone of our work is the Youth AMR
Manifesto, developed after a youth online
consultation at the start of 2024 (2). This
manifesto emphasizes the inclusion of
young people in decision-making, advocacy,
and education to tackle AMR. Key priorities
include creating youth-led and youth-
serving platforms, integrating AMR
awareness into education systems, and
promoting a One Health approach to foster
interdisciplinary collaboration and equitable
solutions.
Key Milestones in 2024
perspectives of young people worldwide,
urging policymakers to integrate youth
contributions into National Action Plans on
AMR.
2.Engagement at the UN General
Assembly:
During the September 2024 High-Level
Meeting on AMR, two working group
members represented the youth
perspective, stressing the need for bold,
multisectoral commitments. Our efforts
highlighted the critical role of young
advocates in bridging the gap between
global discussions and actionable outcome.
3.World Antimicrobial Awareness Week
(WAAW) 2024:
WAAW 2024, themed “Educate. Advocate.
Act Now” highlighted youth as key players
in combating AMR. We led a global
consultation, engaging over 100 young
participants to shape strategies like
developing culturally relevant tools and
fostering youth-policy collaborations. They
also supported the AMR Youth Summit,
amplifying youth voices worldwide and
inspiring innovative advocacy efforts as well
as hosting the youth events database.
4.Participation in the Jeddah Ministerial
Meeting:
The Fourth Global High-Level Conference on
AMR in Jeddah, Saudi Arabia, showcased
youth engagement at its best. Through
interactive sessions and our Youth Quote
Cards Initiative, the representatives shared
powerful messages on the importance of
collective action against AMR.
WMA JDN Special Edition Bulletin on AMR
15
Open access Editorial
Youth engagement is not a mere addition to the AMR
agenda but it is central to ensuring its success.
Young people bring energy, innovation, and the
ability to mobilize communities and that is why
engaging junior doctors is part of our aim as JDN. In
October 2024, the working group met in Nairobi,
Kenya to assess the previous year and plan the 2025
term (3)​
.
The Importance of Youth Engagement in
Sustaining AMR Advocacy
Image 1. Quadripartite Working Group on Youth
Engagement for AMR: Second annual meeting,
Nairobi, Kenya 19–20 September 2024.
In 2025, the working group aims to:
Expand outreach through multilingual
campaigns, ensuring no community is left
behind.
Strengthen partnerships with National Action
Plans to institutionalize youth participation.
Promote the new Quadripartite AMR Toolkit for
Youth Engagement
A Call to Action for Junior Doctors
As junior doctors, our role is essential. Whether
through clinical practice, research, or community
advocacy, we have the power to influence the
responsible use of antimicrobials and to educate
others on the dangers of resistance. By joining forces
with initiatives like the Quadripartite Youth
Engagement Working Group and the JDN working
group on AMR, we can magnify our impact, ensuring
that youth voices remain integral to global AMR
strategies.
Together, let us commit to making 2025 a year of
action and innovation. The fight against AMR demands
the contributions of all, and as junior doctors, we are
uniquely positioned to lead this change. Let’s gather
our collective expertise, passion, and determination to
safeguard the efficacy of antimicrobials for
generations to come.
For more information about the working group, follow
@YouthVoices4AMR on Social Media or visit the
Quadripartite’s AMR Youth Engagement webpage.
For joining the JDN AMR Working Group email:
pestrellaporter@gmail.com
Stay connected, stay engaged, and join the
movement.
REFERENCES
Quadripartite Joint Secretariat On AMR. Working Group on Youth
Engagement [Internet]. 2024 [cited 2024 Dec 23]. Available from:
https://www.qjsamr.org/technical-work/working-group-on-youth-
engagement
1.
WHO. Youth Manifesto for UN General Assembly High-Level Meeting
on Antimicrobial Resistance launched [Internet]. 2024 [cited 2024
Dec 23]. Available from: https://www.who.int/news/item/18-06-
2024-youth-manifesto-for-un-general-assembly-high-level-meeting-
on-antimicrobial-resistance-launched
2.
Quadripartite Joint Secretariat On AMR. Quadripartite Working
Group on Youth Engagement for AMR: Second annual meeting
[Internet]. 2024. Available from:
https://www.qjsamr.org/docs/librariesprovider25/working-group-on-
youth-engagement/report-of-the-second-annual-meeting-for-the-
quadripartite-working-group-on-youth-engagement-for-amr.pdf?
sfvrsn=fdfea6b1_4
3.
WMA JDN Special Edition Bulletin on AMR
Open access Editorial
Building Effective Partnerships for AMR Strategy Implementation
16
interventions. ReAct Africa is also developing
an AMR Youth Coordination Hub, a virtual
space where young leaders can network,
collaborate, and share best practices. These
initiatives have led to the establishment of
youth-led organizations which exemplify the
ripple effects of empowering youth. Through
mentorship and capacity-building sessions,
ReAct Africa equips youth with leadership,
advocacy, and project management skills.
These skills enable young people to conduct
impactful community awareness campaigns,
engage with diverse stakeholders, and
initiate sustainable AMR interventions.
Beyond individual growth, ReAct Africa’s
programs emphasize the importance of peer
learning and collaboration. Platforms such as
the ReAct Africa and South Centre annual
conferences encourage the exchange of
ideas and experiences.
Moreover, participants have used these
opportunities to publish research, contribute
to policy discussions, and organize
grassroots initiatives that address AMR from
a holistic perspective.
ReAct Africa has also seen the value in
aligning its youth engagement work with the
regional priorities of the Quadripartite and
the Africa CDC. This alignment ensures that
its efforts are integrated into broader
frameworks addressing AMR at regional and
global levels, enhancing the relevance and
impact of its youth initiatives. As I was
leading the youth portfolio, I was delighted
to have been one of the contributors to the
Quadripartite Antimicrobial Resistance
Toolkit for youth engagement (4).
ReAct Africa’s commitment to youth
engagement is not only empowering a new
generation of public health leaders but also
amplifying the reach and impact of AMR
interventions. By providing young people
with the resources, mentorship, and
platforms to take ownership of AMR
challenges, ReAct Africa is building a
resilient and proactive response to this
global health threat.
Antimicrobial Resistance (AMR) is a critical
global health challenge that necessitates a
united, multidisciplinary approach (1). ReAct
Africa, a pioneer in AMR advocacy and
intervention, has been at the forefront of
facilitating collaborative efforts to combat
AMR across Sub-Saharan Africa by
supporting countries in the implementation,
prioritization, and revision of the AMR
National Action Plans. Recognizing the vital
role of young people in shaping the future of
public health, ReAct Africa has made youth
engagement a key pillar of its AMR
mitigation strategies (2). Since 2015, ReAct
Africa’s youth-focused initiatives have
cultivated a generation of champions who
are equipped to lead and advocate for
sustainable AMR solutions.
The flagship AMR Leaders Programme for
Tertiary Students in Africa (AMRLEP) has
been instrumental in building the capacity of
young people (3). This program provides
participants with in-depth knowledge of
AMR, mentorship, and practical skills to
apply a One Health approach in their
respective communities. Over 200
participants from eight African nations have
been part of the program, contributing
significantly to AMR mitigation efforts.
Participants have developed leadership
skills, enhanced their understanding of
AMR’s cross-sectoral nature, and initiated
community engagement projects. Many
graduates of AMRLEP have gone on to
influence policy at the national and regional
levels, including contributing to the drafting
and validation of National Action Plans.
ReAct Africa is the main convener of the
African Youth Antimicrobial Resistance
Alliance Task Force (AYARA-TF). AYARA-TF
is a consortium of youth-led organisations
that further strengthens the voices of young
people by fostering collaboration and
advocacy. AYARA-TF serves as an
independent platform for youth to engage in
multidisciplinary dialogues and shape AMR
WMA JDN Special Edition Bulletin on AMR
Julian Nyamupachitu
Julian
Nyamupachitu
Deputy Director
ReAct Africa
17
Open access
3.Antimicrobial Resistance Leadership Program (AMRLEP)
[Internet]. Available from:
https://www.reactgroup.org/africa/youth-enagement/amr-
lep-student-initiative/
4.World Health Organization, Food and Agriculture
Organization of the United Nations, United Nations
Environment Programme, World Organisation for Animal
Health. Antimicrobial resistance toolkit for youth
engagement [Internet]. Geneva: World Health
Organization; 2024. Available from:
https://www.who.int/publications/b/74011
5.United Nations Environment Programme. Addressing
Antimicrobial Resistance through One Health Frameworks
[Internet]. Nairobi: UNEP; 2023. Available from:
https://www.unep.org/resources/superbugs/environmental-
action?gad_source=1&gclid=CjwKCAiAg8S7BhATEiwAO2-
R6rW5wLHpTfSy30Vuh2o_p0_y024PgCEBBNQcuk1BdFxRm
h-BnzDGYBoCuzAQAvD_BwE
While youth engagement remains a central focus,
ReAct Africa also collaborates with governments and
technical working groups to support the
implementation and revision of National Action Plans.
