Stop the “war on superbugs”: new terminology urged

Primary care GPExperts have urged a rethink on the terminology used to describe antibiotic resistance, such as the “war on superbugs”, warning that it is undermining efforts to tackle the problem.

Writing in the journal Nature, international infectious disease experts say that the interchangeable use of different terms to describe antibiotic resistance by the press and scientists is likely to be counterproductive.

“Simple, clear and unambiguous terminology would help to ensure that the global effort against drug resistance is focused on the greatest immediate challenge: the rise of drug-resistant bacteria that cause common illnesses, resulting from the high use of antibiotics by humans. It could also improve people’s understanding and engagement,” they write.

survey in 2015 by the WHO in 12 countries highlighted people’s unfamiliarity with the language of antibiotic resistance, they said. Fewer than half of the nearly 10,000 respondents had heard of the term ‘”antimicrobial resistance”.

The authors urged the newly formed United Nations interagency group set up to coordinate the fight against drug resistance coordinate a review of the terminology used, to help engender a consistent and focused global response to the problem.

“Aggressive tactics to stop the spread of pathogens such as methicillin-resistant Staphylococcus aureus will benefit from a united front in terminology,”
they write. “The appointment of the United Nations Interagency Group provides an opportunity to apply the power of words to drug resistance. We urge this group to focus on three key issues.”

Terminology in focus

Drug-resistant infection: The authors propose this be the overarching term used to describe infections caused by organisms that are resistant to treatment. More specific words such as ‘antibiotic’ or “antifungal’ should be used in preference to ‘antimicrobial’ when referring to medicines against a specific type of organism, they suggest..

Stewardship: This term refers to to how the appropriate use of antibiotics can maximise both their current effects and the chances of their being available for future generations, the authors say, but they warn it is used too narrowly. While most people use it to describe the actions of physicians and pharmacists, it could refer to six endeavours – individual, multidisciplinary, hospital, community, national and global actions.

The War: The authors write that much of the rhetoric around drug resistance has pitched humans in a fight against bacteria with people referring to ‘the war against superbugs’, or the ‘fight against AMR’. In the pursuit of an enemy, responsibility for the increase of antibiotic-resistant bacteria in humans is often placed at the door of animal-health professionals, the livestock industry, farmers and veterinary surgeons, they say.

“This blame narrative is unhelpful,” they write, adding that the predominant driver of antibiotic resistance in humans is the intense pressure exerted by the misuse and overuse of antibiotics in people.

“War and threat were once potent rallying calls. But a more nuanced, balanced, standardised vocabulary is now needed — one that takes ecological ‘balance into account,” they argue.

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