Antimicrobial resistance, antibiotic stewardship, and the midwife's role
Antimicrobial resistance is one of the greatest challenges to health care. With a reduced number of effective antibiotics, treatable conditions, such as ear, tooth and urine infections, may therefore become life-threatening. In order to minimise antimicrobial resistance, midwives should use clinical strategies that facilitate antibiotic stewardship, such as promoting healthy lifestyles, infection control and compliance with prescribed antibiotic treatment, and should endeavour to share knowledge and expertise with members of the wider multidisciplinary team, such as pharmacists. In addition, midwifery curricula should ensure that midwives have a knowledge of the dynamics of antimicrobial resistance and principles of antibiotic stewardship so that health professionals may share their expertise in order to combat this significant challenge, which poses the threat of a post-antibiotic era.
Antimicrobial—or antibiotic—resistance poses an urgent problem for midwives and public health authorities on a global level. Antimicrobial resistance is defined by the National Institute for Health and Care Excellence (NICE) as:
‘The loss of effectiveness of any anti-infective medicine, including antiviral, antifungal, antibacterial and antiparasitic medicines.’
Society now faces the prospect of a future without antibiotics, since it is estimated that 70% of the world's bacteria have developed resistance to antibiotics (Public Health England, 2015). There are various factors that are believed to have caused this situation, which include (Public Health England, 2015):
Before the discovery of penicillin in 1928, an average of 1 in 10 individuals died from meningitis, pneumonia and skin infections, compared with today's rate of 1 in 100 (Ashiru-Oredope, 2015). Similarly, deaths from childbirth-related sepsis were 3 in 100 before antibiotics and are now less than 3 in 100 000 (Ashiru-Oredope, 2015). Indeed, the World Health Organization (WHO) have estimated that antibiotics have extended human lifespan by approximately 20 years (WHO, 2014). Nevertheless, the emergence of multiple resistant organisms, associated with misuse of antibiotics, has contributed to a post-antibiotic era, where the protection that antibiotics have conferred for so many years is no longer reliable (Shute, 2015).
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