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Does antibiotic restriction prevent resistance?
1Emory University School of Medicine, Atlanta, GA, USA.
Abstract:
Antimicrobial resistance among some hospital organisms has increased to a stage where it can no longer be tolerated. The need for preventive and corrective measures is urgent. There is an association between the use of antimicrobial agents and resistance that is likely causal. Alterations in antimicrobial usage have been shown to affect antimicrobial resistance rates, particularly with use of aminoglycosides. Efforts to improve antimicrobial use through educational efforts alone have been largely ineffective, even when coupled with quality management or clinical guideline aspects. Thus, further work is urgently needed to determine the impact of antimicrobial-use controls. Additional large-scale, well controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular biological organism typing, and precise resistance mechanism analysis will be required to determine the best methods to prevent and control this problem and ensure our optimal antimicrobial-use "stewardship." Consideration of the long-term effects of antimicrobial selection, dosage, and duration of treatment on resistance development should be a part of every antimicrobial treatment decision.
Insights
Antimicrobial resistance is a growing problem, and simply educating clinicians has not been effective. New strategies are urgently needed to control antimicrobial use and combat resistance.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Rising antimicrobial resistance in hospital organisms necessitates urgent action.
- A causal link exists between antimicrobial agent use and resistance development.
- Aminoglycoside use significantly impacts antimicrobial resistance rates.
Purpose of the Study:
- To highlight the urgent need for effective antimicrobial use controls.
- To emphasize the limitations of educational interventions in combating antimicrobial resistance.
- To call for further research into antimicrobial stewardship strategies.
Main Methods:
- Review of existing literature on antimicrobial resistance and usage.
- Analysis of the ineffectiveness of educational interventions alone.
- Identification of the need for large-scale controlled trials.
Main Results:
- Educational efforts, even with quality management, have largely failed to curb antimicrobial resistance.
- Antimicrobial usage directly influences resistance rates.
- Current strategies are insufficient to manage the escalating problem.
Conclusions:
- Effective antimicrobial-use controls are essential to combat rising resistance.
- Future research must focus on large-scale trials with robust methodologies.
- Optimizing antimicrobial stewardship requires careful consideration of selection, dosage, and duration.