These collaborations ensure that AMR strategies are
actionable and contextually relevant, aligning with One
Health principles (5). By engaging diverse
stakeholders, ReAct Africa fosters a multidisciplinary
approach to AMR mitigation.
ReAct Africa’s youth-centered approach and
collaborative initiatives exemplify the power of
partnerships in addressing AMR. Through sustained
commitment and innovative strategies, ReAct Africa
continues to lead the charge against AMR and amplify
the importance of collective action in safeguarding the
efficacy of antibiotics for future generations.
REFERENCES
1. Naghavi M, et al. Global burden of bacterial
antimicrobial resistance 1990–2021: a systematic analysis
with forecasts to 2050. Lancet [Internet].
2024;404(10459):1199-1226. Available from:
https://www.thelancet.com/journals/lancet/article/PIIS014
0-6736(24)01867-1/fulltext
2. Medical Students’ Knowledge, Attitudes, and
Motivation towards Antimicrobial Resistance Efforts in
Eastern Uganda, November 2024 [Internet]. 2024 Nov 9.
Available from:
https://doi.org/10.1101/2024.11.09.24317028
WMA JDN Special Edition Bulletin on AMR
Open access Editorial
Dr. Janita Zarrish
Member,
Antimicrobial
Resistance
Working Group,
World Medical
Association –
Junior Doctors
Network.
janitazarrish@gma
il.com
1
18
One Health, One Fight: Junior Doctors in the Battle
Against AMR
1
Dr. Janita Zarrish
Greetings to you all on this special edition
of WMA-JDN newsletter on antimicrobial
resistance (AMR). My name is Dr. Janita
Zarrish, I am a medical doctor from
Pakistan, currently studying MSc Public
Health at London School of Hygiene and
Tropical Medicine. I have been working with
IFMSA and InciSioN as a medical student
and now working with WMA as a junior
doctor. I have participated in several global
health events. Attending these events in
understanding global public health threats,
governance, challenges, policy decisions,
strategies, and how healthcare systems
function at both national and international
levels. As we step into our practical lives,
these events provide opportunities to
connect with experts, policymakers, and
peers from around the world, fostering
professional relationships that can support
future collaborations and career growth.
Our participation as the junior doctor at the
WMA, brings clinical expertise to the
discussion, helping ensure that policies and
decisions are grounded in real-world
medical practice and evidence.
As doctors, we first hand witness the
consequences of AMR in the human
population. Infectious pathogens that were
once responsive to the simplest antibiotics
have now grown into big giants, completely
resistant to the most effective and strongest
antibiotics. AMR is a natural phenomenon
but misuse and overuse of antibiotics has
accelerated the process(1). Poor hygiene
and public awareness, ineffective
governance, and limited investments in
research and development of new
antibiotics has further fuelled the threat(2).
Earlier this year, Dr. Caline Mattar from
WMA-JDN participated in the 2nd UN high-
level meeting on AMR at the 79th UN
General Assembly. During the meeting,
WMA advocated for increased investment
and support to the workforce and health
systems strengthening to allow for
WMA JDN Special Edition Bulletin on AMR
improved antibiotic prescribing, infection
prevention and control practices. The
meeting highlighted the importance of
international collaboration to tackle AMR,
with countries sharing data, strategies, and
best practices to mitigate resistance
globally. It became clear that AMR is a
shared problem that transcends borders,
and collective action is essential for
meaningful progress. A political declaration
on AMR was approved, where leaders from
all member states committed to reduce the
Bacterial AMR associated deaths by 10% by
2030(3). The meeting emphasized on
following action points:
AMR requires collaboration across
environmental, agricultural, veterinary,
industrial, and health sectors to address
the issue effectively.
Developing new antibiotics, alternative
therapies, and rapid diagnostics is
crucial for combating AMR.
Infection prevention through improved
hygiene, vaccination, clean water, and
sanitation reduces the need for
antibiotics.
Public campaigns should raise
awareness about the risks of self-
medication, misuse of antibiotics, and
the importance of completing
prescriptions.
LMICs face greater challenges due to
limited resources and weaker systems,
requiring targeted support.
Antimicrobial stewardship programs
must be implemented in all sectors to
ensure responsible antibiotic use.
As junior doctors, attending such meetings
highlights the invaluable role of integrating
clinical perspectives into global health
policy. During the year, Junior doctors in the
WMA-JDN AMR working group played a
significant role in our fight against AMR.
Before the UN high-level meeting, we
celebrated AMR Wednesdays to raise AMR
awareness on social media.
19
Open access
REFERENCES
1. Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a
Global Multifaceted Phenomenon. Pathogens and Global Health
[Internet]. 2015 Sep 7;109(7):309–18. Available from:
https://pmc.ncbi.nlm.nih.gov/articles/PMC4768623/
2. World Health Organization. Antimicrobial Resistance. World
Health Organization. 2023. Available from:
https://www.who.int/news-room/fact-sheets/detail/antimicrobial-
resistance
3. Political Declaration of the High-level Meeting on Antimicrobial
Resistance [Internet]. Available from: https://www.un.org/pga/wp-
content/uploads/sites/108/2024/09/FINAL-Text-AMR-to-PGA.pdf
During World AMR Awareness Week (WAAW), we
collaborated with World Organization for Family
Doctors (WONCA) – Young Doctors Movement for a
social media campaign targeted for young
professionals to advocate for behavioral change
towards antibiotics prescription practices and
misuse. We also participated in the Youth AMR
Manifesto and are part of Quadripartite Working
Group on Youth Engagement on AMR.
We, as part of the WMA-JDN AMR working group,
have the opportunity to contribute significantly by
advocating for patient-centered approaches and
raising awareness about AMR within our local
communities. Our strength lies in our diverse,
multicultural, and multinational perspectives, which
we can bring together to inform policies and design
effective AMR advocacy campaigns. These
campaigns should be inclusive, ensuring that all
voices are heard and represented. Moving forward,
our focus should be on raising awareness among the
general population and collaborating with national
member associations to disseminate information
about the intersection of hygiene, infection control,
and AMR. This should be done in accessible and
culturally relevant ways, using local languages to
ensure the message resonates with communities and
promotes lasting change.
WMA JDN Special Edition Bulletin on AMR
Open access Editorial
Dr. Shiv Joshi, MD
Founding Member
National Alliance of Medical
Professionals on AMR (India)
drshivjoshi93@gmail.com
Dr. Venkatesh Karthikeyan,
National Convener (AMR)
Indian Medical Association
Dr. Narendra Saini
National Chairman (AMR) &
Former HSG
Indian Medical Association
Dr Meenakshi G
National Consultant (AMR)
Indian Medical Association
1
20
Indian Medical Association’s Efforts in Combating
Antimicrobial Resistance and Junior Doctors’
Engagement
1
Dr Shiv Hiren Joshi, Dr Narendra Saini, Dr Venkatesh Karthikeyan, Dr Meenakshi
Gopimohan
WMA JDN Special Edition Bulletin on AMR
Antimicrobial Resistance (AMR) is a silent
pandemic that threatens global public
health,making infections harder to treat and
increasing the risk of disease spread, severe
illness,and death. In India, the Indian
Medical Association (IMA) has emerged as a
key driver of efforts to combat AMR,
leveraging its network and influence to
implement innovative programs and foster
collaboration across sectors and nations.
Through its Standing Committee for
Antimicrobial Resistance, IMA has
spearheaded numerous initiatives that
highlight the importance of education,
advocacy, and action in addressing this
critical challenge.
National Alliance of Medical Professionals
on AMR (NAMP-AMR)
Recognizing the urgent need for a united
response to AMR, IMA established the
National Alliance of Medical Professionals on
AMR (NAMP-AMR)(1). This landmark
initiative brought together 52 medical
associations and organizations, including
representatives from the NITI Aayog,
Ministry of Health and Family Welfare, World
Health Organization (WHO), National Centre
for Disease Control, and National
Accreditation Board for Hospitals. The
alliance held its inaugural consultation on
July 7, 2024, at IMA House, Delhi, marking
the beginning of a coordinated effort to
address AMR at a national level. The
consultation resulted in actionable strategies
to enhance awareness and drive policy
reforms.
