Can we prevent antimicrobial resistance by using antimicrobials better?

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Pharmacology

Background:

• Antimicrobials are essential in healthcare but face a major threat from widespread antimicrobial resistance.
• The pipeline for new antimicrobial classes has slowed significantly, with only three new classes reaching the market in the last thirty years.
• This decline in new drug development poses a future risk of ineffective treatments for bacterial infections, especially those caused by Gram-negative organisms.

Purpose of the Study:

• To review current evidence and strategies for reducing the development of antimicrobial resistance.
• To highlight the importance of appropriate antimicrobial use in healthcare settings.
• To outline future research and development areas for combating antimicrobial resistance.

Main Methods:

• Review of current scientific literature on antimicrobial resistance and treatment strategies.
• Analysis of pharmacokinetic and pharmacodynamic properties of antimicrobials.
• Examination of antimicrobial cycling and combination therapy approaches.
• Consideration of rapid diagnostic testing for appropriate antimicrobial selection.

Main Results:

• Appropriate antimicrobial use, informed by pharmacokinetic/pharmacodynamic properties, is a key strategy to prevent resistance.
• Antimicrobial cycling and combination therapies show potential in managing resistance.
• Rapid diagnostic testing can aid in the judicious selection of antimicrobials.
• Evidence supports these strategies for various organisms, including Mycobacterium tuberculosis, Gram-negative, and Gram-positive bacteria.

Conclusions:

• Urgent implementation of strategies for appropriate antimicrobial use is necessary to mitigate the growing threat of antimicrobial resistance.
• Further research and development are needed to ensure effective treatments against bacterial infections in the future.
• A multi-faceted approach, including diagnostics and tailored therapeutic strategies, is essential for antimicrobial stewardship.