Antibiotic Resistance: What You Need To Know

It has been less than 100 years since Alexander Fleming first discovered penicillin at St. Mary’s Hospital, London. In that time, hundreds of different types of antibiotics have been synthesised and used to treat diseases that were historically some of our biggest killers: smallpox, cholera, typhoid fever, diphtheria, tuberculosis and syphilis, to name a few. The average global life expectancy at the start of the 20th century was 47 years; today, it is 71 years. We have antibiotics to largely thank for that.

However, a new global crisis is on the way: antibiotic resistance. To put it simply, our use of antibiotics over the last century has not killed off diseases, rather it has forced them to adapt, mutate, and become strong enough to endure antibiotics. We are now entering an age where antibiotics are becoming less effective, while diseases are becoming more powerful.

As such, doctors worldwide are now limiting the prescription of antibiotics, especially for less deadly diseases, in a bid to stave off the rise of antibiotic-resistant diseases. In this article, we’ll explain what antibiotic resistance may mean for you as a patient.

What is antibiotic resistance?

Antibiotics are antimicrobial substances that are prescribed to treat bacterial diseases. They work by either killing the bacteria that cause diseases or by inhibiting their growth. Antibiotic resistance occurs when those diseases become strong enough to counteract the effects of the antibiotic.

Some bacteria have already developed resistance to antibiotics. These include:

Methicillin-resistant Staphylococcus aureus (MRSA)

‘Staph’ is a skin condition that can cause painful sores, swellings and blisters on the body, face and eyelids. When the strain became resistant to beta-lactam antibiotics, it became the more deadly MRSA, which is known to spread rapidly throughout hospitals and contributes to hundreds of thousands of deaths every year.

Vancomycin-resistant Enterococcus (VRE)

Enterococcus faecalis is a species of Enterococci, an intestinal bacteria known to cause urinary tract infections (UTIs), wound infections, bacteremia, endocarditis and meningitis. Enterococci are highly resistant to antibiotics, and when they develop resistance to Vancomycin they become known as VREs. VRE can cause nasty and highly infectious illnesses.

Multi-drug resistant Mycobacterium tuberculosis (MDR-TB)

Mycobacterium tuberculosis causes the tuberculosis (TB) disease, an infection that affects the lungs and can cause a highly infectious and potentially fatal range of symptoms. When the disease becomes resistant to isoniazid and rifampin, it is known as MDR-TB, a more complicated strain that accounts for nearly 250,000 deaths per year.

Carbapenemase-producing Enterobacterales (CPE)

Enterobacter is a species of bacteria found in the gut and faecal matter, which causes a variety of infections including UTIs, respiratory infections, endocarditis and soft tissue infections. They can become resistant to antibiotics, at which point they become known as ‘superbugs’. Patients can carry CPE without knowing it, and the disease spreads quickly by close contact with a carrier.

Which diseases will dominate future health concerns?

We look at which diseases pose the biggest risks in the future

Antibiotic-resistant infections already account for at least 700,000 deaths per year, and it is believed that figure could climb to around 10 million deaths per year by 2050 unless immediate action is taken.

The World Health Organization (WHO) is particularly concerned about gram-negative bacteria becoming resistant to antibiotics. Gram-negative bacteria pass along genetic material that allows them to become drug-resistant as they spread and multiply. Diseases such as e-coli, salmonella and shigella may eventually develop resistance to antibiotics in this way.

Other bacteria the WHO is monitoring as of 2024 include Neisseria gonorrhoeae (which causes gonorrhoea), Streptococcus pneumoniae (which causes pneumococcal infection) and Haemophilus influenzae (which cases meningitis, sepsis, pneumonia and epiglottitis).

What is causing antibiotic resistance?

To put it simply, over the course of the last century doctors have tended to prescribe antibiotics unnecessarily.

In other words, some believe that doctors have tended to prescribe antibiotics in cases where they were not strictly necessary, such as for minor bacterial infections where the patient would have otherwise made a full recovery without intervention.

