​​​​​​​Words matter: Public health experts call for clear language and less rhetoric about superbugs

petri dish with orange agar and white bacteria colonies
Clear talk about superbugs is key to stopping their spread, according to a group of public health experts.

The global response to the growing threat of drug-resistant bacteria requires a wide array of stakeholders to participate, but the words used to talk about the crisis may undermine that cause.

The superbug problem is complex, and requires governments, regulators, the public and people in a number of industries to come together, according to an article written by a group of public health experts from around the world, led by Marc Mendelson, professor of infectious disease at the University of Cape Town in South Africa.

However, a lack of clear terminology and frequent use of inflammatory rhetoric weakens these key partnerships.

“People from these disparate domains are talking past each other,” the group wrote. "Many of the terms routinely used to describe the problem are misunderstood, interpreted differently or loaded with unhelpful connotations.”

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For instance, "antibiotic resistance," "drug resistance" and "antimicrobial resistance" are often used interchangeably. By not choosing one as the de facto term, the message can be confused or misunderstood.

A 2015 World Health Organization survey (PDF) of 10,000 people found that fewer than half understood the term “antimicrobial resistant,” while two-thirds were familiar with either “antibiotic resistance” or “drug resistance.”

The authors recommend using “drug resistant infections” universally, as it clears up confusion about good or bad antimicrobials and clarifies that it’s the bugs—not people—that are becoming resistant.

In addition, antibiotic stewardship is often used to describe a too-narrow set of actions, specifically those of infection control experts or pharmacists. But the practice is broader than that, and should be described as such.

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The authors also call for a detente in the “war” against superbugs—that is, an end to evoking battle imagery when describing efforts to reduce the spread of drug-resistant bacteria. A war narrative can make it seem like all bacteria are the enemy, when many microbes are necessary to human health. An unbalanced gut, for example, can actually make it harder for patients to fend off potentially deadly infections like Clostridium difficile.

“War and threat were once potent rallying calls,” the authors wrote. “But a more nuanced, balanced, standardized vocabulary is now needed—one that takes ecological balance into account.”