In 2008, a few colleagues and I wrote a position paper on antibiotic use and antimicrobial resistance in Singapore, making a number of recommendations which we felt would be important to improve antibiotic use and mitigate the threat of antimicrobial resistance here. Those were not particularly controversial recommendations, and reflected the thinking of the international medical community at that time.

I remember thinking it was ironic that when the article was published, it was placed next to a full-age advertisement on a new antibiotic (I believe it was tigecycline) in the print version of the Singapore Medical Journal.

In 2018, some of us decided to write a follow-up paper describing what had come of those recommendations, and more generally on the situation of antimicrobial resistance and its control in Singapore. The Singapore Medical Journal was kind enough to publish the paper, although – for a variety of good reasons including that of the risk of author bias – narrative reviews are not in vogue academically today.

Looking back, it is amazing how far we have come and how much more we understand about antimicrobial resistance today. At the time, we paid no attention to the issue of antimicrobial resistance in animals and food, concentrating largely on hospitals and human health. Singapore’s National Strategic Action Plan on Antimicrobial Resistance launched in 2017 included strategies for tackling the issue in a far more holistic manner, and involved agencies other than the Ministry of Health.

Still, it is quite clear that we are just embarking on efforts to contain antimicrobial resistance and reduce inappropriate antibiotic use in Singapore, and it will be interesting to review what will happen over the next 10 years. The list of recommendations in 2008 and what we felt were the outcomes over 10 years are shown below.