Commonwealth Alliance of Medical
Professionals on AMR (CAMP-AMR)
Expanding its impact beyond national
borders, IMA played a pivotal role in forming
the Commonwealth Alliance of Medical
Professionals on AMR (CAMP-AMR)(2) . This
alliance, comprising 10 Commonwealth
countries, underscores the importance of
global collaboration in combating AMR.
2 3
4
The release of the Commonwealth
Declaration on Antimicrobial Resistance
further cemented the alliance’s
commitment to collective action. A panel
discussion at the Commonwealth Medical
Association conference facilitated
knowledge exchange, with leaders from
seven countries sharing insights on their
respective AMR strategies and targets.
Professional Engagement Events and
Capacity Building
In November 2024, the IMA AMR Standing
Committee hosted a high-profile
roundtable discussion in Delhi themed
“Educate – Advocate – Act Now.”
Organized ahead of World Antimicrobial
Awareness Week, this event brought
together stakeholders from over 30
distinguished organizations. Discussions
cantered on the United Nations General
Assembly High-Level Meeting Political
Declaration on AMR, highlighting the need
for concerted efforts at all levels.
Additionally, IMA’s commitment to
capacity building was exemplified through
a workshop held in Ahmedabad on
December 1, 2024. Organized in
collaboration with the WHO and IMA
Ahmedabad, the “Capacity Building
Workshop on AMR for IMA Doctors”
equipped healthcare professionals,
particularly junior doctors, with the
knowledge and skills to tackle AMR
effectively. By targeting early-career
professionals including junior doctors, this
workshop emphasized the importance of
cultivating a new generation of leaders
who are well-versed in antimicrobial
stewardship.
The IMA AMR Smart Hospital Project
One of the standout initiatives under IMA’s
AMR strategy is the IMA AMR Smart
Hospital Project. Designed to mentor
2
3
4
21
Open access
hospitals and nursing homes in implementing and
enhancing Antimicrobial Stewardship and Infection
Prevention and Control practices, the project provides
guidance to help healthcare facilities achieve
accreditation standards. Hospitals that successfully
meet these standards are awarded the “IMA AMR
Smart Hospital” certificate, serving as a model for best
practices in AMR mitigation. Junior doctors play a vital
role in this initiative by acting as key agents of change
within their institutions, ensuring that stewardship and
infection control measures are adhered to and
continuously improved.
Digital Campaigns and Awareness Initiatives
Leveraging digital platforms, IMA conducted a
nationwide campaign for World Antimicrobial
Awareness Week 2024. More than 250 doctors
participated in this campaign. Other awareness
activities included Go Blue Day campaigns, poster
competitions for students, and extensive engagement
with junior doctors through IMA’s networks. The IMA
Medical Students’ Network and Junior Doctors’
Network have been instrumental in these campaigns,
fostering grassroots advocacy and building awareness
among young medical professionals. Their participation
ensures that the message of AMR awareness resonates
with future generations of healthcare providers.
Publications and Knowledge Dissemination
IMA has also focused on knowledge dissemination
through impactful publications. Books such as “When
Not to Use Antibiotics” and “Rational Use of
Antibiotics” serve as valuable resources for healthcare
providers. Additionally, the NAMP-AMR initiative’s
outcomes were documented in an article titled
“Multidisciplinary Collaboration in Combatting
Antimicrobial Resistance,” providing insights into the
power of collective action (3). These publications have
been widely shared among junior doctors and medical
students, fostering an evidence-based approach to
antimicrobial use.
Where are we headed?
The Indian Medical Association’s multifaceted
approach to combating AMR underscores the
importance of collaboration, education, and advocacy.
By prioritizing the engagement of junior doctors and
medical students, IMA has ensured that the fight
against AMR is both sustainable and future focused.
From forming alliances like NAMP-AMR & CAMP-AMR
WMA JDN Special Edition Bulletin on AMR
to implementing innovative projects like the AMR
Smart Hospital initiative, IMA has demonstrated that
combating AMR requires a united front. As the global
community continues to grapple with the challenges
posed by AMR, IMA’s efforts provide a model for
impactful and sustainable action. By fostering
partnerships, building capacity, and raising awareness
among young medical professionals, IMA is laying the
groundwork for a healthier, more resilient future.
REFERENCES
1. Koul S. IMA announces national alliance of medical
professionals to tackle AMR
[Internet]. @bsindia. Business Standard; 2024 [cited
2025 Jan 21]. Available from:
https://www.business-standard.com/amp/india-news/ima-
announces-national-
alliance-of-medical-professionals-to-tackle-amr-
124071000997_1.html
2. Bureau O, ET HealthWorld. IMA launches global
alliance to combat antimicrobial
resistance [Internet]. ETHealthworld.com. ETHealthWorld;
2024 [cited 2025 Jan 21].
Available from:
https://health.economictimes.indiatimes.com/news/indust
ry/ima-
launches-global-alliance-to-combat-antimicrobial-
resistance/115454185
3.Karthikeyan V, Saini N, Nadarajan R, Gopimohan M,
Roy P. Multidisciplinary
Collaboration in Combatting Antimicrobial Resistance:
Insights and Outcomes From
the National Alliance of Medical Professionals on
Antimicrobial Resistance (NAMP-AMR) Initiative. Cureus.
2024 Sep 8;16(9):e68932. Available from:
Multidisciplinary Collaboration in Combatting
Antimicrobial Resistance: Insights and Outcomes From
the National Alliance of Medical Professionals on
Antimicrobial Resistance (NAMP-
AMR) Initiative – PubMed
Open access Editorial
22
World AMR Awareness Week: A Talk on Antimicrobial
Resistance at my workplace
World Antimicrobial Resistance (AMR)
Awareness Week, observed annually from
November 18 to 24, serves as a crucial global
initiative to educate individuals, healthcare
professionals, and organizations about the
growing threat of antimicrobial resistance.
This week aims to foster discussions and
increase awareness regarding the misuse and
overuse of antibiotics and other
antimicrobials, which has led to the alarming
rise in resistant infections. On November 22,
2024, I had the honour of organizing and
delivering a talk to the staff of the
Department of Occupational Safety and
Health (DOSH) Negeri Sembilan during a talk
on health program which was also organised
by my team. This talk was attended by
engineers, senior management, and
administrative personnel. For many of the
attendees, this was the first time they had
encountered the concept of AMR and its
profound implications on both human health
and the broader global ecosystem.
In addition to the healthcare implications, I
highlighted the economic and societal costs
associated with AMR. Resistant infections
burden healthcare systems, necessitating
more expensive treatments and longer
recovery periods. This, in turn, leads to higher
healthcare expenditures and diminished
productivity in healthcare settings and the
workforce. The broader economic impact of
AMR is staggering: it is estimated that, by
2050, AMR could cost the global economy up
to $100 trillion.
During the session with DOSH Negeri
Sembilan, I stressed that AMR’s effects are
far-reaching and extend beyond human
health to impact economic stability,
agricultural productivity, and environmental
sustainability. In healthcare settings, AMR
leads to longer hospital stays, the need for
more intensive care, and increased medical
costs. In agriculture, the use of antibiotics in
livestock farming contributes significantly to
the rise in resistant bacteria, which can be
transmitted to humans through the food
supply. This interconnectedness of sectors
WMA JDN Special Edition Bulletin on AMR
Dr. Merlinda Shazellenne
Dr. Merlinda
Shazellenne,
MBBS. OHD.
Medical Education
Director – WMA
JDN
dr.merlinda@gmail
.com
was a key point that resonated with the
diverse group of professionals attending
the session.
The DOSH staff, primarily involved in
occupational safety, were particularly
attentive to how AMR can impact workplace
health and safety. Many engineers were
surprised to learn about the links between
AMR and industrial hygiene, including the
potential for resistant infections to affect
workers in various sectors, from food
production to healthcare and
pharmaceuticals. By integrating AMR
awareness into workplace safety standards
and health protocols, DOSH can help
reduce the risk of infection outbreaks in
workplaces and ensure better protection
for workers.
In addition to the healthcare implications, I
highlighted the economic and societal costs
associated with AMR. Resistant infections
burden healthcare systems, necessitating
more expensive treatments and longer
recovery periods. This, in turn, leads to
higher healthcare expenditures and
diminished productivity in healthcare
settings and the workforce. The broader
economic impact of AMR is staggering: it is
estimated that, by 2050, AMR could cost
the global economy up to $100 trillion.