Another factor is patient demand for antibiotics. Either by insisting that their doctors prescribe antibiotics, or by purchasing them without a prescription, individuals may have inadvertently contributed to the overuse of antibiotics. In some cases, patients may have taken antibiotics unnecessarily, for instance by attempting to use them to treat viral diseases.

Through general over-prescription and overuse of antibiotics, humankind has accelerated the adaptation and mutation of disease-causing bacteria to the point where some are now resistant to certain antibiotics.

In 2015, 30% of all antibiotics prescribed worldwide were deemed unnecessary. In the case of acute respiratory infections, as many as 50% of antibiotic prescriptions may have been unnecessary.

Does not completing my full course of antibiotics contribute to antibiotic resistance?

When you are prescribed antibiotics, your doctor may be quite strict about you completing the full course. This is because it was once suggested that either not completing a course of antibiotics may contribute to antibiotic resistance.

However, recent research has started to suggest the opposite. In 2017, an article in the British Medical Journal pointed out that there is no evidence to suggest that not completing a full course of antibiotics may contribute to antibiotic resistance. Researchers have since acquiesced that further research is needed into the optimal length of antibiotic administration.

Conversely, there is some evidence to suggest that taking antibiotics for longer than necessary may contribute to antibiotic resistance. You should always take antibiotics in accordance with your prescription from a medical professional.

Countries where antibiotics can be purchased without a prescription

In most countries, antibiotics need to be prescribed by a medical professional, such as a doctor, dentist, or a nurse or pharmacist with a special licence to prescribe.

In these countries, changing policies mean that antibiotics will now only be prescribed in cases where those antibiotics are both effective and necessary. You will need to visit your GP or other doctor in order to obtain a prescription, which will then be filled by a pharmacist.

Need to fill your prescription in a foreign country?

Make sure to read our guide on how to use pharmacies overseas

However, there are still many countries around the world where it is possible to buy antibiotics without a prescription. Sales of consumer antibiotics, which are often used to cure minor infections (and often taken incorrectly, i.e. in an attempt to cure viral illnesses such as influenza or COVID-19), are often linked to the rising crisis of antibiotic resistance.

In 2023, the WHO estimated that around one in three people worldwide use antibiotics without a prescription. In the EU, it’s estimated that around 7% of all antibiotics are sold without a prescription.

Countries where you may be able to purchase antibiotics off the shelf include:

Bulgaria
Cyprus
Estonia
Greece
Hungary
Italy

Malta
Poland
Romania
Thailand
Turkey
Spain

The practice is also widely reported throughout developing countries in Africa, Asia and South America.

Taking antibiotics without a prescription can be dangerous

Not only do you run the risk of taking an incorrect dosage, which can lead to painful side effects and allergic reactions, you also contribute to the development of antibiotic resistance.

Always consult a medical professional before taking antibiotics, and do not take any antibiotics that have not been prescribed to you.

Will another pandemic happen in our lifetime?

What could the next pandemic be and what we can do about it?

How does antibiotic resistance affect me?

As bacteria become more resistant to antibiotics, doctors around the world are taking steps to limit the prescription of antibiotics to patients. New policies are being written to ensure that antibiotics are only administered in cases where it is absolutely necessary.

As a patient, it’s difficult to say all the ways antibiotic resistance may affect you in the future. For now, there are a number of ways in which you may start to see global healthcare changing as a result of antibiotic resistance:

The impacts of antibiotic resistance

Patient morbidity – With certain diseases now resistant antibiotics, and antibiotics no longer prescribed for various other diseases, patients may experience longer hospital stays, an increased need for intensive care, excess surgery, periods of quarantine and higher risks to life.
Increased costs – Antibiotics are an affordable means to treat diseases. Without them, patients may experience rising healthcare costs, especially in cases where they require alternative methods of treatment such as screening, nursing, imaging and intensive care.
New guidelines – As doctors worldwide adapt to antibiotic resistance, the way we access healthcare will change. Expect to see alternative forms of medication and treatment prescribed more often.
Complications – The decreasing use of antibiotics may impact other areas of healthcare. For instance, surgeries may become more complex without the ability to prescribe antibiotics.

