Antimicrobial resistance: what a young doctor can do today

Antimicrobial resistance rarely makes the front page, but by the most comprehensive estimate available, bacterial resistance was directly responsible for about 1.27 million deaths worldwide in 2019 and associated with nearly 5 million — more than HIV or malaria ^[1]. The World Health Organization lists it among the top global public health threats, and its Global Action Plan asks every member state to run a national action plan against it ^[2]. None of this is abstract for a young doctor in Uzbekistan: the prescriptions you write in your first year of practice are part of the curve.

Why resistance is a prescribing problem

Bacteria evolve resistance whenever they meet an antibiotic and survive. Every unnecessary course — the viral sore throat treated "just in case", the broad-spectrum agent chosen when a narrow one would do, the ten-day course continued after a three-day infection has resolved — selects for resistant strains, in that patient and in the community. The same is true of antibiotics bought without prescription and of those used in livestock.

This means that resistance is not only a laboratory or policy problem. It is a problem of individual prescribing decisions, repeated millions of times a day.

AWaRe: the WHO's simplest tool

To help prescribers, the WHO groups antibiotics into three categories, the AWaRe classification ^[3]:

The WHO's target is that at least 60% of a country's total antibiotic consumption should come from the Access group ^[3]. The AWaRe antibiotic book (2022) goes further and gives, infection by infection, the first-choice agent, dose and duration — a free, authoritative pocket reference for exactly the decisions a junior doctor makes every day.

Seven habits of a responsible prescriber

1. Decide whether an antibiotic is needed at all. Most upper respiratory infections, acute bronchitis in healthy adults and uncomplicated viral gastroenteritis do not need one.
2. Take cultures before the first dose whenever the result would change management — blood, urine, swab — and look at them when they come back.
3. Choose the narrowest effective agent and prefer Access-group antibiotics where the guideline allows.
4. Write the indication and the planned duration on the chart. "Amoxicillin for community-acquired pneumonia, 5 days" is a plan; "amoxicillin" is not.
5. Review at 48–72 hours. Stop, narrow, switch to oral or continue — but decide, and document it. This "antibiotic time-out" is the single most effective stewardship habit on a ward.
6. Use the shortest evidence-based course. Many infections once treated for 10–14 days have good evidence for shorter courses.
7. Check allergy labels. A recorded "penicillin allergy" is often a childhood rash, not anaphylaxis; a vague label pushes patients onto broader, less effective drugs.

Beyond the prescription pad

Infection prevention is stewardship too: hand hygiene between every patient, vaccination (yours and your patients'), and clean catheter and wound care prevent the infections that would need antibiotics in the first place. And communication matters — many unnecessary courses are written because the doctor assumes the patient expects one. Explaining why an antibiotic will not help a viral illness, and what to watch for, takes two minutes and is itself good medicine.

Keep the knowledge current

Resistance patterns change, and so do first-line recommendations. MedIQ's drug reference covers the antibiotic classes and their interactions, and the EBM tools help you read the trials behind the shorter-course recommendations yourself.