One of the most impactful aspects of my
talk was the emphasis on prevention and
responsible antimicrobial use. Vaccination
programs, proper sanitation, infection
control measures, and the prudent use of
antibiotics are vital strategies to mitigate
the spread of resistance. However, AMR is a
multifaceted issue that requires
cooperation at all levels—from individuals
and healthcare providers to governments
and industries. I urged the attendees to see
their roles as professionals in their
respective fields and as key players in a
collective global effort to combat AMR.
The session concluded with a discussion on
how we can contribute to the fight against
25
Open access Editorial
AMR, from reducing unnecessary antibiotic use in
healthcare and agriculture to promoting hygiene and
sanitation practices in our communities and
workplaces. Many participants expressed a desire for
more information and training on the topic, a clear
indication that the awareness week had sparked a
genuine interest in tackling this global health threat. It
was encouraging to see such enthusiasm for a topic
that, until now, had remained mainly outside their
radar.
In summary, World AMR Awareness Week is a
powerful reminder of the need for collective action to
combat antimicrobial resistance. The talk with DOSH
Negeri Sembilan was a significant milestone in
spreading awareness about this urgent issue. The
engagement and enthusiasm of the attendees
highlighted the importance of incorporating AMR
awareness into a wide range of sectors, from
healthcare to engineering. With continued education
and action, we can work together to ensure that
antimicrobial resistance does not jeopardize the future
of public health, our economies, or our quality of life.
WMA JDN Special Edition Bulletin on AMR
REFERENCES
World Health Organization. Antimicrobial
resistance. Available from:
https://www.who.int/news-room/fact-
sheets/detail/antimicrobial-resistance
1.
World Bank. The economic costs of
antimicrobial resistance. Available from:
https://www.worldbank.org/en/topic/health
2.
Centers for Disease Control and Prevention.
Antibiotic resistance threats in the United
States, 2019. Atlanta: U.S. Department of
Health and Human Services; 2019. Available
from: https://www.cdc.gov/antimicrobial-
resistance/
3.
Open access Editorial
24
Revolutionizing Antimicrobial Resistance Management
with Digital Health
Antimicrobial resistance (AMR) has
emerged as a critical global health
challenge, turning once-treatable infections
into life-threatening conditions. AMR occurs
when bacteria evolve to resist the effects of
antibiotics, rendering standard treatments
ineffective. A major contributor to this issue
is the inappropriate prescription of
antibiotics, often influenced by patient
demands or delays in obtaining accurate
diagnostic results. Additionally, in many
regions, the availability of antibiotics
without a prescription further exacerbates
their misuse, compounding the problem(1).
Addressing AMR requires a comprehensive
approach, combining traditional strategies
with innovative technologies, particularly
the digitalization of healthcare services,
which can enhance diagnostics, optimize
antibiotic use, and promote education for
patients and healthcare providers(1).
Digital platforms equipped with rapid
diagnostic technologies can swiftly identify
the bacteria causing an infection and
determine its resistance profile. This
enables healthcare providers to prescribe
the most appropriate antibiotic, avoiding
unnecessary treatments and minimizing the
risk of resistance. In resource-limited
settings, mobile health applications and
telemedicine platforms can bridge the gap
by connecting healthcare providers with
diagnostic experts, granting access to tools
that might otherwise be unavailable(2).
In addition to diagnostics, digital health
tools play a pivotal role in monitoring
antibiotic use to ensure adherence to
treatment guidelines. Electronic health
records can track prescriptions in real-time,
alerting healthcare providers to potential
overuse or misuse. This systematic
monitoring not only supports the
responsible prescription of antibiotics but
also aids in identifying patients at higher
risk for resistant infections, allowing for
timely intervention(3).
Telemedicine, a cornerstone of digital
health, offers significant advantages in
addressing AMR, particularly in regions with
limited access to healthcare facilities.
Remote consultations can provide patients
with appropriate guidance on whether
antibiotics are necessary, reducing the
likelihood of unwarranted prescriptions. By
making expert advice more accessible,
telemedicine promotes the responsible use
of antibiotics, even in underserved areas(4).
Equally important is the role of digital
health in patient education. A widespread
lack of understanding about the dangers of
antibiotic misuse underpins much of the
global AMR crisis. Digital platforms,
including mobile applications, websites,
and online educational tools, can inform
patients about the importance of following
prescribed treatments, completing
antibiotic courses, and avoiding self-
medication. These platforms can also serve
as reminders, reinforcing adherence to
treatment regimens and discouraging
harmful practices(1).
Digital health initiatives can further
enhance education by incorporating
behavioural frameworks such as the Health
Belief Model (HBM). This model emphasizes
that individuals are more likely to adopt
healthy behaviours when they perceive a
significant threat, recognize the benefits of
action, and feel confident in their ability to
act. By integrating personalized education
into digital tools, patients can be
empowered to understand the
consequences of AMR, motivated to follow
treatment plans, and encouraged to take
greater responsibility for their health.
Moreover, digital health technologies
contribute significantly to the surveillance
of AMR. Real-time data on resistance trends
can be collected through digital platforms
and shared with public health authorities,
facilitating the monitoring of emerging
WMA JDN Special Edition Bulletin on AMR
Dr Kalaivane Kannadasan
Dr Kalaivane
Kannadasan
MBBS (AIMST)
MPH (Hons)
(Malaya)
Public Health
Medicine Registrar
Candidate of
Doctor of Public
Health (DrPH)
University of
Malaya
Email:
dr.vanidas@gmail.
com
25
Open access Editorial
resistant strains and informing targeted responses to
outbreaks. For instance, mobile health apps and cloud-
based systems can gather and transmit data to global
networks like the World Health Organization’s Global
Antimicrobial Resistance Surveillance System (GLASS),
strengthening global efforts to combat AMR (5).
Finally, digital health can accelerate the discovery of
new antibiotics and alternative treatments. AI-
powered platforms, for example, can analyse vast
datasets to identify promising drug candidates or
optimize the use of existing antibiotics. These
advancements ensure that current antibiotics are
utilized in the most effective way possible while
supporting the development of innovative therapies to
address resistance.
In gist, digital health represents a powerful tool in the
fight against AMR by revolutionizing diagnostics,
enhancing antibiotic stewardship, improving
surveillance, and fostering education for both patients
and healthcare professionals. However, to unlock its
full potential, substantial investments in digital
infrastructure and literacy are crucial. Collaboration
among governments, healthcare providers, and the
global health community is essential to ensure that
these technologies are accessible, equitable, and
effective. By embracing digital health, we can
strengthen the fight against AMR and safeguard the
efficacy of antibiotics for future generations.
WMA JDN Special Edition Bulletin on AMR
REFERENCES
Ahmed SK, Hussein S, Qurbani K, Ibrahim RH,
Fareeq A, Mahmood KA, Mohamed MG.
Antimicrobial resistance: Impacts, challenges, and
future prospects. Journal of Medicine, Surgery, and
Public Health. 2024;2:100081.
1.
Elbehiry A, Marzouk E, Abalkhail A, El-Garawany
Y, Anagreyyah S, Alnafea Y, et al. The
Development of Technology to Prevent, Diagnose,
and Manage Antimicrobial Resistance in
Healthcare-Associated Infections. Vaccines (Basel).
2022;10(12).
2.
Rezel-Potts E, Gulliford M. Electronic Health
Records and Antimicrobial Stewardship Research: a
Narrative Review. Curr Epidemiol Rep. 2022:1-10.
3.
Stoltzfus M, Kaur A, Chawla A, Gupta V, Anamika
FNU, Jain R. The role of telemedicine in healthcare:
an overview and update. The Egyptian Journal of
Internal Medicine. 2023;35(1):49.
4.
Robillard DW, Sundermann AJ, Raux BR, Prinzi AM.
Navigating the network: a narrative overview of
AMR surveillance and data flow in the United
States. Antimicrob Steward Healthc Epidemiol.
2024;4(1):e55.
5.
Nilaa chandrasekar,
MBBS Student,
Vinayaka Mission
Kirupananda Variyar
Medical College &
Hospital,
Salem,
Tamilnadu,
India.
nilaachandrasekar@
gmail.com
26
Open access Editorial
Anti-Microbial Resistance: A platonic peer
Nilaa chandrasekar
Anti-microbial resistance, caused by
misuse or overuse of drugs to cure a
disease in a short period, is none the less,
a core component of professional
education and training. The microbes like
bacteria and virus evolve through various
genetic changes that occur when the
antimicrobials are consumed in surplus
amounts. The various genetic changes
include mutations, gene transfer, selective
pressure, etc. It is a topic that kindles the
mind to think about how equipoise Works
in the medical field. The impact made by
this revolutionary outbreak needs attention
from the very root. Hence, integrating this
to the curriculum of MBBS would be of
substantial value.
