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Antimicrobial resistance (AMR) is an escalating public health threat, with significant rises in serious but resistant infections around the world.
According to National Audit Office figures from February 2025, AMR contributes to an estimated 35,200 deaths annually in the UK, and could be associated with 8.22 million deaths globally by 2050.
Drug-resistant infections in humans increased by 13 per cent between 2018 and 2025, despite a Government target to reduce them by 10 per cent during this period.
Antibiotic resistance, which makes antibiotics less effective or ineffective, is the most common and widely recognised form of antimicrobial resistance. Its global rise is driven partly by the misuse and overuse of antibiotics in humans, especially in primary care.
In September this year, the Government published an AMR engagement guide for healthcare professionals to raise awareness of how the overuse of antibiotics can be dangerous, and to promote behaviours that can prevent infections and reduce resistance.
According to this guide, AMR is “everybody’s problem” – which means that everyone should be helping to tackle it, including the public and community pharmacy teams. The Government’s guide is designed to help people clearly understand what AMR is, why it matters and how it affects everyday life
Are water companies part of the problem?
Up to 90 per cent of antibiotics taken by humans pass into sewage systems, according to the Microbiology Society, making wastewater a significant contributor to, and potential route for, the spread of antimicrobial resistance (AMR).
According to the National Audit Office: “Research has shown that chemicals and residues in the aquatic environment affect the prevalence and diversity of AMR. In
the UK, this impact is likely being exacerbated by the increasing incidence of untreated wastewater entering waterways.”
UK rivers and seas become contaminated by wastewater via sewer overflows, septic tanks and treatment plants. Wastewater may contain antibiotics and other antimicrobials, along with drug-resistant micro-organisms and their genetic material, which can potentially go on to infect new hosts.
The National Preparedness Commission says that antibiotics used on animals and plants in agriculture can also be washed away into the surrounding environment, such as soil and water. Untreated wastewater spills have also become increasingly common in recent years – and some water companies routinely and illegally dump untreated wastewater.
Knowledge gaps
AMR affects people from all backgrounds, ethnicities and cultures worldwide. However, research shows that understanding of AMR varies across different population groups. National surveys show that people from lower socioeconomic backgrounds, minority ethnic communities, and those with lower levels of education or health literacy have significantly lower awareness and understanding of AMR. Knowledge varies among healthcare professionals too.
Research published in the JAC-Antimicrobial Resistance journal in December 2025 highlighted knowledge gaps among UK healthcare professionals, including community pharmacy teams.
While most pharmacists and pharmacy technicians said they know what AMR is, 14 per cent of pharmacists and 48 per cent of pharmacy technicians were unaware that antibiotic-resistant bacteria can spread from person to person. In addition, six per cent of pharmacists and 15 per cent of pharmacy technicians did not know that healthy people can carry antibiotic-resistant bacteria.
Improving knowledge of AMR and why it matters among pharmacists and pharmacy teams is particularly important due to their role in medication reviews, the dispensing of antibiotics, the safe disposal of leftover antibiotics and providing information to patients on how to take antibiotics safely. The AMR engagement guide provides straightforward explanations that pharmacy team members and other healthcare professionals can use when talking to members of the public.
Why AMR matters
Antimicrobial medicines are medicines used to treat infections or prevent infections from spreading. They include antibiotics, antivirals, antifungals, antiparasitics and antiseptics. AMR develops when microbes (bacteria, viruses, fungi or parasites) change over time and survive the medicines that used to kill them or stop their growth. The resistant microbes can spread from person to person (or animal to animal). They can also share their resistance with each other by passing along pieces of genetic material.
AMR can occur naturally and has existed for millions of years. However, the introduction of antimicrobial medicines into modern medicine, along with their misuse and overuse, has significantly accelerated this process. Ideally, the solution to AMR would be to keep developing new antimicrobials, but only one new usable class of antibiotic has been discovered since 1987.
According to the Antibiotic Guardian website, more than three million surgical operations and cancer treatments every year could become life threatening without effective antibiotics.
