Antimicrobials are ubiquitous in the modern home and have long been considered helpful in the fight against germs and viruses. They are a class of chemicals designed to inhibit the growth of undesirable microorganisms, such as bacteria, fungi and viruses, and are commonly found in products ranging from soaps and toothpaste to cutting boards, as well as in paints and carpet treatments.

However, the widespread presence of antimicrobials has led to their detection in most Americans, raising significant health concerns due to associations with endocrine, thyroid and reproductive issues. Moreover, their overuse can contribute to the development of resistant bacterial strains. The World Health Organisation considers Antimicrobial Resistance (AMR) as a major global public health and development threat.

Routes of Exposure

Exposure to antimicrobials can occur via various routes depending on the agent's type and intended use. This can include direct skin contact with creams, ingesting medications, breathing them in during use, and through injections for medical treatments. In the household, using disinfectants, such as chlorine-based cleaners or sprays, can lead to inhalation or skin contact.

Antimicrobial residues from agricultural and industrial activities can contaminate soil and water. These residues can then enter the food supply chain through animal husbandry, crop protection and food processing, posing a risk of ingestion by people through the food and water they consume.

Health Concerns

The widespread use of antimicrobials has raised health concerns. Key issues include:

• Antimicrobial resistance (AMR): The development of resistance in microorganisms, leading to reduced effectiveness of antimicrobial treatments.
• Microbiome disruption: Imbalances in the body's collection of microbes, both on the skin and within internal systems like the gut, can negatively impact the immune system and lead to health issues.
• Allergic reactions: Varying from mild skin irritations to severe responses to antimicrobial agents.
• Toxicity: Extended exposure to high antimicrobial doses can harm vital organs.
• Endocrine disruption: Certain antimicrobials, such as triclosan, may interfere with hormonal functions.
• Overuse and misuse: Excessive or incorrect use can heighten resistance and cause additional health complications.

Environmental Concerns

The environmental implications of antimicrobials are significant and complex, as detailed in a report by the US Centers for Disease Control and Prevention (CDC) and the UK Science and Innovation Network. Their widespread use contributes to antimicrobial resistance, posing a threat to ecosystems and public health. In soil, these substances can interfere with crucial ecological processes. Upon entering water systems through household wastewater, they can build up within aquatic life, disrupting delicate habitats. The tenacity of these substances, resisting breakdown over time, intensifies their environmental effects.

Reducing the Impact

A comprehensive 'One Health' approach is essential to lessen the antimicrobial footprint, incorporating responsible use in healthcare, advancements in wastewater treatment, and the pursuit of eco-friendly alternatives, reflecting the interconnectedness of human, animal and ecological health.

For healthier and environmentally friendly alternatives specifically for the home, consider the following:

• Antimicrobial-free paints: Select paints that are low in Volatile Organic Compounds (VOCs) and free from added antimicrobials (avoiding 'antibacterial' on the label), to reduce exposure to harmful chemicals.
• Natural carpets or area rugs: Consider using carpets or area rugs made from natural fibers without antimicrobial treatments. Options include wool, sisal or jute, which are less likely to contribute to indoor air pollution and are better for the environment.
• Eco-friendly cleaning solutions: For a healthier home, use biodegradable cleaners like baking soda, vinegar and lemon juice for various cleaning tasks. Create homemade disinfectants with antimicrobial essential oils such as tea tree, lavender and eucalyptus, and opt for plant-based air fresheners that use natural extracts instead of synthetic antimicrobials.

Regulatory Initiatives

In the US, the regulation of antimicrobials is managed by a robust framework involving the FDA, EPA and USDA, evolving to meet challenges like antimicrobial resistance. The Federal Food, Drug and Cosmetic Act (FD&C Act) empowers the FDA to regulate the approval, safety, efficacy and labeling of antimicrobial drugs. The National Antimicrobial Resistance Monitoring System (NARMS) tracks resistance patterns across humans, animals and food. The EPA, under the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA), ensures the safe use of antimicrobial products such as disinfectants. Staying abreast of these regulations is vital for those involved in any aspect of antimicrobial usage in the country.

Photography: Optimarc/Adobe