Antimicrobial products – do they contribute to antimicrobial resistance? 

The overuse and misuse of antibiotics, both in human and animal treatment, is widely acknowledged as the major cause of AMR.¹

Antibiotic-resistant genes have also been identified in isolated populations of environmental bacteria that have existed for millions of years—so resistance can also naturally occur.

The World Health Organization (WHO) has declared AMR to be one of the top 10 global public health threats facing humanity.

Many countries and cross-jurisdictional organisations have or are developing strategies to combat AMR. Antimicrobial household or hand hygiene products are not the focus of these strategies. In fact, hygiene is commonly mentioned for its importance in preventing the spread of infection.

For example, the Australian Government set up an AMR website as part of Australia’s response. This provides guidance for the public, emphasising good hygiene and the appropriate use of antibiotic medicines. There is no comment on antibacterials for home use. Similarly, Australia’s ‘National Antimicrobial Resistance Strategy – 2020 and Beyond’, launched in March 2021, does not mention concerns regarding antimicrobial household or hand hygiene products. 

One important thing you can do to help fight AMR is to practice good hygiene. This includes appropriate hand washing and surface cleaning/disinfecting in your home. Good hygiene helps prevent infection, which means less need for antibiotic prescribing. And good hygiene also helps stop the spread of infections that are caused by antibiotic-resistant bacteria.

You may have heard of ‘targeted hygiene’. This means using appropriate hygiene at key moments when harmful microbes are most likely to pose an exposure/infection risk. These key moments include when handling/eating food and after coughing or sneezing, using the toilet/bathroom, handling dirty clothing, caring for infected family members and touching surfaces that are frequently touched by others. Antimicrobial products may be called for in some of these situations, whereas physical removal with soap and water will be sufficient for others.

‘Targeted hygiene’: using appropriate hygiene at key moments when harmful microbes are most likely to pose an exposure/infection risk

Antibacterial hygiene products have been in use for well over 50 years.

Over this time, studies have investigated whether there is a link between the use of antibacterial products—in both households and clinical settings—and AMR. Several reviews of the accumulated evidence have not found a definitive link between the use of antibacterial products and AMR.

A 2024 study² that received some minor media attention simply surveyed biocidal ingredients in major categories of cleaning and personal care products available via retail in Australia—it provided no new experimental data providing evidence for a link between the use of these products and AMR.

The International Scientific Forum on Home Hygiene (IFH) published an information paper on the use of disinfectants and antibacterials in the home in 2015.³ This paper concluded that ‘although some laboratory studies have demonstrated links between microbiocides and antibiotic resistance there is no equivocal evidence that microbiocide usage contributes to the development of antibiotic resistance either in clinical practice or in the general environment’, and that this is despite ‘decades of continuous use of microbiocides in clinical and other situations’. The IFH notes that other reviews^4,5,6 have reached the same conclusion but also highlights the importance of continuing to research and monitor the situation.

In the USA, the use of some antibacterial ingredients such as triclosan has been banned in consumer antibacterial hand wash products since late 2017. The ingredients are still permitted in products used in clinical settings and in consumer hand wipes.

This ban was based on a lack of information rather than any new evidence of safety concerns. The US Food & Drug Administration (FDA) stated that ‘manufacturers did not demonstrate that the ingredients are both safe for long-term daily use and more effective than plain soap and water in preventing illness and the spread of certain infections’.⁷ 

Australia’s chemical ingredient regulator, AICIS (formerly NICNAS), reviews the safety of chemical ingredients used in many household and personal care products on an as-needed basis. A 2009 review of triclosan concluded ‘there is no evidence that the use of triclosan is leading to an increase in triclosan-resistant bacterial populations or that there is any increased risk to humans regarding antibiotic resistance'.⁸ 

In another example, a 2011 study showed ‘no increased antibiotic resistance in participant groups regularly using wash products containing triclocarban or triclosan…This adds to and confirms previous yet limited community data showing a lack of evidence that the use of antibacterial wash products facilitates antibiotic resistance and antibiotic/antibacterial cross-resistance.’⁹

Australian regulators continue to review emerging evidence and decisions made by overseas regulators.