Patients buying antibiotics over the counter without a prescription at a pharmacy; doctors prescribing antibiotics when they’re not needed or using the wrong type of antibiotic when they are. The improper use of antibiotics increases antibiotic resistance in bacteria. Providing patients and people with information on when and how to use antibiotics is important in leading to behaviour that will reduce their misuse.

Laboratories are a key tool in fight against antibiotic resistance. A laboratory can determine the exact type of bacteria causing an infection, as well as which antibiotics it is resistant to. However, setting up a lab is not easy in many places, especially those affected by violence or are seriously under-resourced. Staff must be highly trained and follow rigorous protocols. MSF has laboratories with these capabilities in Jordan, Yemen, Mali, and Central African Republic.

In some parts of the world, health staff – doctors, nurses, pharmacists – are part of the problem. Medical staff can provide people with the wrong type of antibiotic – which can be ineffective and lead to resistance developing – or providing antibiotics when they’re not needed at all. We have started to train our medical staff, including across the Middle East, in antibiotic stewardship – such as doctors knowing which drugs to prescribe and when. Staff also need to resist pressure from patients into being given or prescribed antibiotics when they’re not needed.

Even if rigorous rules on the use of antibiotics can help prevent bacteria from becoming resistant in the hospital itself, some patients will already be infected with resistant bacteria when they are admitted to hospital. And it is crucial that these resistant bacteria do not infect anybody else. Infection prevention and control (IPC) measures are vital in hospitals to prevent their spread. Pillars of IPC centre around hygiene: hand hygiene (washing and sanitising hands); cleaning, sanitising, sterilising the environment and medical devices; and controlling channels through which infections are spread – such as placing patients in isolation.