The misuse of antibiotics is increasing
especially in human, and animal health, as
well as in agriculture and it contributes to
the spread of gene resistance, creating a
“Silent Pandemic” that could surpass other
causes of mortality by 2050. AMR affects
both humans and animals, with resistant
pathogens posing challenges in treating
infections. Various mechanisms, such as
enzymatic modification and biofilm
formation, enable microbes to withstand
the effects of antibiotics. The lack of
effective antibiotics threatens routine
medical procedures and could lead to
millions of deaths annually if left
unchecked.
AMR has arisen as a multifaceted issue
that impacts the health of both humans
and animals. The excessive and improper
utilization of antibiotics in various
domains, such as healthcare facilities,
agricultural practices, and veterinary
medicine, has expedited the emergence of
drug-resistant strains of microorganisms.
The excessive dependence on antibiotics
has resulted in the emergence of
antibiotic-resistant bacteria, commonly
known as superbugs, which pose
significant challenges in treatment efficacy
and can lead to severe infections.
Furthermore, the inadequate progress in
developing novel antimicrobial
medications exacerbates the issue,
as the rate at which resistance develops
surpasses the rate at which effective
antibiotics are being developed.
Patients should know the consequences of
the misuse of microbicides and for that the
doctors and most importantly future
doctors should gain a grip on this subject.
With the collaboration of various
departments such as microbiology,
biochemistry, pharmacology, and
community medicine awareness towards
AMR can be easily inculcated in the
students from the very beginning of their
course in a pulchritudinous way.
Microbiology would help the students learn
the structure and assets the microbes are
holding in our body that are involved in the
development of resistance to the drugs.
Pharmacology deals with the composition
of medicines which are manufactured by
various pharmaceutical companies whether
it jeopardises with the doses of
antimicrobials in the medicine itself or how
many doses of a particular medicine should
be consumed by the patient for the ailment
to heal in the normal period as it should.
Community medicine is yet another
significant subject that helps in spreading
awareness and engaging the students in
active learning of AMR in a fun manner. All
of this helps the students experiencing
jouska learn about AMR in a fast and
efficient fashion along with other scientific
reasoning. It is a scintillating process of
substantial development which when
incorporated in a systematic way in the
undergraduate medical curriculum can be
passed on. It not only builds assets to
society but also eliminates the liability of
antimicrobials abuse. This can additionally
iron out the quid-pro-quo happening over
the counter which heterophemizes the
performance of medication in the future.
WMA JDN Special Edition Bulletin on AMR
REFERENCES
Ahmed, Sirwan & Hussein, Safin & Qurbani, Karzan & Ibrahim,
Radhwan & Saber, Abdulmalik & Mahmood, Kochr & Mohamed,
Mona. (2024). Antimicrobial resistance: Impacts, challenges,
and future prospects. Journal of Medicine Surgery and Public
Health. 2. 100081. 10.1016/j.glmedi.2024.100081.
1.
Dr. Krishna
Mahendrakumar
Jasani
Senior Resident,
Department of
Community and
Family Medicine, All
India Institute of
Medical Sciences
(AIIMS), Rajkot.
krishnajasani2@gmai
l.com
27
Open access Editorial
Strengthening the Fight Against Antimicrobial
Resistance by Web-based monitoring system
Dr. Krishna Mahendrakumar Jasani
Antimicrobial resistance (AMR) is a critical
global health challenge that undermines
the efficacy of treatments against
infections, leading to increased morbidity,
mortality, and healthcare costs. The
discovery of antibiotics by Alexander
Fleming in 1928 marked a revolutionary
advancement in medicine (1); However, the
extensive and often indiscriminate use of
antibiotics has paved the way for the
emergence of drug resistance and the
looming threat of super-resistant bacteria
(2). AMR, characterized by the reduced
effectiveness of antibiotics, antivirals,
antifungals, and antiparasitics, poses a
significant threat, with projections
indicating it could cause 10 million deaths
annually by 2050 and cost the global
economy $100 trillion(3). India, as one of
the largest consumers of antibiotics, is
particularly vulnerable, with an estimated 2
million annual deaths by 2050 attributed to
AMR(4). Contributing factors include
overuse, inadequate dosing, poor
adherence to treatment guidelines, and
incomplete antimicrobial courses.
Addressing these challenges demands a
systematic, innovative, and multi-
stakeholder approach.
Inspired by the success of Ni-kshay, India’s
digital tuberculosis management system, a
similar digital platform can be developed to
combat AMR through enhanced
antimicrobial stewardship. This dashboard
could provide actionable insights into
adherence trends, geographic hotspots for
high antimicrobial usage, and instances of
incomplete treatments. These insights
would enable policymakers and healthcare
administrators to target interventions
effectively. Furthermore, integrating this
system with mobile-based applications
could allow patients to self-report
adherence, access educational resources,
and receive reminders, thereby fostering a
sense of ownership and accountability in
their treatment(5). Public-private
partnerships (PPPs) would play a crucial
role in scaling this initiative by involving
private practitioners and pharmacies,
complemented by robust regulatory
frameworks and training programs for
healthcare providers.
Implementation strategies for such a
system include stakeholder collaboration to
foster synergy among government bodies,
healthcare providers, and technology
developers. Community engagement and
awareness campaigns would ensure
adherence and foster accountability in
antimicrobial use. Training programs would
equip healthcare providers with knowledge
and tools for effective antimicrobial
stewardship, while regulatory frameworks
would monitor and control antimicrobial
prescriptions and sales.
The expected outcomes of this initiative
include significant improvements in
treatment adherence, a reduction in the
prevalence of incomplete antimicrobial
courses, and a decrease in the global
burden of AMR. Real-time monitoring
through the dashboard would enable
policymakers to develop targeted
strategies, addressing geographic and
demographic vulnerabilities. Additionally,
the integration of mobile technology would
enhance patient engagement, promoting a
sense of ownership over treatment
adherence. The economic benefits are
equally substantial, with reduced
healthcare costs stemming from improved
treatment outcomes and lower rates of
resistance-related complications.
Future directions for this initiative involve
scaling the platform to encompass a
broader range of antimicrobial agents and
incorporating advanced technologies such
as artificial intelligence (AI) for predictive
modelling. AI algorithms could identify
resistance hotspots and optimize
interventions by analyzing patterns in real-
time data. Expanding the initiative’s scope
to include international collaborations
WMA JDN Special Edition Bulletin on AMR
28
Open access Editorial
would facilitate the sharing of data and best practices,
fostering a unified global response to AMR. Evaluation
metrics, including adherence rates, reduction in
resistance trends, and economic impact assessments,
will be critical for assessing the program’s efficacy and
guiding future refinements.
By leveraging lessons from Ni-kshay and integrating
technological, community-driven, and policy-based
approaches, this model offers a promising solution to the
AMR crisis. The success of such a system will depend on
sustained collaboration among stakeholders, the
adaptability of the platform to diverse healthcare
contexts, and continued investment in research and
development. This initiative could serve as a cornerstone
in the global effort to combat AMR, ultimately reducing
the burden of resistance and safeguarding the efficacy of
life-saving antimicrobials.
REFERENCES
Fleming A. On the antibacterial action of cultures of a
Penicillium, with special reference to their use in the
isolation of B. influenzae. Rev Infect Dis. 1980;2(1):129–
39.
1.
Dantas G, Sommer MO, Oluwasegun RD, Church GM.
Bacteria subsisting on antibiotics. Science.
2008;320(5872):100–3.
2.
Review on Antimicrobial Resistance. Antimicrobial
resistance: tackling a crisis for the health and wealth of
nations [Internet]. 2014 [cited 2024 Jan 29].
3.
Balachandra SS, Sawant PS, Huilgol PG, Vithya T, Kumar
GS, Prasad R. Antimicrobial resistance (AMR) at the
community level: An urban and rural case study from
Karnataka. J Family Med Prim Care. 2021;10(3):1404–11.
4.
Toppo M, et al. “TB drug stock planning in advance is a
futile activity”: Health system’s perceived challenges and
suggested solutions pertaining to Nikshay Aushadhi portal
in central India. Indian J Tuberc. 2023. Available from:
https://doi.org/10.1016/j.ijtb.2023.06.021
5.
WMA JDN Special Edition Bulletin on AMR
Maymona J.
