Appropriate use of antibiotics: an unmet need

Abstract

Increasing bacterial resistance combined with a steady decline in the discovery of new antibiotics has resulted in a global healthcare crisis. Overuse of antibiotics, for example, in the poultry and cattle industry, and misuse and improper prescription of antibiotics are leading causes of multidrug resistance (MDR). The increasing use of antibiotics, particularly in developing countries, is a big concern for antibiotic resistance and can cause other health threats such as increased risk of recurrent infections and increased risk of cardiovascular death with chronic use of macrolides. Carbapenems are the last line of defense in many cases of resistant infection, but trends show that resistance against these agents is also increasing. This narrative review is based on relevant literature according to the experience and expertise of the authors and presents an overview of the current knowledge on antibiotic resistance, the key driving factors, and possible strategies to tackle antibiotic resistance. Collectively, studies show that hospital-wide antibiotic stewardship programs are effective in decreasing the spread of antibacterial resistance. As resistance varies according to local patterns of use, it is essential to observe the epidemiology at both a regional and an institutional level. Furthermore, adaptation of clinical guidelines is necessary, particularly for inpatient care. Future guidelines should include a justification step for continued treatment of antibiotic treatments and criteria for selection of antibiotics at the start of treatment. Nonantibiotic prevention strategies can limit infections and should also be considered in treatment plans. Vaccines against MDR organisms have shown some efficacy in phase II trials in critical care patients. Nonimmunogenic and microbiologic treatment options such as fecal transplants may be particularly important for elderly and immune-compromised patients.

A Significant Question in Cancer Risk and Therapy: Are Antibiotics Positive or Negative Effectors? Current Answers and Possible Alternatives

“…The significance of this issue is highlighted by (a) the over-exposure of humans to antibiotics through self-medication or by sharing prescriptions with friends or relatives in many communities, regions and countries where antibiotics can be accessed without prescription [ 99 ], a societal problem that can be easily solved with appropriate guidance [ 100 ]; and (b) by misguided indication and inappropriate dosing schemes prescribed by physicians and medical institutions [ 101 , 102 ] for the treatment of clinical cases not even involving bacterial infections, in many cases to simply satisfy the demands of patients to be prescribed “anything” to sense that they are adequately taken care of. In addition to these instances of uninformed, unnecessary, unjustified and inadequate antibiotic use that still make us question the safety of antibiotics in the 21st century [ 103 , 104 ], cancer patients are being exposed frequently to antibiotics as prophylactic or therapeutic components of their anticancer treatment protocols, particularly during postoperative periods after surgery [ 105 , 106 , 107 ] as well as while patients are immunosuppressed by the action of chemotherapeutic drugs [ 108 , 109 ].…”

Determining procalcitonin at point-of-care; A method comparison study of four commercial PCT assays

“…It is also being evaluated to shorten the course of antibiotic therapy in patients with respiratory tract infections [ 2 ] and in septic patients during intensive care treatment [ 3 , 4 ]. Moreover, PCT is increasingly accepted as a biomarker to guide the appropriate and effective use of antibiotics, potentially lowering the risks of complications associated with antibiotic overuse, such as anaphylactic reactions [ 5 ] and the emerge of resistant bacterial infections [ 6 ]. Plasma PCT levels also correlate with increasing severity of sepsis and organ dysfunction, providing prognostic value and supporting risk stratification algorithms [ 7 ].…”

Utilizing Red Spotted Apollo Butterfly Transcriptome to Identify Antimicrobial Peptide Candidates against Porphyromonas gingivalis

“…Albeit their exceptional potency against pathogens, these have been little utilized until recently. The overuse or inappropriate dosage of classical antibiotics has developed a serious problem of anti-microbial resistance [ 2 , 3 ]. Thus, AMPs can be considered as an alternative pharmacological resource from nature confronting antibiotic resistant microorganisms.…”