Usage of antibiotics

There is no doubt that antibiotics have transformed healthcare.

They are an essential weapon in our ability to tackle infectious diseases, but are also used routinely across a wide range of medical practices. For example, antibiotics are needed to protect cancer patients who are undergoing chemotherapy from infections, and are also needed to prevent infections following surgery. But as AMR becomes a growing problem, many have recognised the need to be more prudent about the use of antibiotics in healthcare. Antimicrobial stewardship is an approach designed to reduce the burden of AMR by optimising the use of antibiotics, and includes a number of different interventions. Some examples of the issues antimicrobial stewardship aims to tackle are:

(1) Availability of antibiotics. In many developing countries such as India, antibiotics are available over the counter and don’t require a prescription. This means that it is common for people to take antibiotics when they don’t need them, and/or take them at the wrong dose or period of time.

(2) Usage of antibiotics in agriculture. Antibiotics are used widely in livestock farming, and it is thought that antibiotic resistant bacteria that are generated in farming can be spread to humans (watch Week 2, interview with Catherine Ludden)

(3) Prescribing habits of healthcare providers. In one study in the USA, 86 million patients visited their doctor with a respiratory issue not thought to be treatable by antibiotics, such as asthma. However 27 million of these patients still received an antibiotic.

(4) Lack of diagnostics. If the healthcare practitioner doesn’t know what is causing the infection and whether it is resistant, it is difficult to make the right prescription, which can lead to inappropriate use of antibiotics. The next step will discuss this in greater detail.

Any use of antibiotics represents a selective pressure that will encourage bacterial antibiotic resistance. Taking antibiotics when there is no bacterial infection will encourage resistance to develop in a patient’s normal healthy microflora, and taking antibiotics for the wrong length of time can allow partially resistant bacteria to survive and take over. These partially resistant bacteria can then evolve greater resistance over time. We will discuss the ways bacteria can become resistant to antibiotics later this week.

Read original research relating to point 3, prescribing habits of healthcare providers Antibiotic prescribing for adults in ambulatory care in the USA, 2007-09 in Journal of Antimicrobial Chemotherapy

In the comments area, share with others what Antimicrobial Stewardship strategies are being used in your country of residence?
Is antibiotic use being controlled where you live?
If ‘yes’, how?
If ‘no’, what are the barriers to antibiotic use control and how can these barriers be overcome?