Choudry, MD, MPH
General Surgery,
Vicente Sotto
Memorial Medical
Center, Cebu
Medical Officer IV,
Basilan Medical
Center, Isabela,
Region IX
Faculty, School of
Medicine, Ateneo de
Zamboanga
University
Visiting Faculty,
College of Medicine,
Western Mindanao
State University
1
29
Open access Editorial
Antimicrobial Resistance in the Philippines:
Perspectives from Junior Doctors
1
Maymona J. Choudry, Jamalul Islam I. Ghazali
“Antimicrobial resistance is one of the
greatest threats to global health, food
security, and development today. It affects
everyone, everywhere, and it requires a
coordinated and sustained response at the
global, national, and local levels.” — United
Nations (UN)
The World Health Organization (WHO) has
declared antimicrobial resistance (AMR) as
one of the top 10 global public health risks.
In 2019 alone, drug-resistant infections
resulted in nearly 4.95 million deaths
worldwide, with a significant 1.27 million of
those deaths being directly attributed to
AMR. These numbers highlight the
devastating impact AMR has on human
health and the need for urgent action. AMR
occurs when microorganisms such as
bacteria, viruses, fungi, and parasites
evolve to resist the drugs that once killed
them or inhibited their growth. This
resistance can render common infections,
including pneumonia, tuberculosis, and
urinary tract infections, more difficult to
treat, leading to longer hospital stays, more
complicated surgeries, and higher mortality
rates. The increasing threat of AMR calls for
a global, coordinated response to protect
the effectiveness of antibiotics and other
antimicrobial agents.
In the Philippines, the impact of AMR is
alarmingly high, with the country accounting
for a significant number of AMR-related
deaths in Southeast Asia. According to
reports, 15,700 deaths in the Philippines in
2019 were directly caused by AMR, with an
additional 56,700 deaths linked to its
effects. This places the Philippines at the
forefront of AMR-related health burdens in
the Southeast Asia region, where it ranks
fourth in age-standardized mortality rates
across 13 countries. The consequences of
AMR in the Philippines are not only seen in
mortality rates but also in the strain it
places on the country’s healthcare system.
2
2
Jamalul Islam I.
Ghazali, RMT
Doctor of
Medicine, Matias
H. Aznar Memorial
College of
Medicine, Inc.,
Cebu
Post Graduate
Intern,
Zamboanga City
Medical Center
The number of deaths attributed to AMR
exceeds those caused by chronic
respiratory diseases, digestive diseases,
maternal and neonatal disorders, and even
self-harm and interpersonal violence. This
stark reality underscores the urgent need
for comprehensive interventions and
strategies to combat AMR in the country.
Addressing the growing problem of AMR in
the Philippines requires a well-coordinated,
multi-faceted approach that involve
education, regulation, healthcare reform,
and international collaboration. Public
education is essential to raising awareness
about the dangers of improper antibiotic
use and the importance of antimicrobial
stewardship. It is crucial for both
healthcare providers and the public to
understand that overuse and misuse of
antibiotics contribute significantly to the
rise of resistant strains.
Additionally, stricter regulation and
enforcement of policies on the sale and
distribution of antibiotics are needed to
prevent their misuse. The healthcare
system itself must be reformed to ensure
better infection prevention and control,
along with improved surveillance and
diagnostic capabilities. Finally, international
collaboration is crucial in addressing AMR
as a global issue, requiring the sharing of
knowledge, research, and resources across
borders.
To address AMR effectively, the Philippine
government developed the Philippine
National Action Plan on Antimicrobial
Resistance (PNAP-AMR), which brings
together multiple government agencies,
including the Department of Health (DOH),
Department of Agriculture (DA), Department
of Science and Technology (DOST),
Department of Trade and Industry (DTI),
and the Department of the Interior and
WMA JDN Special Edition Bulletin on AMR
30
Open access Editorial
Local Government (DILG). The PNAP-AMR aims to
strengthen the country’s response to AMR by focusing
on several key goals. These include enhancing
surveillance and laboratory capacity to monitor AMR
trends, ensuring access to safe and high-quality
antimicrobials, promoting the rational use of
antibiotics, reducing infections in all settings,
fostering innovation and research on AMR, and raising
public awareness on the importance of combating
AMR. These strategic actions are designed to curb the
spread of resistance and protect the public from its
dangerous consequences.
The Research Institute for Tropical Medicine (RITM)
has been at the forefront of efforts to combat AMR in
the Philippines. As a key player in antimicrobial
resistance surveillance, RITM operates the
Antimicrobial Resistance Surveillance Reference
Laboratory (ARSRL), which serves as the central hub
for the country’s Antimicrobial Resistance
Surveillance Program (ARSP). This laboratory-based
system is crucial for tracking the prevalence of AMR
across the country. The ARSP operates through 26
sentinel sites nationwide, where priority specimens
are routinely sent for clinical testing. The data
collected from these sites are essential for identifying
AMR patterns and potential outbreaks, enabling
timely and targeted responses. The program’s
emphasis on surveillance is critical for detecting new
resistance trends and guiding clinical decision-
making, which helps to mitigate the spread of
resistant infections.
In addition to surveillance and regulation, raising
public awareness about AMR is vital for fostering a
more informed society. One significant initiative in this
regard is the Philippine Antimicrobial Awareness
Week (PAAW), an annual event aimed at educating
both healthcare professionals and the general public
about the risks of AMR.
The 2024 PAAW officially launched in Iloilo City on
November 20, bringing together health professionals,
advocates, and community members for a day focused
on this critical issue. The theme of the event, “Sama-
samang Magtulungan upang Antimicrobial Resistance
ay Mapigilan: Maki-alam. Manghikayat. Agarang
Kilos,” emphasizes the need for collective action to
combat AMR. During the event, expert-led discussions
were held on the importance of antimicrobial
stewardship and the impact of AMR on agriculture, a
key area often overlooked in discussions about
resistance. Such initiatives are instrumental in
creating a sense of urgency about AMR and ensuring
that everyone, from healthcare providers to the
general public, understands their role in preventing its
spread.
AMR is a growing global threat that requires
immediate and sustained action. The situation in the
Philippines highlights the urgent need for
comprehensive strategies that involve government
agencies, healthcare professionals, and the public.
The country can take significant steps toward
addressing this critical issue through national action
plans, improved surveillance, and public awareness
initiatives. Collaborative efforts at both the national
and international levels will ensure that antimicrobial
treatments remain effective for future generations,
ultimately safeguarding global health from the
devastating effects of AMR.
WMA JDN Special Edition Bulletin on AMR
31
Open access
REFERENCES
Research Institute for Tropical Medicine. RITM conducts NDF
2023 [Internet]. Available from: https://ritm.gov.ph/ritm-
conducts-ndf-2023/
1.
Institute for Health Metrics and Evaluation. Philippines [Internet].
Available from:
https://www.healthdata.org/sites/default/files/2023-
09/Philippines.pdf
2.
World Organisation for Animal Health. The Philippine Action Plan
to Combat Antimicrobial Resistance [Internet]. 2020. Available
from: https://rr-
asia.woah.org/app/uploads/2020/03/philippines_the-philippine-
action-plan-to-combat-antimicrobial-resistance.pdf
3.
Department of Health Western Visayas Center for Health
Development. Story [Internet]. Facebook; 2024 Nov 22 [cited
2025 Jan 29]. Available from:
https://www.facebook.com/story.php/?
story_fbid=1026630009275055&id=100057841951646&_rdr
4.
World Organization for Animal Health. Country Report:
Philippines [Internet]. 2020 Mar. Available from: https://rr-
asia.woah.org/app/uploads/2020/03/country-report-
philippines.pdf
5.
WMA JDN Special Edition Bulletin on AMR
Open access Editorial
Antimicrobial Resistance in low- and middle-income
countries: An Established Global Health Crisis
32
Antimicrobial resistance (AMR) has emerged as
a significant global health crisis, with far-
reaching consequences for human health,
economies, and societies. Low- and middle-
income countries, in particular, are
disproportionately affected by AMR due to
various factors, including inadequate access to
healthcare, poor sanitation, lack of standard
microbiology laboratories, and the misuse of
antimicrobials. This paper examines the scope
of the AMR crisis in low- and middle-income
countries, its causes, consequences, and
potential solutions.
The World Health Organization (WHO) has
identified AMR as a major global health threat,
with the potential to undermine decades of
progress in public health and modern medicine
such as cancer chemotherapy, caesarean
section, hip replacements, organ
transplantation, and other surgeries (1). In
developing countries, the situation is
particularly dire. According to the WHO,
Bacterial AMR was directly responsible for an
estimated 1.27 million deaths annually in 2019
and contributed to 4.95 million deaths, with
this number projected to increase to 10 million
by 2050 if left unchecked (2).
