Germ infections worldwide are becoming increasingly difficult to treat as antibiotics become less effective. With antimicrobial resistance (AMR) becoming a serious threat around the world, we spoke to Associate Professor David Lye, who is a senior consultant to the One Health Antimicrobial Resistance Workgroup, which comprises Singapore Ministry of Health (MOH), Health Promotion Board (HPB), Singapore Food Authority (SFA), National Parks, National Environment Agency (NEA) and Public Utilities Board (PUB), to find out how we can protect ourselves against superbugs.

General info on AMR

Q: AMR is said to be a serious threat globally. Could you share with us what AMR is, and how it occurs?

A: AMR occurs when germs (such as bacteria, fungi and viruses) develop resistance to a specific antimicrobial drug (such as antibiotics and antivirals) after being exposed to it. As such, that particular drug becomes less effective or ineffective when used to treat the infection.

While drug resistance may be a natural evolutionary phenomenon, the overuse and misuse of antibiotics have contributed to the increased occurrence of antibiotic resistance around the world. An example of misuse is when antibiotics are prescribed for common respiratory illnesses such as cold and flu, which are not caused by bacteria and therefore not treatable by antibiotics. Common viral infections that cause prolonged fever, such as glandular fever and dengue fever, cannot be treated with antibiotics as well.


Q: What is the difference between antibiotic resistance and antimicrobial resistance?

A: Antibiotic resistance is a specific type of antimicrobial resistance, referring to the resistance to antibiotics that are used to treat bacterial infections such as skin infections, urine infections and lung infections.

On the other hand, antimicrobial resistance is a broader term that includes resistance to medication used to treat infections caused by microorganisms other than bacteria, including parasites (such as malaria), viruses (such as influenza, dengue and HIV) and fungi (such as yeast and mould).


Q: Why is AMR a global concern? What are the possible complications that could arise?

A: According to the World Health Organisation, superbugs may make it harder for us to effectively treat infections, leading to prolonged illness, higher healthcare costs and even death. The lack of effective antibiotics may have a negative impact on the success of common medical procedures such as chemotherapy, organ transplantation and surgery. In fact, doctors are concerned that even simple infections that arise from a cut may lead to death due to AMR and the lack of effective antibiotics.




According to the US Centers for Disease Control and Prevention (CDC), superbugs have caused the deaths of at least 23,000 people in the US each year.


Q: What exactly are Superbugs and how do they spread?

A: The superbugs that have been identified by the CDC so far include carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA), EDBL- producing Enterobacteriaceae (extended-spectrum β-lactamases), vancomycin-resistant Enterococcus (VRE), multidrug-resistant Pseudomonas aeruginosa and multidrug-resistant Acinetobacter. These are mainly hospital germs; for example Enterobacteriaceae and Enteroccus are more likely to cause urinary infections, and Staphlyococcusaureus can cause skin infections.

Superbugs can be spread from person to person especially in the hospital setting or even from food. For example, farm animals that are fed antibiotics to encourage faster growth or prevent infections may develop antibiotic-resistant germs. These germs could remain in the meat if the meat is not properly cooked. Although there is no conclusive evidence yet, this is one possible way that superbugs could be passed on to humans.


AMR & Me

Q: Why are antibiotics effective against bacteria but ineffective against viruses? How can doctors differentiate between a bacterial and viral illness?

A: Antibiotics kill bacteria either by attacking their cell walls or by inhibiting their growth. Viruses, however, have a different cell structure to bacteria and replicate in a different way. Hence, antibiotics are ineffective against them.

Bacterial and viral infections can bring about similar symptoms including fever, coughing, sneezing and vomiting, and it may be hard for an untrained eye to distinguish between them. This is why it is important for you not to self-medicate and to seek medical attention when you are ill with a bacterial or viral infection.

Your doctor will typically be able to diagnose the cause of your illness through asking you a series of questions, examining you and with the help of their expertise. Sometimes, additional blood or urine tests, or X-rays may be needed to confirm a diagnosis.


Q: What should I do if a doctor prescribes antibiotics to me?

A: It is important for you to take the doses regularly as advised by your doctor, even if you think that you have recovered. In addition, never save your antibiotics for the next time you fall ill, as different illnesses require different medications. Please discuss with your doctor if you have any concerns about taking antibiotics.


Q: What happens if I do not complete the course of antibiotics as prescribed?

A: Not all the bacteria that are making you ill may be gone from your body, even if you believe that you have recovered. As such, a shortened treatment may not be as effective , increasing the risk of you falling ill again. It also increases the risk of the bacteria becoming resistant to the type of antibiotics you were taking.


Q: If I am suffering from the same illness as my family member, can I share the antibiotics that was prescribed to her?

A: No, it is not recommended for you to share the antibiotics even if you think that you are suffering from the same illness. This is because the doctor has prescribed the medication based on your family member’s medical history and symptoms, which means that what is suitable for her may not be suitable for you and may even worsen your condition. This is why you should always check with your doctor and never self-medicate.


Q: Can vaccinations protect us from antibiotic resistance? If so, which vaccinations should we take?

A: Vaccination plays an important role in the fight against antibiotic resistance by helping people to build up immunity against certain bacterial or viral infections, thereby reducing the risk of infection and the need for antibiotics. Please check the National Childhood Immunisation Schedule and National Adult Immunisation Schedule for more information about the recommended vaccinations. You may also consider protecting yourself by getting influenza vaccination every year.


Q: Do my pets (dogs and cats) need to be vaccinated as well?

A: All dogs and cats that are sold in pet shops or imported are required to be vaccinated . If you are unsure about the required vaccination for your pets, please check with your veterinarian.


Q: How can I protect myself from antibiotic resistance?

A: Firstly, there are some simple steps you can take to reduce the spread of infection and thereby minimise the use of antibiotics:
• Covering your mouth when you cough or sneeze
• Washing your hands frequently with soap and water
• Cultivating healthy lifestyle habits such as eating a nutritious diet and exercising regularly

Secondly, you should practise the prudent use of antibiotics to avoid accelerating the development of antibiotic resistance, such as:
• Using antibiotics only when prescribed by a doctor
• Following your doctor’s advice on how to take antibiotics
• Not sharing your antibiotics with anyone
• Do not demand antibiotics from your doctor


Q: Practising good hygiene is said to be one of the top ways to prevent bacterial infection. Would switching to antibacterial soap be even more effective?

A: There is no conclusive evidence that antibacterial soap is more effective than regular soap. To prevent bacterial infections, wash your hands frequently with soap, especially after you go to the toilet and before you eat your meals.