Antibiotic Resistance: Moving From Individual Health Norms to Social Norms in One Health and Global Health

Abstract

Antibiotic resistance is a problem for human health, and consequently, its study had been traditionally focused toward its impact for the success of treating human infections in individual patients (individual health). Nevertheless, antibiotic-resistant bacteria and antibiotic resistance genes are not confined only to the infected patients. It is now generally accepted that the problem goes beyond humans, hospitals, or long-term facility settings and that it should be considered simultaneously in human-connected animals, farms, food, water, and natural ecosystems. In this regard, the health of humans, animals, and local antibiotic-resistance-polluted environments should influence the health of the whole interconnected local ecosystem (One Health). In addition, antibiotic resistance is also a global problem; any resistant microorganism (and its antibiotic resistance genes) could be distributed worldwide. Consequently, antibiotic resistance is a pandemic that requires Global Health solutions. Social norms, imposing individual and group behavior that favor global human health and in accordance with the increasingly collective awareness of the lack of human alienation from nature, will positively influence these solutions. In this regard, the problem of antibiotic resistance should be understood within the framework of socioeconomic and ecological efforts to ensure the sustainability of human development and the associated human-natural ecosystem interactions.

Accounting for variation in and overuse of antibiotics among humans

“…One solution is to use “social norms” (“how others consider my behavior”) as an approach, since such initiatives have reduced smoking behaviors, for example. [ 207 ] Employing norms has been used to affect physician behavior, [ 208 ] but the results with relation to antibiotic use have been mixed. [ 209–211 ] Practitioners must learn about better ways to communicate about antibiotic risks and benefits at levels appropriate to all patients, and to have tools that provide for greater flexibility of prescribing.…”

Evolutionary Pathways and Trajectories in Antibiotic Resistance

“…The study of evolutionary pathways and trajectories should provide the basic knowledge to apply interventions directed to control antibiotic resistance (65,1209). (875,876,1117,1211). Interventions can be aimed in two directions: i) modifying the ecology landscapes that favor the emergence and dissemination of antibiotic resistance, essentially by controlling anthropogenic activities and ii) developing "therapeutic approaches" to curb or slow the evolutionary processes fostering antibiotic resistance.…”

High prevalence of antibiotic resistance in commensal Escherichia coli from healthy human sources in community settings

“…Thus, our data should prove useful to support the course for the fight against antibiotic resistance by researchers, community pharmacists, public health policymakers, advocacy groups, farmers, among others. A collective approach involving every country to fight antibiotic resistance is crucial to reduce the mortality, morbidity, associated health and healthcare costs, and the spread of resistant bacteria 10 , 42 .…”