One of the primary drivers of AMR in resource-
poor settings is the misuse of antimicrobials. In
many of these countries, antibiotics are readily
available over the counter, leading to
widespread self-medication and misuse (3).
Additionally, weak healthcare systems and
poor regulation of pharmaceuticals by
government authorities contribute to the
proliferation of substandard and counterfeit
antibiotics with the problem of access to the
right antibiotics remaining a perennial problem
in the AMR landscape. The unavailability of
standard clinical microbiology laboratories
coupled with inadequate antimicrobial research
and development pipeline further exacerbates
the problem.
Poor sanitation and inadequate access to
healthcare due to poverty and inequality also
play significant roles in the spread of AMR in
developing countries. In many of these
countries, healthcare facilities lack basic
infrastructure, including clean water,
sanitation, and hygiene facilities (4). This
creates an environment conducive to the
spread of microorganisms, which in turn
fuels the development of AMR. Additionally,
the cost of quality healthcare is potentially
out of reach for the common man who
essentially relies on out-of-pocket payment
for access.
The consequences of AMR in low- and
middle-income countries are severe and
catastrophic. AMR increases the risk of
treatment failure, leading to prolonged
illnesses, increased mortality, and higher
healthcare costs (3). Moreover, AMR
undermines the effectiveness of vaccines,
making it more challenging to control
infectious diseases (1).
To combat AMR in developing countries, a
multifaceted approach is necessary. Firstly,
improving access to healthcare and
strengthening healthcare systems is critical.
This includes investing in healthcare
infrastructure including upscaling our
clinical microbiology laboratories, training
healthcare workers, and improving access
to essential medicines (2).
Secondly, promoting the rational use of
effective antimicrobials is essential. This
can be achieved through public awareness
campaigns, education and training of
healthcare workers, and implementation of
antimicrobial stewardship programs (3).
Thirdly, enhancing surveillance and
monitoring of AMR is vital. This includes
robust surveillance systems, monitoring
antibiotic use and resistance patterns, and
sharing data internationally (1).
Finally, addressing the root causes of AMR,
including poverty, poor sanitation, and
inadequate access to healthcare, is crucial.
WMA JDN Special Edition Bulletin on AMR
Chizaram A. Onyeaghala
Chizaram A.
Onyeaghala,
Secretary, National
Committee on
Infectious Diseases,
Nigerian Medical
Association.
chizero15@gmail.co
m
33
Open access
REFERENCES
World Health Organization. Global Action Plan on Healthy
Lives and Well-being for All (2019-2023) [Internet]. Available
from: https://www.who.int/initiatives/sdg3-global-action-plan
[cited 2024 Dec 24].
1.
Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF,
Sumpradit N, et al. Antibiotic resistance – the need for global
solutions. Lancet Infect Dis. 2013;13(2):1057–98.
2.
Pittet D, Allegranzi B, Boyce J. The World Health
Organization’s global patient safety challenge: “Clean Care is
Safer Care.” Infect Control Hosp Epidemiol. 2009;30(5):439–
42.
3.
World Health Organization. Antimicrobial Resistance
[Internet]. 2023 Nov 21. Available from:
https://www.who.int/news-room/fact-
sheets/detail/antimicrobial-resistance [cited 2024 Dec 24].
4.
United Nations. UN High-Level Meeting on Antimicrobial
Resistance [Internet]. 2024 Sep 26. Available from:
https://www.un.org/en/civil-society/high-level-meeting-
antimicrobial-resistance [cited 2024 Dec 24].
5.
This requires a comprehensive approach that
involves governments, international organizations,
civil society, and the private sector (2).
The United Nations General Assembly High-level
Meeting on AMR that was held for the second time
in New York on 26 September 2024 with the theme
“Investing in the Present and Securing Our Future
Together: Accelerating Multisectoral Global,
Regional, and National Actions to Address
Antimicrobial Resistance” is an example of the
global solidarity needed to address the threat AMR
poses to global health, food security, and achieving
the 2030 Sustainable Development Goals. The
meeting offered a critical opportunity for political
leaders and stakeholders from across different
sectors to collectively commit to clear, new targets
and practical steps to addressing AMR (5).
In conclusion, AMR is an established global health
crisis that disproportionately affects resource-poor
countries. The causes of AMR in these countries are
complex and multifaceted, and addressing them
requires a comprehensive approach that involves
access to healthcare, promoting rational use of
effective antimicrobials and equitable access to
vaccines, enhancing surveillance and monitoring
through quality diagnostics and robust data, and
addressing the root causes of AMR. Only through
collective action can we hope to mitigate the impact
of AMR on human health and ecosystems and
ensure that infectious diseases remain treatable for
future generations.
WMA JDN Special Edition Bulletin on AMR
Open access Editorial
Daniel Andrés
Sierra García, MD
MSc. Innovative
Medicine
Uppsala
Universitet
Guatemala,
Guatemala
daniel-
andres.sierra-
garcia.1114@stud
ent.uu.se
34
A Global Threat: Antimicrobial Resistance through the
One Health Lens
Daniel Andrés Sierra García
The extensive use of antimicrobial drugs
has substantially reduced endemic illness
and infection-related mortality, yet it has
triggered an alarming situation –
antimicrobial resistance (AMR). Predicted to
cause up to 10 million deaths by 2050, AMR
stands as one of the major global health
threats in this century(1,2).
Antimicrobial resistance in a
nutshell
At its core, AMR is the mechanism by which
microbes resist the effects of antimicrobial
drugs, a phenomenon existing in nature
long before the widespread antimicrobial
use. Nevertheless, the extended misuse and
overuse of antimicrobials in human
medicine, veterinary practices, and
agriculture have massively accelerated
AMR. As a result, the standard treatment of
infectious diseases is now under threat,
demanding urgent response to this
problem(3,4).
One Health framework
One Health acknowledges the
interconnectedness of human, animal, and
environmental health. It recognizes that the
emergence and spread of AMR is not
confined solely to humans but is intricately
linked across the three sectors and its
interconnections. As a comprehensive
strategy that connects human, animal, and
environmental domains, a One Health
approach is imperative to curb the path of
AMR (1,5).
In human health, antimicrobials are
primarily used for infection treatment and
prophylaxis. However, widespread misuse,
unrestrained over-the-counter sales, and
self-medication, significantly contribute to
AMR. With the global consumption of
antimicrobials expected to double in the
upcoming years, anthropogenic factors like
world trade, conflict, migration, food
production massification, and climate
WMA JDN Special Edition Bulletin on AMR
Figure 1: The complexity of AMR across the One Health domains. This scheme shows the interconnectedness between
humans, animals, and the surrounding environment, and how these relations facilitate the transmission of AMR.
(Created with BioRender. Adapted from Walsh TR, Nat Microbiol, 2018.)
35
Open access
REFERENCES
Hernando-Amado S, Coque TM, Baquero F, Martínez JL.
Defining and combating antibiotic resistance from One
Health and Global Health perspectives. Nat Microbiol.
2019 Aug 22;4(9):1432–42.
1.
Udaondo Z, Huertas MJ. Fighting the enemy: One Health
approach against microbial resistance. Microb Biotechnol.
2020 Jul 1;13(4):888–91.
2.
Akram F, Imtiaz M, Haq I ul. Emergent crisis of antibiotic
resistance: A silent pandemic threat to 21st century. Microb
Pathog. 2023 Jan 1;174:105923.
3.
Aslam B, Khurshid M, Arshad MI, Muzammil S, Rasool M,
Yasmeen N, et al. Antibiotic resistance: One Health One
World outlook. Front Cell Infect Microbiol. 2021;11:Article
617617.
4.
Kim DW, Cha CJ. Antibiotic resistome from the One-Health
perspective: understanding and controlling antimicrobial
resistance transmission. Exp Mol Med. 2021;53:301–9.
5.
Global Impact
From a public health perspective, human health is
considered a priority, but its interdependence with
animal health and the associated environment
cannot be ignored. Since AMR microbes are extended
in multiple niches, AMR strains of fungi and bacteria
represent a significant global problem, raising
mortality rates due to the inefficiency of currently
available antimicrobials. The escalating global
consumption of antimicrobials, with chances of a
catastrophic future where no antimicrobials are
effective for human disease, is leading to prolonged
illness and increased mortality rates (2–4).
Challenges and future directions
Governments, organizations, and scientists
worldwide recognize the urgency of addressing AMR.
Antimicrobial stewardship plans, ensuring
responsible antimicrobial use for therapeutic
purposes in human and animal health, are crucial.
