Positively Green

As outlined by the World Health Organisation, Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial agents. As a result of drug resistance, antibiotics and other antimicrobial agents become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness and death.

The World AMR Awareness Week (WAAW) is a global campaign to raise awareness and increase understanding of AMR and to promote global action to tackle the emergence and spread of drug-resistant pathogens. AMR is also an environmental issue: AMR and climate change are two of the top health emergencies and can be considered as two interlinked public health priorities  

Many diseases are climate-sensitive, and the climate change-facilitated alterations to water, food/nutritional security, eco-systems may lead to an increase in the spread of many bacterial and vector-borne diseases in humans, animals and plants. Antibiotic resistance in common pathogens like Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus increases by 4.2%, 2.2%, and 3.6%, respectively, with a 1-degree Celsius rise in temperature.  As our climate warms, non-native species of mosquitos and ticks increasingly find UK conditions suitable for survival, reproduction and establishment, resulting in higher infection rates and associated antimicrobial use. 

An increased use of antimicrobials in turn increases the production of the medicines which in itself is carbon intensive. Pharmaceuticals contribute to greenhouse gas emissions at various stages of their lifecycle, including manufacturing, sourcing materials, transportation , packaging, incineration, disposal, and drug usage. Beyond greenhouse emissions, the excess release of pollutants during the production stage of pharmaceuticals comes with significant environmental risks such as water pollution.

This pollution is an important driver of major environmental and health challenges such as climate change, biodiversity loss, and the acceleration of antimicrobial resistance. Pharmaceuticals can enter the environment at all stages of their life cycle, and their residues have been globally detected in surface water, sewage effluents, groundwater, drinking water, manure and soil. The widespread presence of Active Pharmaceutical Ingredients (APIs) in the environment is particularly alarming because these compounds are designed to be biologically active even at low concentrations. Their unintended effects in natural habitats can be profound and diverse: for example, studies have shown that these substances can significantly alter the behaviour and physiology of aquatic organisms. 

Antimicrobial stewardship is an important consideration for UHP, and our pharmacists work with our clinicians to:

• Educate patients on how to take and dispose of antibiotics safely.

• Optimise treatment by ensuring the correct drug, dose, route and duration

• Promote oral over intravenous where possible to further reduce waste, patient harm and carbon emissions- In terms of plastic waste, every IV to oral switch results in 1.48kgco2e carbon savings. 5 days of the common antibiotic metronidazole is equivalent to driving 78.9 miles in an average sized car, whereas 5 days of oral metronidazole is equal to driving only 0.4 miles.

To find out more, contact our Antimicrobial Pharmacy team.