The risk of resistance in humans rises when an antibiotic is prescribed unnecessarily for a viral infection, isn’t the most suitable treatment for a specific bacterial infection, or is used for longer than necessary. Poor infection control, cleaning, sanitation, ventilation, overcrowding and food hygiene contribute to the rise of AMR too.
When microbes become resistant, patients may be sicker for longer, have longer stays in hospital, and take longer to recover from an infection. This can lead to repeated hospital stays and the need for more hospital consultations. In some cases, treatment failure can lead to admission to intensive care or even death. AMR therefore places more pressure on healthcare systems – and economics – worldwide.
On an individual level, AMR can affect people’s ability to work and look after themselves and their families. On a wider level, it can affect plants and animals, reducing productivity, threatening food security, and increasing risks to animal health and welfare. Once resistant infections spread between people, animals, food and the environment, AMR becomes harder to control
Using antibiotics safely
When speaking to customers about the safe use of antibiotics, it’s important to discuss the following key counselling points and safety messages:
- Antibiotics may not be needed for their symptoms. Explain the difference between viral infections and bacterial infections
- Discuss when they should expect to feel better once they start taking antibiotics, why this may not happen straight away, and when to go back to their doctor if they are not feeling better
- Highlight the importance of finishing the full course of antibiotics, even after symptoms improve. Taking only part of a course can mean that any remaining bacteria can cause the infection to start again or even mutate to develop resistance
- Make sure patients know they should take antibiotics at regular intervals as prescribed – at the correct dose, at a specific time and before, with or after food. This will help to keep a steady level of medicine in their body and reduce the risk of side effects
- Make sure they have checked with the pharmacist about possible interactions before starting antibiotics. This includes with other medicines, alcohol, herbal remedies, dietary supplements and even food and drink. Some antibiotics should not be taken with dairy products or certain fruit juices
- Discuss which side effects are ‘normal’ for that particular antibiotic, how to manage common side effects and when to seek advice
- Explain why they should never share antibiotics (or other prescribed medicines) with family and friends. Using antibiotics unnecessarily, taking the wrong antibiotic or the wrong dose can lead to antibiotic resistance or leave an infection untreated
- Highlight the importance of returning unused antibiotics to the pharmacy for disposal by explaining the potential impact on the environment, especially if medicines were to be flushed down the toilet or sink.
Antibiotic stewardship
According to the Government’s new AMR engagement guide, simply telling people about AMR is not enough.
People’s understanding of AMR is shaped by their personal experiences with antibiotics, the trust they place in healthcare professionals and how clearly these risks are communicated.
Clear and coordinated messages can help to increase public awareness of the risks, the scale of the problem, and the practical steps people can take to protect themselves and others: this is called antibiotic stewardship or guardianship.
Antibiotic stewardship isn’t about reducing the use of antibiotics altogether. Instead, it’s about making sure that antibiotic prescriptions, dosages and course lengths are appropriate, reducing unnecessary exposure to the medicines and preventing patients (and bacteria) from developing resistance to the medicines.
Healthcare professionals and members of the public can become ‘antibiotic guardians’ at antibioticguardian.com by making a personal pledge about how they will make better use of antibiotics and help save these vital medicines from becoming obsolete.
“Pharmacy teams are often one of the most accessible points of contact for people seeking advice about infections,” says Tase Oputu, president of the Royal College of Pharmacy. “They can help patients understand when antibiotics are and aren’t appropriate, provide advice on managing symptoms and self-care, and explain how to use antibiotics safely when they are prescribed. These conversations can help people understand that antibiotics are not always the right treatment and support more responsible use of these medicines.”
The AMR engagement guide recommends that healthcare professionals, including pharmacy teams:
- Make every contact count, taking every opportunity to discuss the risks of AMR. This includes interactions via webpages and other online and virtual spaces
- Take part in World Antimicrobial Awareness Week and other relevant health awareness dates
- Use ‘teachable moments’ when people are already engaged with health services, such as visiting
the pharmacy for treatments and advice.
View the Government’s AMR engagement guide here.
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