Public health interventions, such as sanitation and
extended vaccination, complement these efforts. A
paradigm shift in research and development is
essential, focalizing research efforts on discovering
new antibiotics or alternative therapies. The
absence of new antibiotics in the last 30 years
underscores the need for innovation, with
alternative therapies like bacteriocins, bacterial
genetic modification, bacteriophage therapy, toxins,
and predatory bacteria, requiring further research
for clinical application (2–4).
WMA JDN Special Edition Bulletin on AMR
change further complicate the issue. Cultural habits,
including food choices and hygiene practices, also
play a role in AMR transmission (1,4).
In animal health, antimicrobials are extensively used
in livestock and aquaculture, for therapy,
prophylaxis, metaphylaxis, and growth promotion.
Some of these practices are associated with
prolonged use of antibiotics in sub-lethal
concentrations, dumping not absorbed and partially
metabolized antimicrobials into the environment.
Approximately two-thirds of total antimicrobial
consumption is used in animal production,
significantly contributing to the transmission of AMR
to humans through direct contact and consumption
of animal products(2,4,5).
The environment, often overlooked, serves as a
major reservoir for AMR, with soil and freshwater
settings acting as major reservoirs and dissemination
routes for AMR. Anthropogenic pollution, and human
and animal waste, introduce AMR factors to the
environment, creating AMR hotspots in wastewater
and manure due to the presence of remains of
antibiotics, hard metals, and disinfectants.
Consequently, drinkable water and agricultural
products, constantly exposed to environmental AMR
factors, serve as reintroduction routes of AMR to
humans and animals, completing the transmission
cycle (1,4,5).
Open access Editorial
Fatma F Shakarchi, MD
MSc
National Point of
Contact, Space
Generation Advisory
Council (SGAC), in
support of the United
Nations Program on
Space Applications,
Vienna, Austria
Medical Doctor,
Firdous Hospital,
Baghdad, Iraq
1
36
Antimicrobial Resistance in Ophthalmology: A Global
Perspective
1,2
Fatma F Shakarchi, MD MSc
Antimicrobial resistance (AMR) is quickly
becoming a serious challenge in eye health.
The rise in multi-drug-resistant infections,
like methicillin-resistant Staphylococcus
aureus (MRSA), highlights the urgent need
for a united effort to protect the power of
antibiotics in treating eye infections.
2
Ocular Infections and the Pathogens
Responsible
Ocular infections commonly arise due to
microorganisms, particularly gram-positive
bacteria such as Staphylococcus aureus,
coagulase-negative Staphylococci, and
Streptococcus pneumonia. In addition,
Gram-negative organisms, such as
Pseudomonas aeruginosa, contribute
significantly, especially in keratitis and
endophthalmitis(1).
They are treated with non-targeted
antibiotics as broad-spectrum
fluoroquinolones. The result is the gradual
emergence of resistance to ocular
pathogens, which impacts the future use of
these agents. Gram-positive bacteria, for
example, Staphylococcus aureus (SA), also
demonstrated fluoroquinolone resistance in
9-13%, while gram-negative pathogens like
Pseudomonas exhibit resistance rates as
high as 39% in certain regions(2).
Mechanisms Driving Resistance
The mechanisms of AMR are multiple,
including the enzymatic inactivation of
antibiotics, alteration of drug targets, efflux
of antimicrobial agents, and diminished
permeability of bacterial cell membranes.
These acquisitions make bacterial escape or
overcoming therapeutic strategies much
more difficult, leading to either more
complex treatment regimens or a higher
potential to cause blindness, such as
corneal perforation or enucleation in severe
cases of endophthalmitis.
AMR in Ophthalmology: Global Landscape
INDIA
This is particularly concerning in India,
where we are facing the challenge of
multidrug resistance among ocular
organisms. Certain strains of
Staphylococcus aureus show resistance to
the widely used fluoroquinolones of
ofloxacin, gatifloxacin, and moxifloxacin.
Gram-negative bacilli display intermediate
resistance to tobramycin and remain
vulnerable to ceftazidime. The Asia Cornea
Society’s multicenter study’s results
demonstrate the high frequency of
resistance isolates and the pressing need
for regional stewardship programs(3).
The Ocular Tracking Resistance in The U.S.
Today (Ocular TRUST) program lasted
between 2005 and 2008 and provided data
on isolated staphylococci showing
methicillin resistance up to 80%. Co-
resistance to other classes of antibiotics
including fluoroquinolones remains a
growing concern. Interestingly, resistance
patterns have remained stable for a long
time, which suggests predominant factors
that need to be addressed
systematically(4).
THE UNITED STATES OF AMERICA
THE UNITED KINGDOM
In the United Kingdom, from studies carried
out between 2009 and 2015, it was noted
that there is considerable AMR across the
care settings. In Pseudomonas spp., it was
chloramphenicol while swiveling for fusidic
acid, it was especially high in Haemophilus
spp. The epidemiological picture is made
even worse by seasonal fluctuations owing
to an upsurge of infections in the spring
season(5).
WMA JDN Special Edition Bulletin on AMR
37
Open access
Stakeholders must prioritize the implementation of
AMS programs tailored to ophthalmology. The
ophthalmology community can help prevent AMR by
encouraging collaboration, improving research, and
educating healthcare practitioners.
REFERENCES
Callegan MC, Engelbert M, Parke DW 2nd, Jett BD,
Gilmore MS. Bacterial endophthalmitis: epidemiology,
therapeutics, and bacterium-host interactions. Clin
Microbiol Rev. 2002 Jan;15(1):111-24. doi:
10.1128/CMR.15.1.111-124.2002. PMID: 11781270;
PMCID: PMC118063.
1.
Piddock LJ. Fluoroquinolone resistance: overuse of
fluoroquinolones in human and veterinary medicine can
breed resistance. BMJ. 1998 Oct 17;317(7165):1029-30.
doi: 10.1136/bmj.317.7165.1029. PMID: 9774285;
PMCID: PMC1114060.
2.
Chatterjee S, Agrawal D, Gomase SN, Parchand SM,
Gangwe AB, Mishra M. Fluoroquinolone resistance in
bacterial isolates from ocular infections: trend in antibiotic
susceptibility patterns between 2005-2020. Indian J
Ophthalmol. 2022 Dec;70(12):4391-4398. doi:
10.4103/ijo.IJO_1033_22. PMID: 36453351; PMCID:
PMC9940527.
3.
Asbell PA, Sahm DF, Shedden A, et al. Ocular TRUST:
nationwide antimicrobial susceptibility patterns in ocular
isolates. Am J Ophthalmol. 2008;145(6):951-958. doi:
10.1016/j.ajo.2007.12.044.
4.
Gerver SM, Nsonwu O, Thelwall S, Brown CS, Hope R.
Trends in rates of incidence, fatality and antimicrobial
resistance among isolates of Pseudomonas spp. causing
bloodstream infections in England between 2009 and
2018: results from a national voluntary surveillance
scheme. J Hosp Infect. 2022 Feb;120:73-80. doi:
10.1016/j.jhin.2021.11.013. Epub 2021 Nov 20. PMID:
34813873.
5.
Conclusion
To address AMR in ophthalmology, a multifaceted
approach is required, including worldwide
surveillance, regional stewardship, and local adoption
of best practices. Sustained efforts to integrate AMS
into ophthalmic treatment are critical to maintaining
antibiotic efficacy and ensuring that the vision
preservation aim is possible for future generations.
The Role of Antimicrobial Stewardship in
Ophthalmology
Although Antimicrobial Stewardship (AMS) has shown
great promise in reducing Antimicrobial Resistance
(AMR) in systemic diseases, its application in
ophthalmology is still relatively limited. The World
Health Organization’s 2015 global action plan
developed a framework for AMS. It places a strong
emphasis on cooperation, education, and the creation
of guidelines. These guidelines can be modified for
ophthalmology in the following ways:
Monitoring and Reporting: The regular monitoring
of resistance patterns is essential to identify AMR.
Collaborating with laboratories and microbiology
experts is crucial for guiding the strategic selection
of antibiotics, paving the way for more precise and
effective treatments.
1.
Awareness and Education: The dangers of AMR and
the significance of using antibiotics sparingly can
be emphasized in training programs for patients,
prescribers, and pharmacists.
2.
Protocol Development: The development of
evidence-based recommendations for the use of
antibiotics in ocular infections should be
spearheaded by ophthalmology professional
societies.
3.
Implementation of the Policy: Regular evaluation
of antimicrobial prescribing procedures and results
is essential to evaluate the effectiveness of AMS
programs.
4.
WMA JDN Special Edition Bulletin on AMR
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