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