September 3, 2025
PETALING JAYA – Ensure cleaner air for the nation or risk seeing more people develop antibiotic resistance, resulting in possible higher health costs in the future, say medical experts.
This warning comes following the recent findings of a research linking antibiotic resistance (AMR) to air pollution that was published in the journal Lancet Planetary Health.
Universiti Kebangsaan Malaysia (UKM) public health expert Prof Dr Sharifa Ezat Wan Puteh said that the AMR study involving 116 countries revealed that for every one per cent increase in particulate matter (PM) in the air, there is a corresponding increase in AMR, said to be between 0.5% and 1.9%.
“There are two postulations on how this phenomenon occurs. One is that air pollution leads to gene changes in organisms that then increases resistance, making them more virulent.
“The other is that PM2.5 acts as a ‘transport vehicle’ for organisms (meaning) they can travel long distance, even ending up in our respiratory system,” said Prof Dr Sharifa yesterday.
(PM2.5 refers to extremely small airborne particles, in this case 2.5 micrometres or less in diameter, that can penetrate deep into the lungs.)
In the report, researchers created a model to check the levels of PM2.5 pollution. Their findings detected a correlation between high levels of PM2.5 air pollution and high levels of AMR that increase over time.
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Levels of AMR is also said to rise in particle pollution levels.
Prof Dr Sharifa said that air pollution in the country is a concern as the air quality index fluctuates depending on the presence of transboundary haze, vehicle particulate emissions and industrial pollution.
“Besides antibiotic resistance, poor air quality also poses direct health risks such as respiratory and chromosomal problems, or genetic changes and cancer risks.”
She added that findings showed it takes between 21.7 and 36.4 days to treat those with AMR, depending on whether or not patients have other underlying issues.
“The median admission costs for AMR patients range from RM12,476.28 to RM19,295.11.
“Both length of stay and total cost of admissions have increased annually, from RM3.7mil in 2017 to RM9.7mil in 2019 for patients with health issues linked to AMR.”
Prof Dr Sharifa added that elderly patients and those with severity levels II and III were more likely to incur higher medical costs exceeding the national base rate.
Level II signifies that an individual is in no actual harm, though there is a potential of it being more than minimal harm (but not in immediate jeopardy).
Level III indicates actual harm that is not in immediate jeopardy.
Public health expert Datuk Dr Zainal Ariffin Omar said that the nation is not immune from the risk of a global rise in AMR due to poor air quality.
“We share the risk. The bacteria may be present in our environment,” the former Malaysian Public Health Physicians’ Association president said.
Dr Zainal added that the situation is compounded by periods of significant air pollution, particularly from seasonal haze such as forest fires and urban emissions.
“This elevated PM2.5 level, combined with existing issues of antibiotic overuse, puts the country at risk,” he said.
Former health deputy director-general Datuk Dr Christopher Lee said that particulate matter in polluted air can act as a carrier for bacteria, which could also include antibiotic resistance genes.
“These very tiny particles can travel long distances, carrying resistant microbes from sources like hospitals, sewage treatment plants and farms, to other areas and the population.”
He also said that another reason for the rise in AMR is due to prevalence of respiratory infections in highly-polluted areas, leading to more antibiotics used in that population.
Although air-pollutant may be a factor, he said that the main driver of AMR is excessive and often unnecessary use of antimicrobial medication.