Antimicrobial resistance (AMR) happens when bacteria, viruses, fungi and parasites stop responding to the medicines designed to kill them. A major study published in The Lancet estimated that bacterial AMR was directly responsible for over a million deaths in 2019 and associated with several million more, with the highest burden in sub-Saharan Africa and South Asia. Without action, common infections and routine surgery could become far more dangerous. Nurses, as the largest group of health professionals and the people who give most antibiotic doses, are essential to stewardship.
Why resistance spreads
- Overuse of antibiotics, including for viral infections like colds and most diarrhoea.
- Antibiotics sold without prescription, and incomplete or substandard courses.
- Poor infection prevention and control in health facilities.
- Lack of clean water and sanitation.
- Antibiotic use in animals and agriculture.
- Substandard and falsified medicines.
What nurses can do
1. Get cultures right
- Take samples before antibiotics where it doesn’t delay urgent treatment.
- Use correct technique to avoid contamination. See our blood culture guide.
- Don’t send urine dipsticks or cultures from asymptomatic older adults or routine catheter specimens without clinical indication; this leads to unnecessary antibiotics. See our UTI guide.
2. Give antibiotics on time
In sepsis, timely antibiotics save lives. Delayed and missed doses also contribute to treatment failure. Prioritise time-critical antibiotics.
3. Prompt reviews
- Many stewardship programmes promote a review at 48–72 hours: Is the antibiotic still needed? Can it be narrowed based on culture results? Can it switch from IV to oral? What’s the stop date?
- Nurses can prompt this conversation on ward rounds.
- IV-to-oral switch when the patient is improving and can absorb oral medicines reduces line infections and allows earlier discharge.
4. Allergy accuracy
Many patients labelled “penicillin allergic” aren’t truly allergic; they had a side effect such as nausea, or a childhood rash. An incorrect label leads to broader, less effective and more expensive antibiotics. Document the reaction details precisely.
5. Infection prevention
- Hand hygiene: the single most effective measure.
- Standard and transmission-based precautions for resistant organisms (MRSA, CPE/CRE, VRE).
- Line and catheter care to prevent device infections. See central line care and catheter care.
- Vaccination of patients and staff.
6. Patient and public education
- Antibiotics don’t work for viruses (colds, flu, most sore throats and coughs).
- Take antibiotics exactly as prescribed; don’t share or save leftovers.
- Don’t buy antibiotics without a prescription.
- Prevent infections with handwashing, vaccination, safe food and water.
WHO’s AWaRe classification
WHO groups antibiotics into Access (first-line, lower resistance potential, such as amoxicillin), Watch (higher resistance potential, such as ceftriaxone and ciprofloxacin, to be used more carefully) and Reserve (last-resort antibiotics). WHO has set a goal for most antibiotic use to come from the Access group. Knowing these groups helps nurses understand prescribing decisions and question unnecessary broad-spectrum use.
Nurse prescribers
In many countries, nurses prescribe or dispense antibiotics, especially in primary care. Use national guidelines, avoid prescribing under pressure from patients, and use delayed prescriptions or safety-netting where appropriate.
Based on WHO AMR fact sheets, the WHO AWaRe antibiotic book, the GRAM study (The Lancet, 2022) and NICE NG15 (Antimicrobial stewardship). Educational content.