Antibiotic Resistance: Are We Winning the Battle, But Losing the War?

Laziness, disillusionment, anger— these are just a few words that come to mind when considering the problem of antibiotic resistance.   From the deliberate misuse of antibiotics in animal feeds, to wide-spread, inappropriate prescriptions for viral infections, the sheer scale of the problem lends itself to feelings of powerlessness and frustration.  For many of us, it’s simply easier to ignore the warning signs and shrug off the future consequences of doing nothing.  Unfortunately, the reality is that people are dying every day—in hospitals, nursing homes and long-term care facilities—from bacteria that were once treated with antibiotic therapy. What were once miracle drugs just a few decades ago—able to eradicate any bacterial infection in the blink of an eye— are now no longer working for a number of infections.  With a lack of good treatment options against resistant strains such as MRSA, enterococci, and c. difficile, frontline health professionals are becoming increasingly alarmed and frightened for future patients.

The last decade has been crucial in the battle against bacterial resistance.  Through ongoing education campaigns—for both doctors and patients— the American CDC (Centres for Disease Control and Prevention) and other groups have made small, but important, progress in curtailing the unnecessary use of antibiotics.  The good news is antibiotic prescriptions have decreased over the past decade or so.  This November, a joint assembly of the CDC and 25 other organizations released new data on the progress made between 1990 and 2010, noting a 17% decline in prescriptions.  The bad news is that as of 2010, antibiotic prescription rates are still very high in America, with 801 prescriptions per 1,000 people.

Areas with the highest prescription rates were West Virginia, Kentucky, Tennessee, Louisiana, and Mississippi.  The lowest rates were seen in California, Oregon, Washington, Alaska, and Hawaii.  Interestingly, most of the best behaved states— California, Washington, Hawaii and Oregon— have passed legislature to report infection rates, which could account for some of their success.  On the other hand, Tennessee and West Virginia—two of the worst behaved—also employ similar programs.

Also noted in the data was the increased use of broad-spectrum antibiotics among practitioners — that is, antibiotics that cover more species of bacteria at the same time.  The more species, or classes, of bacteria affected by an antibiotic, the more likely resistance or tolerance will be encountered down the road.  Broad-spectrum antibiotics also increase the risk of secondary super infections, such as c. difficile among patients, as they wipe out more of the body’s protective bacterial flora.

Similarly concerning was the decreasing effectiveness of antibiotics to treat urinary tract infections, or UTIs.  Ineffectively treated UTIs have the ability to spread to the kidneys, causing life-threatening infection or permanent kidney damage.

Because resistance is evolving much more rapidly than new drugs are being created, the only way to ensure that antibiotics are useful in the future is to a) Use them more appropriately in the present and b) Devote more resources to newer, replacement drugs.  Currently, neither of these requirements are being met.  If something isn’t done quickly, humanity may lose one of its most important scientific achievements—the ability to fight serious, life-threatening bacterial infections.

http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/35933

http://www.cdc.gov/hai/stateplans/required-to-report-hai-NHSN.html

http://www.umm.edu/patiented/articles/how_serious_a_urinary_tract_infection_000036_5.htm

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