Most readers are (hopefully) well aware of the serious threat posed by antimicrobial resistance (AMR), which could claim up to 10 million lives globally each year by 2050. In response, policymakers at the global, European, and national levels have mobilised landmark initiatives — most recently the UN Political Declaration on AMR agreed in 2024 and the Partnership on One Health AMR (OHAMR) launched by the EU in 2025. While these policy milestones represent an important leap forward, one critical element remains too often overlooked: the central role of prevention.
Overprescription and Unequal Burden
Antibiotics are widely used in all healthcare settings: hospitals, long term care facilities and in the community and more than 80% of prescriptions originate from primary care. Respiratory tract infections (RTIs) account for about 50% of prescriptions, while urinary tract infections (UTIs) represent the second leading cause of prescriptions [1]. Despite advances, antibiotics continue to be prescribed when they are unnecessary. RTIs are a striking example: an estimated 83% of adults with viral RTIs still receive antibiotics, even though these drugs have no effect on viruses [2]. UTIs — among the most common infections worldwide — trigger antibiotic prescriptions in roughly 83% of cases [3], with more than half of patients forced to switch treatment due to bacterial resistance [4]. This overprescription or misuse not only exposes individuals to side effects but also accelerates the cycle of resistance.
An unfortunate reality is that the burden of these very common infections is not felt equally. Women suffer disproportionately, both directly — UTIs affect women at rates far higher than men [5] — and indirectly, as primary caregivers for children. In Southern and Eastern Europe, where health systems face greater strain and fewer resources, the challenge is even more acute [6].
Prof. Gerdien Tramper, Consultant Paediatrician and Clinician Scientist at Franciscus Hospital, Rotterdam, highlights the burden of infections in children:
“Recurrent respiratory tract infections can take a significant toll on children and their families — especially on mothers, who shoulder the disproportionate share of caregiving responsibilities. The stress of repeated illness, sleepless nights and time away from work understandably fuels a desire for quick solutions. Parents may sometimes seek antibiotics for reassurance and clinicians too can feel pressured to prescribe them — even when the evidence for their use in the treatment of viral infections is not there.”
The Case for Prevention and Antibiotic Stewardship
The best outcome for patients, caregivers and health systems is simple: stop infections before they occur. Prevention, especially for patients experiencing recurrent ones, not only spares them the anxiety of illness and potential complications but also helps break the cycle of antibiotic resistance while alleviating financial pressure on the healthcare system. Economists estimate that every euro invested in prevention yields around €3 in economic benefits [7]. Yet too often, strategies remain reactive — diagnosing and treating infections after the fact — rather than pre-empting them.
Current infection prevention discussions typically focus on water, sanitation & hygiene and may also include routine vaccination campaigns. While these are vital foundations, they are not enough. A broader toolkit is essential, including prophylactic vaccines, passive immunisation, decolonisation approaches or immunotherapies priming the innate immune system and strengthening antimicrobial defences (such as bacterial lysates). Such preventative therapies can also assist in breaking the cycle of antibiotic resistance by reducing the number of infections and hence the use of antibiotics.
But prevention doesn’t stop there. Public health awareness initiatives in the community — public education campaigns that help people recognise infection warning signs, understand when antibiotics are not needed (e.g. in the case of viral infections) and seek prompt medical advice — can also improve proper use of antibiotics and reduce inappropriate demand. At the same time, awareness needs to be improved in the clinical setting. We need robust guidelines and continuous training for healthcare professionals to ensure responsible prescribing practices.
Prof. Aurélien Dinh, Infectious Disease Specialist at Hospital Ambroise-Paré, Paris, also stresses this point:
“We need better education of healthcare professionals on antimicrobial stewardship — reducing prescriptions of antimicrobials and reducing treatment duration. Given the impact prolonged treatment can have on antibiotic use, clinical guidelines should be as short as possible.”
Shifting the Narrative
To succeed, we must reframe infection prevention. Not as a static hygiene checklist, but as a dynamic, innovation-driven field that strengthens equity and system resilience. Every infection prevented is one less opportunity for antibiotic misuse or overuse and hence one less opportunity for resistance to flourish. In an era where our antibiotic arsenal is shrinking, prevention is not optional — it is essential.
Policymakers, health systems and advocates: let’s stop treating prevention as a side note. By embedding a comprehensive, forward-looking prevention strategy at the heart of AMR policy, we can protect individual patients, ease the burden on caregivers, narrow health inequalities and safeguard the efficacy of antibiotics for generations to come. Prevention isn’t just one pillar of AMR strategy – it is the foundation.
References:
[1] Llor and Bjerrum (2014). Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem – PMC
[2] Van Houten et al. (2019), Antibiotic Misuse in Respiratory Tract Infections in Children and Adults – A Prospective, Multicentre Study (Tailored Treatment)
[3] Suast et al. (2022), Diagnosis and Antibiotic Treatment of Urinary Tract Infections in Danish General Practise: A Quality Assessment
[4] Olson et al. (2009), Antibiotic Resistance in Urinary Isolates of Escherichia coli from College Women with Urinary Tract Infections
[5] Czajkowski et al. (2021), Urinary Tract Infections in Women
[6] European Centre for Disease Control / WHO Europe Region (2023), Antimicrobial Resistance Surveillance in Europe
[7] Masters et al. (2017), Return on investment of public health interventions: a systematic review
