Factors Behind the Emergence of Antibiotic Resistance
Factors Behind the Emergence of
Antibiotic Resistance
https://content.govdelivery.com/accounts/USCDC/bulletins/136b8a2
Over-prescription and overuse of antibiotics
Medical culture can inadvertently promote and perpetuate unnecessary use of antibiotics or overuse of the most potent, broad-spectrum antibiotics1
Despite understanding the long-term risks of resistance, doctors are often focused on treating the potential infection in front of them, in their individual patient1
Long-term risks are not prioritized and the judicious use of antibiotics is not valued1
Doctors are also commonly worried about the risk of not acting to prevent or treat the infection, reporting an inability to accept the risk that avoiding prescribing the most potent broad spectrum antibiotic might present1
In many lower and middle income countries antibiotics can be purchased without a prescription2
The widespread unnecessary use of antibiotics (especially in lower and middle income countries) is largely due to the general population’s lack of knowledge of about how antibiotics work, and limited awareness of the consequences of antibiotic resistance in public health2
64% of 10 000 respondents over 5 developing countries believe antibiotics can be used to treat colds and flu, despite the fact that antibiotics have no impact on viruses3
Patients not taking antibiotics as prescribed
Suboptimum patient compliance on use can contribute to resistance: Stopping taking antibiotics when feeling better when not finished
prescribed course3
Taking leftover antibiotics from previous treatment courses3 Sharing unused drugs with other people3
Close to one third (32%) of people across 12 countries surveyed believed they should stop taking antibiotics when they felt better, rather than completing the prescribed course of treatment3
For some deep-seated infections, such as tuberculosis or osteomyelitis, symptoms can improve even though the bacteria might still be flourishing2
Many of these practices are common in both developed and developing countries3
Unnecessary use of antibiotics in agriculture
and livestock Much of the use of antibiotics in animals is not therapeutic4
Significant volumes of antibiotics are used prophylactically amongst healthy animals to: Stop the development of an infection within a flock or herd4 Promote growth, to speed up the pace at which animals gain weight4
Overuse presents the risk that drug-resistant strains are passed on through direct contact between humans and animals (notably farmers)4
These drug-resistant strains can then be passed on to humans more generally through the food chain, i.e. when consumers prepare or eat the meat itself4
There is also a further indirect threat to human health as result of animal excretion4
Huge amounts of antibiotics are used for agriculture in some countries—up to four-times the amount used in human medicine in some cases4
https://agricultureproud.files.wordpress.com/2013/11/1452174_695477840471943_52921068_n1.jpg
Poor infection control and hand hygiene in hospitals
and clinicsInsufficient infection control surveillance systems
within hospitals (especially in lower and middle income countries) can lead toSpread of nosocomial (hospital acquired) infections2 Outbreaks caused by resistant pathogens2
Exacerbated by inherent problems: overcrowding and insufficient equipment and trained personnel2
These resistant pathogens become a reservoir of resistant genes2 Can also be spread to the community through unsafe
water and poor sanitation2
Lack of Rapid Laboratory Tests
It may not always be obvious whether an illnesses is due to infection and whether it is bacterial (and might need treatment) or viral2
Tests may help, however may help, however often patients must wait some time for results2
Treatment is usually then given based on clinical judgement – often influenced by the patient’s anxiety and the doctor’s intolerance of risk2
Leads to overuse and overprescription
References1. Ingram P, Seet J, Budgeon C, Murray R. Point‐prevalence study of
inappropriate antibiotic use at a tertiary Australian hospital. Internal medicine journal. 2012;42(6):719-721.
2. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance—the need for global solutions. The Lancet infectious diseases. 2013;13(12):1057-1098.
3. Antibiotic resistance: Multi-country public awareness survey [Internet]. Geneva: The World Health Organization; 2015 [cited 2016 Apr 3]. Available from: http://apps.who.int/iris/bitstream/10665/194460/1/9789241509817_eng.pdf?ua=1
4. O’Neill. Antimicrobials in agriculture and the environment: reducing unnecessary use and waste the review on antimicrobial resistance [Internet]. UK Department of Health Commission [cited 2016 March 18]. Available from: http://amr-review.org/sites/default/files/Antimicrobials%20in%20agriculture%20and%20the%20environment%20-%20Reducing%20unnecessary%20use%20and%20waste.pdf