In summary, the impacts of antibiotic resistance could include fewer antibiotics being prescribed, higher healthcare costs, and the emergence of of new, possibly more deadlier variants of diseases.

Artificial intelligence is a major trend throughout healthcare

Discover how is AI supporting medical diagnosis

What can you do about antibiotic resistance?

Most countries around the world have already implemented policies to combat the development of antibiotic resistance. These policies include regulating the prescription of antibiotics even among medical professionals, investing in research into antibiotic resistance, implementing surveillance to monitor the use of antibiotics in the population and improving infection control to stop the spread of diseases known to be resistant to antibiotics.

If you would like to learn more about policies affecting antibiotic resistance, a good place to start is with the UK government’s 2024–2029 five year action plan.

As individuals, we can also take steps to ensure we are doing our part to slow down antibiotic resistance. Here are some things you could do if you want to ensure the stop of antibiotic resistant infections:

1/ Remember that prevention is the best cure

The best way to stop the spread of infections developing resistance to antibiotics is for people not to get those diseases in the first place. As we’ve learned from the COVID-19 pandemic, it is possible to stop diseases spreading from person to person by taking a few simple steps when you start to display symptoms.

If you have an illness, avoid coming into contact with other people as much as possible. Practise good hygiene, such as washing your hands regularly with soap for at least 20 seconds, and wearing a facemask when out in public. If you are able, you should stay home and away from others until you are no longer symptomatic.

2/ Get vaccinated

Another way to limit or prevent the spread of diseases is to inoculate yourself against them. All medically approved vaccines have an efficacy rate of at least 50%, meaning they can reduce the risk of serious illness by half, and therefore reduce the use of antibiotics. Vaccines are widely available against many diseases that might otherwise require antibiotics to treat, such as typhoid fever.

Speak to your doctor to see if you would benefit from new vaccines, or boosters to support your existing vaccines.

It’s important to look out for your health, safety and well-being abroad

We look at how to protect your life and well-being as an expat

3/ Consult your doctor

Your doctor will be briefed on antibiotic resistance, and will be informed by their medical council and the latest research about best practice in handling antibiotics.

By speaking to a doctor before seeking medication, you open the door to the opportunity to try alternative means of treatment. Your doctor will also be able to record the data from your treatment in the hopes of developing new forms of treatment to combat antibiotic resistance.

You may therefore be prescribed:

Alternative forms of treatment, such as bacteriophages, probiotics or plant-based medications
Antibody treatment, if this is available
Non-medication based treatments such as rest and exercise

4/ Only take antibiotics that have been prescribed for you

Even if you live in a country where antibiotics are available over the counter, you should only take antibiotics as they are prescribed by a doctor, dentist or licensed medical professional. This means:

Only taking antibiotics that are prescribed to you
Taking those antibiotics only as prescribed
Only taking antibiotics at the time they were prescribed

Avoid using antibiotics that were prescribed to someone else, antibiotics that you have leftover, and antibiotics that you have purchased with a prescription.

5/ Do not demand antibiotics

If your doctor decides not to prescribe antibiotics, it’s because they are following the latest medical guidance and best practices to ensure you receive the most appropriate treatment. If you’re still unsure, you can seek a second opinion—but it’s important to follow medical advice and only take antibiotics when they are truly needed.

Do not be tempted to go and seek antibiotics through alternative means – this may prove ineffective and be dangerous to your health.

Health is naturally a big priority for people

What are the world’s biggest health concerns?

Protect your health worldwide

William Russell, we have over 30 years’ experience providing international health insurance to expats living all over the world.

We offer flexible policies to suit your needs, giving you access to a network of over 40,000 private medical facilities, hospitals and clinics across the globe.

Find out more about our international health insurance policies and get a quote online in under two minutes today.

Discover how our international health insurance could help protect you and your family

Learn More

This article does not constitute medical advice. The article is for general information about medical conditions and medical treatment. If you need medical advice, please speak to a qualified medical professional.

Antibiotic Resistance: What You Need to Know

In this article