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The Race Against Antibiotic Resistance: Addressing a Growing Public Health Crisis

Laura Joszt
When antibiotics were discovered, they were considered a miracle. Decades of overuse have created a current public health crisis with a growing number of antibiotic-resistant bacteria. However, not all hope is lost in the fight against antibiotic resistance. There are programs in place to promote judicious use of antibiotics and policies and funding to help incentivize development of new antibiotics.
The discovery of antibiotics was considered a miracle that underpinned modern medicine as we know it today, but growing antibiotic resistance threatens that progress.

Every year, 2 million Americans are infected with an antibiotic-resistant bacteria, with at least 23,000 people dying from the bacteria.1 Each year, there are more and more examples of patients who can no longer be treated safely and effectively with antibiotics or of doctors who are revisiting older antibiotics, whose use was discontinued due to side effects, because they are the only options available, explained David Hyun, MD, senior officer, Antibiotic Resistance Project, The Pew Charitable Trusts.

In general, antibiotics have been very good tools in clinicians’ arsenal. Dennis Gingrich, MD, FAAFP, professor, Department of Family and Community Medicine, Department of Humanities, Pennsylvania State College of Medicine, called them a “godsend in treating infections” that saved a lot of lives over the years. But as new antibiotics have been discovered, bacteria have developed resistance to these new antibiotics.

How quickly do bacteria develop a resistance to an antibiotic after it’s developed? Almost immediately, according to Jason Burnham, MD, instructor in medicine, John T. Milliken Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis.

“Basically, as soon as you develop new things, new antibiotic resistance comes out,” he said. “And the number of patients who have antibiotic-resistant bacteria infections just increases year after year after year.”

Research from Pew2 has found that 1 in 3 antibiotics prescribed in the outpatient setting are unnecessary, Hyun said. Furthermore, about three-quarters of that unnecessary use was associated with visits for acute respiratory conditions, which are usually viral in nature and for which antibiotics are not indicated.

“The acute respiratory conditions appear to take up the lion’s share of the amount of unnecessary prescribing that is currently happening in the outpatient space,” Hyun said.

Genetic Drift Is to Blame
When bacteria are exposed to an antibiotic, most of them are killed off because they are sensitive to the antibiotic; but a few of the bacteria develop mutations that make them resistant. The bacteria transmit genetic elements from one to the other, which means the growth of resistant bacteria is rapid, Gingrich explained.

“So, really, genetic drift is what leads to the resistant bacteria,” he said. “And infections caused by antibiotic-resistant bacteria are difficult to treat.”

The increasingly difficult-to-treat issue of antibiotic resistance has become a public health hazard. Gingrich called it a “crisis” and even noted that it is similar to the opioid crisis in terms of the need to generate public awareness and change prescribing patterns to reduce the use of inappropriate antibiotic use.

Resistance to antibiotics has grown for a number of reasons, one of which is overprescribing in humans. Burnham explained that overprescribing has happened because of diagnostic uncertainty. While healthcare providers have gotten better at diagnosing a patient, for years it had been a guessing game, he said.

“It was like, ‘Hmm, well, I know if I give you an antibiotic, if you have a bacteria, you’ll get better,’” Burnham said. “A lot of times providers are thinking antibiotics are probably not harmful, so let’s just give.”

Recent research has found, however, that there are side effects associated with antibiotics. Burnham noted that one of the top reasons children have been going to the emergency department is because they have a viral infection, but they were given an antibiotic, and as a result they have a rash or other reaction.

“So, they’re not benign, but there’s this still overarching assumption that it’s no big deal to give an antibiotic,” he said.

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Doctors More Likely to Overprescribe Antibiotics for Children During Telemedicine Visits
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