Author: Barry C. Fox, Ph.D. Med., University of Wisconsin
Antibiotics have been around since the 1940s and are common today. Then why the sudden rise in interest? Well, unfortunately, antibiotic-resistant germs are becoming much more common and, to further complicate matters, the development of new antibiotics has stalled in the last two decades.
What contributes to the acceleration of antibiotic resistance?
The World Health Organization has declared concerns about antibiotic resistance in recent years. The ability to develop antibiotics decreased over time. These include the inability to detect new molecular targets in bacteria and the failure to find targeted drugs that exhibit antimicrobial properties.
Another troubling problem is that they discourage the pharmaceutical industry from developing drugs that are only taken for a limited period of time, and that have limited monetary incentives compared to drugs for chronic diseases such as hypertension or diabetes. Since 1983, there has been a staggering decline in the number of antibiotics detected.
Take the example of prescription antibiotics for respiratory tract infections that include sinusitis, ear infections, sore throats, and colds in the chest. Respiratory diseases make up the vast majority of outpatient antibiotic use. Primary care providers in these conditions prescribe antibiotics about 50 percent of the time.
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Why do doctors prescribe a drug when it is not really needed?
It is known that antibiotics do not work on viral diseases, and there are more and more drugs based on evidence that the condition of the ear and sinuses improves within 10 days with or without antibiotics. Also, only five percent of adult sore throats are caused by streptococcus, which requires antibiotics. Antibiotics are really only needed for prescribing in respiratory conditions somewhere between five to 10 percent of the time.
So why is there such a difference between prescribing habits and actual need? Well, there are factors in motion that can easily lead to an over-the-counter antibiotic.
From the patient’s point of view, they could have been treated with antibiotics in the past for the same condition and had the impression, rightly or wrongly, that they had improved because of the antibiotics.
From a healthcare professional’s perspective, it takes time to explain to the patient why they may not need an antibiotic. They also want to meet their patient’s expectations, out of concern that the same patient might go down the street to another antibiotic prescriber.
The situation is only exacerbated by the severity of the disease, which means that visits to emergency centers and emergency departments are likely to have even more implicit pressure to issue an antibiotic prescription.
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People, doctors have to be smart
The CDC has been aware of this paradox of patients and service providers for at least the last decade and has launched a campaign known as Get Smart to educate patients and families about the need, risk, benefits and side effects associated with antibiotic prescriptions. It also provides educational tools for health care providers to help patients understand why antibiotics may not be appropriate.
The use of antibiotics kills not only the predicted bacteria but also the collateral damage to the good bacteria. This he did Clostridium Difficile the largest emergency health care for the United States (caused by the overgrowth of these bad bacteria in the colon). In macro terms, people have a particular interest in ensuring that antibiotics are prescribed only when necessary.
In a hospital setting, the percentage of antibiotics prescribed that are either unnecessary or misused is incredibly no different from those in an outpatient setting, 50 percent. Patients in the hospital, however, have little or no choice in the process of deciding whether to receive antibiotics or not.
Antimicrobial management: a team of professionals in each hospital
Who will protect patients? Well, the concept has evolved over the past decade known as antimicrobial management. His intention is to use antibiotics wisely and safely. The antibiotic surveillance team consists of professionals who review the habits of prescribing antibiotics in the hospital for each individual patient, as well as the overall trends in prescriptions.
Another dimension of antibiotic resistance is the widespread use of antibiotics in food-producing animals, which makes up an incredible 80 percent of total antibiotic use. More than 75 percent of this use is used only for fattening animals.
This use, especially with subtherapeutic concentrations of antibiotics, contributes to the emergence of antibiotic-resistant bacteria in food-producing animals that can be transmitted to humans.
Fortunately, there are legal efforts in the United States that bring together pharmaceutical manufacturers, the American Dairy Association, and the health service to agree to limit the use of antibiotics in food-producing animals for medical purposes only.
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Slowing down the rate of resistance development in bacteria
In 2014, President Obama issued both the Executive Order and the U.S. National Strategy for the Fight Against Antibiotic Resistant Bacteria, which included the establishment of a working group to fight resistant bacteria.
To stimulate the development of new antibiotics, the Food and Drug Administration (FDA) is also trying to motivate pharmaceutical companies to devote time and money to research and development of new antibiotics, including passing the Antibiotic Incentive Generation Act now.
The FDA may also designate a potentially new antibiotic as an accelerated antibiotic and grant it priority. This requires that all federal health programs have antimicrobial management, strengthening national surveillance and international cooperation efforts against resistant bacteria, and promoting the development of next-generation antibiotics.
Common questions about what can be done to stop antibiotic resistance
The primary reason is that patients do not wait for explanations and they could just as easily get the medication they want from another doctor who is willing to prescribe them. So doctors must try to meet the patient’s expectations, even though they know how drug resistance will grow.
Antibiotics should only be used when necessary. So, one way to improve its use is not to try to force our doctor to prescribe the medications we want, even when the doctor deems them unnecessary. Had most of us done so, it would have slowed the growth rate in drug resistant microbes.
The antibiotic surveillance team usually consists of pharmacists, infectious disease physicians, and microbiologists. The job of this team is to ensure that unnecessary antibiotics are not prescribed, so that this does not happen drug resistant bacteria.