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The big question: "How could antibiotics be used more responsibly?"

This month we ask “How could antibiotics be used more responsibly?”

Jonathan Lewis
Laboratory Manager- Department of Microbiology 

Gloucestershire Hospitals NHS Foundation Trust

Unfortunately, there is no easy answer to this question. Each country can do its bit, but antibiotic resistance is a truly global problem.

It is not uncommon for resistance to develop in areas of the world where there are overcrowded populations and overuse of antibiotics. These conditions are perfect for bacteria to be exposed to the pressures needed for resistance to develop. Resistant bacteria are then carried to other countries as people travel.

As individuals, we can play our part in preventing resistance from getting worse, and protecting some of our current antibiotics. Two of the most important factors are only using antibiotics where necessary and making sure to complete a prescribed course, if given. The number of new antibiotics being developed by the drug companies is low, due to the costs involved and the risk of a limited return on investment. This means we have 
to protect the ones we are using now. Antibiotics are also used widely for veterinary and agricultural purposes and there is evidence of cross-over resistance developing. Countries with tighter controls on antibiotic use in animals tend to have a lower rate of resistance in human bacteria.

It’s too easy to take antibiotics for granted. We have all been fortunate to live in a time when antibiotics are freely available and still effective against infections. However, the balance is starting to shift in the wrong direction.

 

Phillipa Burns
Trainee Consultant Clinical Scientist HSST
Hull University Teaching Hospitals

Antibiotics are arguably one of the greatest health inventions of the last century – a successful adjunct to vaccines in the prevention of infectious disease.

Their potency has dwindled due to the evolution of antimicrobial-resistant organisms, inextricably linked to increased antimicrobial prescribing. The decision to prescribe is often made before microbiology results are available; our current diagnostics are too slow to impact prescribing practice.

Some centres, like ours, have adopted molecular syndromic testing panels to improve accuracy of diagnosis, but they are costly. We need rapid, simple diagnostics to enable the right drug to be prescribed for the shortest time possible.

Antimicrobial stewardship is crucial for the health of the individual patient and for the wider health of the population; it preserves what we have now for the future. We enforce this message through ward rounds, encouraging a switch from broad-spectrum to narrow and shortening courses, we know this tactic can spare the gut microbiota and remove a selection pressures that drive resistance. Unfortunately, our work is focused on hospital patients and we have no real influence on community prescribing – we need to do more.

As scientists we can make a difference by supporting the adoption of rapid diagnostics, pledging to be antibiotic guardians and engaging with the British Society of Antimicrobial Chemotherapy, which offers free membership!

 

Michael Palmer
Laboratory Manager- National Mycology Reference Laboratory
Public Health England/North Bristol NHS Trust

It is widely understood that the over-prescribing and inappropriate use of antibiotics has led to the emergence of resistant organisms and, in some instances, multi-resistant strains.

There is plenty of evidence to suggest that antimicrobial resistance increases with the length of exposure an organism has to a particular agent. Despite this, the general advice is to finish a course of treatment, an area which deserves more research. Evidence from the World Health Organization suggests that for some infections shorter antibiotic courses may be effective while reducing an organism’s exposure and thereby the development of resistance. In the meantime, however, a more targeted approach to antimicrobial prescribing is required, enlisting the help of the microbiology laboratory to provide specific antibiotic profiles that can support robust antimicrobial stewardship programmes to inform decision-making.

Reducing the number of infections is possible by using vigorous cross-infection protocols and vaccination in both human and animal settings – hence reducing the need for antimicrobial treatment. Other stakeholders can play their part and the patient should take their medication as prescribed and not share unfinished antibiotics with family or friends.

Doctors and vets should only prescribe antimicrobials if they are necessary and, where possible, based on laboratory results, while agricultural use should be restricted, and governments must be involved in international plans.

Image credit | Alamy

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