Use of Antibiotics
Overview of use of antibiotics
Since penicillin was introduced in the 1940s, more than 150 antibiotics have been developed for the treatment of infectious diseases. Although these drugs have saved millions of lives, their misuse has caused problems. Antibiotic resistance has emerged as a major public health problem in the last decade. The rapid increase in resistance among common bacterial pathogens, such as Streptococcus pneumoniae, is mainly due to the high rates of antibiotic use, most of which is unnecessary.1 - 4 Since bacterial diseases are communicable, the consequences of resistance affect communities and are not limited to individual carriers. Young children have had the highest antibiotic use rates of any age group.5
What Causes Antibiotic Resistance
Antibiotic resistant bacteria emerge when an antibiotic fails to kill all of the bacteria it targets, and the surviving bacteria become resistant to that particular drug and frequently other antibiotics also. Physicians then prescribe a more potent antibiotic, but the bacteria quickly become resistant to this also, perpetuating a cycle in which increasingly powerful drugs are required to treat infections.
Antibiotic-resistant strains of bacteria began to appear soon after penicillin was introduced. Today, antibiotic-resistant strains have become common, and bacteria resistant to a number of antibiotics have developed. Initially, which was confined only to hospitals, are now appearing in the wider community (e.g. methicillin-resistant Staphylococcus aureus (MRSA)). Vancomycin was a reliable treatment for MRSA infections, but in recent years, resistance has emerged even to this drug.
Irrational use of antibiotics is the major cause of the emergence of resistant strains. One should not consume antibiotics inadvertently, for e.g. in case of viral infections, where antibiotics do not help, but instead lead to the problem of resistance. The other important aspect is that when a course of antibiotic is prescribed, then one should take the complete course of medication and not stop once the symptoms go away. This also adds to the problem of resistance.
Consequences of Antibiotic Resistance
The potential consequences of the continued development of antibiotic-resistant bacteria could be severe. Diseases thought to have been eradicated have re-emerged. Tuberculosis, due to the resistance acquired by the bacterium Mycobacterium tuberculosis is more difficult to cure now than previously. Without new methods for attacking them, potentially fatal bacterial infections could pose a serious threat to the world’s population. Some of the most serious diseases that can be caused by bacterial infection are pneumonia, meningitis, tuberculosis, endocarditis, sepsis, cholera and botulism, while some of the frequent, nonlethal conditions for which antibiotics are prescribed are ear, urinary tract and streptococcal throat infections.6
Overcoming Antibiotic Resistance
Community-level interventions to reduce unnecessary prescribing of antibiotics are required which simultaneously target all sources of perceived demand for unnecessary antibiotic use, as well as change the physician prescribing behavior.7 There have been interventions in specific health care delivery systems or for particular conditions, like otitis media in children and bronchitis in adults.8,9
In USA, the Centers for Disease Control and Prevention (CDC) have implemented national efforts to address antibiotic overuse through education of providers,3 as well as campaigns to change the knowledge and attitudes of the public about the harms of antibiotic overuse.10 As a result, the overall national antibiotic use rates have decreased markedly since the early 1990s, but data are mixed on the ability of community-wide interventions to change antibiotic use rates effectively.11,12 Most have been limited in the number of communities studied, the ability to control for differences among them, or the duration of intervention.13,14
Antibiotic-resistant bacteria will continue to be a global health concern, and of all the preventive aspects discussed, using antibiotics wisely is the most important step of preventing their spread.
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2.Pletz MW, McGee L, Jorgensen JH, Beall B, Facklam RR, Whitney C, et al. Levofloxacin-resistant invasive Streptococcus pneumoniae in the United States: evidence for clonal spread and the impact of conjugate pneumococcal vaccine. Antimicrob Agents Chemother. 2004; 48: 3491–3497.
3.Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz B. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics. 1998; 101: 163–165.
4.Nyquist AC, Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing of children with colds, upper respiratory tract infections, and bronchitis. JAMA. 1998; 279: 875–877.
5.McCaig LF, Besser RE, Hughes JM. Antimicrobial drug prescription in ambulatory care settings, United States, 1992–2000. Emerg Infect Dis. 2003; 9: 432–437.
6.Available at: http://dsp-psd.pwgsc.gc.ca/Collection-R/LoPBdP/BP/prb9910-e.htm. Accessed on: April 23, 2008.
7.Barden LS, Dowell SF, Schwartz B, Lackey C. Current attitudes regarding use of antimicrobial agents: Results from physicians’ and parents’ focus groups. Clin Pediatr (Phila). 1998; 37: 665–671.
8.Finkelstein JA, Davis RL, Dowell SF, et al. Reducing antibiotic use in children: A randomized trial in 12 practices. Pediatrics. 2001; 108: 1–7, 17.
9.Gonzales R, Steiner JF, Lum A, et al. Decreasing antibiotic use in ambulatory practice: Impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA. 1999; 281: 1512–1519.
10.Centers for Disease Control and Prevention. Get smart: Know when antibiotics work. Available at: www.cdc.gov/drugresistance/ community. Accessed on: April 23, 2008.
11.McCaig LF, Besser RE, Hughes JM. Trends in antimicrobial prescribing rates for children and adolescents. JAMA. 2002; 287: 3096–3102.
12.Finkelstein JA, Stille C, Nordin J, et al. Reduction in antibiotic use among US children, 1996–2000. Pediatrics. 2003; 112: 620–627.
13.Belongia EA, Sullivan BJ, Chyou PH, et al. A community intervention trial to promote judicious antibiotic use and reduce penicillin-resistant Streptococcus pneumoniae carriage in children. Pediatrics. 2001; 108: 575–583.
14.Trepka MJ, Belongia EA, Chyou P-H, et al. The effect of a community intervention trial on parental knowledge and awareness of antibiotic resistance and appropriate antibiotic use in children. Pediatrics. 2001; 107(1). Available at: www.pediatrics.org/cgi/content/full/107/1/e6.
Written by: batul nafisa
Date last updated: March 12, 2015