Article by Associate Professor Dr Petrick Periyasamy
Clinical Physician And Consultant In Infectious Diseases
Head Of Infectious Diseases
University Kebangsaan Malaysia Medical Centre
Imagine a future where a simple cut could lead to dire consequences, minor infections become untreatable, and routine medical procedures carry life-threatening risks. This isn’t just the storyline of a dystopian film; it’s the alarming reality we are facing due to antimicrobial resistance (AMR). The overuse and misuse of antibiotics are fuelling the rise of superbugs that are outsmarting modern medicine. In Malaysia, the situation is increasingly critical. Even common ailments, such as a sore throat, are contributing to this growing crisis, and the potential fallout could be catastrophic.
The World Health Organization (WHO) has raised the red flag: AMR is among the top 10 global health threats, and it is advancing more rapidly than we can keep up with. A shocking study published in The Lancet revealed that in 2019 alone, 1.27 million people worldwide died from drug-resistant infections—a figure surpassing deaths from HIV/AIDS and malaria combined. If we persist on this path, AMR could claim 10 million lives each year by 2050, outpacing cancer as the leading cause of death. Economically, the toll could be staggering, with a potential global GDP loss of $100 trillion.
This isn’t just a problem in far-off countries; it’s happening right here in Malaysia, and the situation is deteriorating. A single-centre study conducted at the primary care clinic of University Hospital Kuala Lumpur found that viral pharyngitis accounts for 64% of pharyngitis cases, confirming that most cases are viral and do not require antibiotics.
However, recent studies raise concerns about antibiotic overprescription. A cross-sectional study conducted in private primary care clinics in Malaysia found that only 42.9% of antibiotic prescriptions for acute pharyngitis were appropriate, while over 58.5% of prescriptions were deemed excessive. Another study examining URTI patients in an Emergency Department on the east coast of Malaysia in 2018–2019 revealed that 29% of cases received inappropriate antibiotic prescriptions.
In response to these alarming trends, a Consensus on the Treatment of Acute Sore Throat in Malaysia was published in 2024 to guide clinicians on best practices, ensuring that antibiotic prescriptions are evidence-based and aligned with international recommendations.
Unfortunately, Malaysia is still unknowingly contributing to the AMR crisis for several reasons:
Overprescribing by Doctors – Malaysian doctors often prescribe antibiotics for conditions that don't warrant them, like viral infections, including colds and sore throats. A concerning study found that 68% of Malaysians received antibiotics unnecessarily, which only accelerates bacterial resistance.
Antibiotic Misconception – Many Malaysians have misconceptions about antibiotics. In a recent survey of 1031 Malaysians, 71% believe that antibiotics are effective against colds and that they kill viruses, and 66% believe antibiotics relieve pain. This practice helps bacteria become stronger and more lethal.
Superbugs in Hospitals – Dangerous drug-resistant bacteria like Methicillin-resistant Staphylococcus aureus (MRSA) and Carbapenem-resistant Enterobacteriaceae (CRE) are spreading through Malaysian hospitals, making previously manageable infections nearly impossible to treat. Even simple surgeries or childbirths could turn fatal.
Antimicrobial resistance (AMR) is also placing a significant burden on Malaysia’s healthcare system. The cost of treating drug-resistant infections can be up to three times higher than treating non-resistant cases, leading to increased financial strain on hospitals and patients alike. Prolonged hospital stays, the need for more potent and expensive medications, and the financial hardship of affording life-saving treatments make AMR not just a medical challenge but a pressing economic and healthcare crisis.
A World Bank study warns that by 2050, AMR could shrink the global economy by 3.8%, pushing 28 million people into poverty. Malaysia’s healthcare system, already under strain, risks collapsing under the weight of increasing medical costs and treatment failures.
To address the escalating threat of antimicrobial resistance (AMR), Malaysia has launched the Malaysian Second Action Plan on Antimicrobial Resistance (MyAP-AMR) 2022–2026, building upon the initial 2017 plan and aligning with the World Health Organization's Global Action Plan. This comprehensive strategy emphasises a One Health approach, integrating efforts across human health, animal health, and environmental sectors. Key initiatives include:
- Enhanced Governance: Strengthening the National Antimicrobial Resistance Committee (NARC) to ensure effective coordination and implementation of AMR-related activities.
- Surveillance and Research: Expanding surveillance systems to monitor AMR trends in both healthcare and agricultural settings and promoting research to inform evidence-based policies.
- Infection Prevention and Control (IPC): Implementing stringent IPC measures in healthcare facilities and promoting best practices in animal husbandry to reduce the spread of resistant pathogens.
- Optimised Use of Antimicrobials: Enforcing regulations to control the sale and use of antibiotics in humans and animals and promoting antimicrobial stewardship programs to ensure responsible usage.
- Public Education and Awareness: Conducting nationwide campaigns to raise awareness about AMR among the public, healthcare professionals, and farmers, emphasizing the importance of prudent antimicrobial use.
Authorities stress that healthcare practitioners and citizens have a role in combating AMR. Malaysians can take several crucial steps to prevent this crisis from worsening. First, avoiding self-medication is key—never take antibiotics without a doctor's prescription. Additionally, patients should also trust healthcare professionals when they advise that antibiotics are unnecessary, as improper use only accelerates resistance. Finally, raising awareness within communities can help curb misinformation about antibiotics and their misuse. Educating family and friends on the dangers of AMR will encourage responsible antibiotic consumption and promote long-term public health benefits.
If Malaysia fails to act now, the repercussions could be devastating. The worst-case scenario is the arrival of a post-antibiotic era, where common illnesses once deemed minor become fatal. If bacteria continue developing resistance at the current rate, life as we know it could be drastically altered, with modern medicine unable to protect against what were once routine infections.
The time to act is NOW. The Malaysian government, healthcare professionals, and the public must work together to combat this escalating threat. The moment for complacency has passed—the battle for our health begins today.
