Antibiotic Resistance and Usage

• Antibiotic resistance is a global health threat that can lead to longer hospital stays, higher medical costs, and increased mortality

Antibiotic Use Scenarios

• Antibiotics are crucial for treating bacterial infections, but their misuse and overuse contribute to resistance
• Prescribing practices are a key factor; antibiotics should only be used when necessary and appropriate
• Inappropriate use includes prescribing for viral infections, using broad-spectrum antibiotics when a narrow-spectrum one would suffice, and using antibiotics for too long
• Patient adherence to prescribed regimens is also critical to prevent resistance
• Over-the-counter availability of antibiotics in some countries facilitates misuse
• Self-medication without medical supervision contributes significantly to the problem

Preventive Use of Antibiotics

• Prophylactic use of antibiotics involves administering them to prevent infections before they occur
• Surgical prophylaxis is a common practice; antibiotics are given before surgery to prevent post-operative infections
• The choice of antibiotic and duration of prophylaxis should be evidence-based
• Guidelines recommend specific antibiotics for different surgical procedures
• Dental procedures sometimes warrant prophylactic antibiotics, especially for patients at high risk of infective endocarditis
• Immunocompromised patients, such as those with HIV or undergoing chemotherapy, may receive prophylactic antibiotics to prevent opportunistic infections
• Travelers to certain regions may use prophylactic antibiotics to prevent infections like malaria or traveler's diarrhea; this practice should be limited

Protective Use of Antibiotics

• Protective use of antibiotics involves using them to prevent secondary infections in individuals who are already ill
• Influenza infections can sometimes lead to secondary bacterial pneumonia, and antibiotics may be used to prevent this complication
• In cases of traumatic injury, antibiotics can protect against potential infections
• During outbreaks of infectious diseases, antibiotics may be used to protect vulnerable populations
• This approach is different from treating an existing infection; the goal is to prevent a new infection from occurring
• Protective use strategies must be carefully considered to balance benefits and risks

Case Scenario: Upper Respiratory Tract Infection (URTI)

• A patient presents with symptoms of a common cold, including a runny nose, sore throat, and cough.
• The doctor should assess the patient to determine the likely cause of the infection (viral vs. bacterial)
• If the symptoms suggest a viral infection, antibiotics are not appropriate
• The doctor should educate the patient about viral infections and symptomatic treatments (rest, fluids, pain relievers)
• If bacterial infection is suspected, a throat swab may be used to confirm the diagnosis.
• If the infection is bacterial, the appropriate antibiotic should be prescribed based on guidelines
• The patient should be given clear instructions on how to take the antibiotic and complete the full course
• The patient should be advised about potential side effects and what to do if they occur
• Follow-up may be needed to assess treatment response and ensure the infection is resolving

Case Scenario: Surgical Site Infection (SSI) Prevention

• A patient is scheduled for elective surgery
• Pre-operative assessment should identify risk factors for SSI, such as diabetes, obesity, or smoking
• Pre-operative skin preparation with antiseptic solutions is essential
• Prophylactic antibiotics should be given within one hour before the surgical incision
• The choice of antibiotic should be based on the type of surgery and likely pathogens
• Intra-operative techniques to minimize contamination should be followed
• Post-operative wound care and monitoring for signs of infection are important
• The patient should be educated on wound care and signs of infection to watch for at home

Case Scenario: Urinary Tract Infection (UTI)

• A female patient presents with symptoms of a UTI, including dysuria, frequency, and urgency
• A urine sample should be collected for analysis and culture
• Antibiotic treatment should be initiated based on local resistance patterns
• Nitrofurantoin or trimethoprim-sulfamethoxazole are commonly used first-line agents
• Prescribe the narrowest spectrum antibiotic appropriate for the infection
• The patient should be educated about the importance of completing the full course of antibiotics
• Follow-up urine cultures may be needed to confirm eradication of the infection
• Recurrent UTIs may require further evaluation and preventive strategies

Antibiotic Resistance Mechanisms

• Bacteria develop resistance through various mechanisms
• Enzymatic inactivation of antibiotics involves bacteria producing enzymes that break down the antibiotic molecule
• Modification of the antibiotic target site prevents the antibiotic from binding effectively
• Reduced permeability of the bacterial cell wall prevents the antibiotic from entering the cell
• Active efflux pumps remove the antibiotic from the cell, reducing its concentration
• Bacteria can acquire resistance genes through horizontal gene transfer
• Plasmids and transposons facilitate the spread of resistance genes among bacteria

Strategies to Combat Antibiotic Resistance

• Antibiotic stewardship programs promote appropriate antibiotic use in healthcare settings
• Improved diagnostic testing can help identify the cause of infections and guide antibiotic selection
• Infection prevention and control measures can reduce the spread of resistant organisms
• Hand hygiene, isolation precautions, and environmental cleaning are essential
• Development of new antibiotics is needed to address emerging resistance
• Research into alternative therapies, such as phage therapy, is ongoing
• Public education campaigns can raise awareness about antibiotic resistance
• Vaccination can prevent some infections and reduce the need for antibiotics
• Surveillance of antibiotic resistance patterns is important for monitoring trends

Impact of Antibiotic Resistance

• Increased morbidity and mortality are associated with antibiotic-resistant infections
• Patients with resistant infections may require longer hospital stays and more intensive treatment
• Healthcare costs are higher for patients with resistant infections
• Antibiotic resistance can complicate the treatment of common infections
• The spread of resistance can threaten the effectiveness of antibiotics for future generations
• Antibiotic resistance is a public health priority requiring coordinated global action