Antibiotic resistance has a language problem

Failure to use simple, clear and consistent language can undermine global responses to the urgent threat of bacteria that are resistant to available antibiotics. Experts are now calling on a newly formed United Nations taskforce to prioritise action in ensuring global terminology is reviewed.

In a joint comment published today in Nature (3 May 2017) experts from South Africa, Switzerland, France and the UK say this is essential to addressing misunderstandings and improving awareness among the public and policymakers.

Lead author Marc Mendelson, professor of infectious diseases and Head of Infectious Diseases and HIV Medicine at Groote Schuur Hospital and the University of Cape Town, said, “The terms we currently use in communicating risk to the public, are failing to get through. With increasing involvement of non-clinical specialists and the public in a multi-disciplinary response to the global health crisis of bacterial resistance to antibiotics, we need standardised, balanced and clearly understood terminology, to unite the disparate role players towards action.

“Such terminology must be understood across language, geographic, disciplinary and social settings and will require a programme of research to optimise its use.”

Three key areas

The group calls for a focus on three key language areas:

First, 'drug-resistant infections' rather than 'antimicrobial resistance' should be the overarching English term for infections caused by bugs resistant to treatment, including antibiotics.

Second is principle and practice of 'stewardship'. Stewardship must be expanded outside of its traditional bounds of institutions and be clearly identified as the strategy ensuring appropriate use of antibiotics by every individual prescriber in human and animal health, whether in institutions or communities, practices or farms.

Third is the word 'war'. The authors say that rhetoric pitching humans in a fight against bacteria requires more nuanced and balanced use, considering humans' ecological relationship with bacteria. They add that existing rhetoric doesn't recognise the fact that more we 'attack' the more we interrupt the vital role bacteria play in human immunity, digestion and gut health.

Survey results

A 2015 survey by the World Health Organisation across 12 countries highlighted the lack of familiarity with the language of antibiotic resistance.

A study by Wellcome Trust in the same year also found people in the UK have little awareness of what 'antibiotic resistance' means and how it might affect their health.

Co-author Tim Jinks, Head of Drug Resistant Infections at Wellcome Trust said: “Drug-resistant infections already cause 700 000 deaths a year. It is vital that the problem is communicated in a way that everyone can understand how serious the threat to health is.”

He said that the confusion created by the different terms in use is hindering people from understanding that this is a health problem of today. It also hampers their understanding of what governments, health leaders and individuals need to do to address it.

Céline Pulcini, professor of infectious diseases in Nancy, France and secretary of European Society of Clinical Microbiology and Infectious Diseases Study Group for Antibiotic Policies, added, "As an example of language and geographic differences, people talk about 'antibiotic resistance' in France, not about 'antimicrobial resistance'. 'Stewardship' does not translate in French and needs an agreed definition to enable a common understanding that works across languages."