The Millennium Bug 

Where are we going with antibiotic therapy?

Bacteria resistant to antibiotic therapy are becoming more common and this has led to mounting concern in the U.K. and world-wide. Many disease causing bacteria are becoming multi-resistant, that i.e, are resistant to several types of antibiotic drugs. Antibiotic resistance arises through natural selection: genetic material encoding for resistance being transferred as plasmids (self replicating loops of DNA). Multi-resistance can result from acquisition of plasmids encoding multiple resistance mechanisms.

Excessive and inappropriate use of antibiotics is believed to be one of the most important factors in the increasing prevalence of multiple resistance. About half of all antibiotic use in the U.K. and America is in animals, much in the form of mass treatment in animal foodstuffs for growth promotion (increasing productivity and profit).

In man, 80% of antibiotic prescribing occurs in the general practice setting; the remaining 20% in hospitals, much for the prevention of surgical infection. Overuse of broad – spectrum antibiotics (effective against a wide range of bacterial species) has been blamed for the increased resistance of gut bacteria and the evolution of M.R.S.A. (Multiple resistant Staph. Aureus) in hospitals. Many believe that spread is facilitated by high pressure health care systems: rapid bed turnover, transfers between wards, hospitals or nursing homes. Overcrowding of wards, overstretching of medical and nursing staff all have the potential to undermine basic measures for infection control.

Multi-resistant organisms are important especially in the weak or elderly for whom they can pose a serious threat to life, delay discharge home, or demand expensive isolation procedures. Multi-resistant gut organisms such as Salmonella Typhi (causing enteric fever) may be spread by increasing international travel. There is travel advice for precaution/avoidance of such infections. In several areas, development of new drugs is not keeping pace with proliferation of multi-resistant bacteria.

Priorities include increasing awareness through education, and legislation (i.e.. ban in feedstuffs). The development of evidence – based antibiotic prescribing policy and systematic surveillance of resistance through the Public Health Laboratory Service, at local, national and international levels. This will require sustained efforts from governments, healthcare professionals, the pharmaceutical industry and the public, otherwise Lord Lister’s antiseptic and isolation procedures may yet return.

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