Slowing the Emergence and Spread of Antimicrobial Resistance

To reverse the alarming trend of increasing antimicrobial resistance, everyone must cooperate. On an individual level, physicians as well as the general public must take more responsibility for the appropriate use of these life-saving drugs. On a global scale, countries around the world need to make important policy decisions about what is, and what is not, an appropriate use of these medications.

The Responsibilities of Physicians and Other Health Care Workers

Physicians and other health care workers need to increase their efforts to identify the causative agent of infectious diseases and, only if appropriate, prescribe suitable antimicrobials. They must also educate their patients about the proper use of prescribed drugs in order to increase patient compliance. While these efforts may be more expensive in the short term, they will ultimately save both lives and money.

The Responsibilities of Patients

Patients need to carefully follow the instructions that accompany their prescriptions, even if those instructions seem inconvenient. It is essential to maintain the concentration of the antimicrobial in the blood at the required level for a specific time period. When a patient skips a scheduled dose of a drug, the blood level of the drug may not remain high enough to inhibit the growth of the least sensitive members of the population. If these less sensitive organisms then have a chance to grow, they will give rise to a population that is not as sensitive as the original. Likewise, failure to complete the prescribed course of treatment may not kill the least sensitive organisms, allowing their subsequent multiplication. Misusing antimicrobials by skipping doses or failing to complete the prescribed duration of treatment promotes the gradual emergence of resistant organisms. In essence, the patient is selecting for the step-wise development of resistant mutants.

The Importance of an Educated Public

A greater effort must also be made to educate the public about the appropriateness and limitations of antibiotics in order to ensure that they are utilized wisely. First and foremost, people need to understand that antibiotics are not effective against viruses. Taking antibiotics will not cure the common cold or any other viral illness. A few antiviral drugs are available, but they are effective against only a limited group of viruses such as HIV and herpesviruses. Unfortunately, surveys indicate that far too many people erroneously believe that antibiotics are effective against viruses and often seek prescriptions to "cure" viral infections. This misuse only selects for antibiotic-resistant bacteria in the normal flora. Even though these organisms are not pathogenic themselves, they can serve as a reservoir for R plasmids, eventually transferring their resistance genes to an infecting pathogen.

Global Impacts of the Use of Antimicrobial Drugs

Worldwide, there is growing concern about the overuse of antimicrobial drugs. Countries may vary in their laws and social norms, but antimicrobial resistance recognizes no political boundaries. An organism that develops resistance in one country can quickly be transported globally. In many parts of the world, particularly in developing countries, antimicrobial drugs are available on a non-prescription basis. Because of the consequences of inappropriate use, there is a growing opinion that over-the-counter availability of these drugs should be curtailed or eliminated. Another worldwide concern is the use of antimicrobial drugs in animal feeds. Low levels of these drugs in feeds result in larger, more economically productive animals, and therefore, less expensive meat, a seemingly attractive option. This use, like any other, however, selects for drug-resistant organisms, which has caused some scientists to question its ultimate wisdom. In fact, infections caused by drug-resistant Salmonella strains have been linked to animals whose feed was supplemented with those drugs. In response to these concerns, there is growing pressure worldwide to ban the use of antimicrobial drugs in animal feeds.

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