It is being misused that antibiotics are available.
Do you agree or disagree? What are the implications for healthcare professionals and patients?
The prevention and treatment for bacteria-related infectious diseases is dependent on controlling the growth of microorganisms.
Antibiotics are an important agent that is used to inhibit microbial growth.
Two Greek words are used to derive the term antibiotic: anti, which means against, and bios, which means life.
Antibiotics are by-products produced within microorganisms. They are used to inhibit bacterial growth or kill micro-organisms (bactericidal).
Penicillin was discovered in 1928 by Sir Alexander Fleming (a Scottish scientist).
Fleming was a pioneer in the field of antibiotics, and he also made an important prediction 80 years before his time.
Fleming was awarded the Nobel Prize for his 1945 discovery. He said that the “thoughtless person playing penicillin treatment for the death man who is infected with the penicillin resistant organism” (Calderone (2015).
Figure 1: Antimicrobial Drugs Properties
(Source: Owen Punt and Stranford 2013,
Figure 2: Microbial Sources of Antibiotics
Source: Owen Punt and Stranford 2013.
Antimicrobial Resistance and Excessive Use of Antibiotics pose a threat
One of the most serious threats to human health worldwide is antimicrobial resistant.
Llor and Bjerrum 2014 estimate that 20% to 30% of all cases of tuberculosis are now resistant (Rifamcipin and Isoniazid).
The effectiveness of anti-tuberculosis medications against tuberculosis has been good for 10 years. However, this effect is currently insufficient.
More than half (50%) of multi-drug resistant tuberculosis (MDR) cases can be effectively treated by using other existing drugs (World Health Organization, 2014).
Numerous MDR tuberculosis strains were detected in 84 countries (World Health Organization 2013,).
Aside from tuberculosis and extended-spectrum beta lactam-producing Enteroacteriaceae as well as Carbapenem–resistant Enterobacteriaceae was recently identified (Society of Healthcare Epidemiology of America, 2012).
It is difficult to find new chemotherapeutic drugs against MDR bacteria, with a special mention for those that produce carbapenemases. (Boucher et al.
A majority of antibiotics that are available are not effective in treating the disease.
In hospitals, antibiotic resistance is a major problem.
The National collaborating Centre for Infectious Diseases (2010) states that MDR bacteria is also found in patients receiving primary care.
This is not a common scenario in poor countries or third world countries, but it is nonetheless a reality worldwide.
There is a wide variation in the rates of antibiotic resistance between different countries.
As an example, resistant Escherichia Coli varies between Greece (18.2%), and Sweden (1.0%). Klebsiella pneumoniae rates vary between Sweden (0.7%) and Greece (64.1%) (European Centre for Disease Prevention and Control 2011.
Asia is home to the highest levels of antibiotic resistance. Klebsiella pneumophila has shown resistance to the third generation cephalosporins.
WHO considers many of these antibiotics essential for the treatment and prevention of bacterial infections.
The problem of antibiotic resistant not only affects the whole community but also individuals.
Recent reports indicate that people who have been treated for antibiotic-resistant infections in the respiratory tract or urinary tract reported that they still experience resistance up to 12 years after treatment. Thus, the need to seek out the second-line treatment.
The rate of antibiotic resistance is higher in countries with higher antibiotic consumption.
Infection by antibiotic resistant bacteria causes severe illness, increased risk of complications, higher rates of hospitalization, and higher mortality rates (Livermore 2012.
Antibiotic resistance results in an increase in healthcare costs that amount to around EUR9 billion each year in Europe (Oxford, Kozlov 2013,).
Figure 3: Overuse of Antibiotics: Potential Risks
(Source: Llor und Bjerrum 2014
The overuse of antibiotics not only increases disease resistance but also causes many complications, as shown in figure 3.
Drug-related emergencies are common in the United States.
Use of antibiotics excessively can cause neurologic, gastrointestinal, and psychiatric complications.
AMR can cause mild side-effects, but some can lead to death.
Hepatotoxicity caused by amoxicillin or clavulanate can lead to severe and potentially life-threatening complications.
Over-prescribing antibiotics can increase patient re-attendance, as it medicalizes self-limiting conditions.
Increased hospital attendance means that more antibiotics will be administered.
Implications for Health Professionals
Presently, we are in the midst of the postantibiotic era.
All disease-causing bacteria are now resistant to antibiotics that are often used to treat them.
Without antibiotics, minor injuries can be treated with great difficulty. Furthermore, the costs of health-care will rise if you have to stay longer in hospital.
The mortality rates associated with infection can be higher than those in the 20th century.
Around the world, antibiotics are used.
It is used in animal feed, and sometimes as a non-prescription option. In some cases, sales of antibiotics can be incentivised. Half of all hospital revenue comes from antibiotic sales.
The overreliance on antibiotics is now a major problem.
Overuse of antibiotics has become a bigger problem due to a lack of surveillance and policy tools.
It is crucial that antibiotic stewardship be implemented at this point (Howard et. al.
Legare and colleagues.
According to Legare et. al. 2012, doctors’ prescribing habits are influenced by a variety of threats such as the demand from patients for fast recovery, threat from alternative healthcare systems or the lucrative nature financial incentives.
The balance must be struck between restricting access to antibiotics and prompt diagnosis of chronic infections.
The balance between the use and non-use of antibiotics is hard in countries with strong healthcare systems. It becomes exponentially more difficult in those countries which lack adequate health care facilities.
However, antibiotic resistance was confirmed by the rise of the antibiotic-resistant Enterobacteriaceae in developing countries. This is the primary reason for new born sepsis (Van Duin, et al.
To address this problem, concretion actions are needed globally.
Microbial diagnostic testing can help to prevent unwanted antibiotic use and limit the scope of treatment for microbial infection.
Unfortunately, microbial diagnostics are slow and can delay treatment. This can increase mortality and lead to broad-spectrum antibiotic therapy being prescribed (Sibley Peirano, Church 2012).
This delay can be avoided by using a rapid diagnostic test that promotes targeted antibiotic therapy from the beginning (Caliendo and al.
The prescribing physicians should be educated about the importance to cite these test results when administering anti-biotics. This would prevent overuse.
This will help prevent the spread of antibiotic-resistant bacteria (Kotwani, et al.
There is more research needed in the area psisculture, agriculture, and veterinary antibiotics.
The best way to reduce antibiotic use in animal husbandry is to ensure food safety or avoid the use of antibiotics.
Research is still needed to determine if antibiotics are safe for humans and if they can be used in non-human animals.
Since the 1970s, only two new classes have made it to the pharmaceutical market (Howard et. al.
Llor & Bjerrum (2014) claim that new generation antibiotics are urgently needed.
The profitability of new antibiotics is not easy.
In order to improve research in this field, innovative funding is required. This will also mean the effective elimination of the incentive-based pay structure used by pharmaceutical companies to maximize their sales turnover (Llor and Bjerrum 2014.
This innovative funding structure should include new collaboration models that encompass research funders as well as academia.
Additionally, funding must be raised to support the development and production of antibiotic alternatives like vaccines and antivirulence drugs such as antibiotic adjuvants and inhibitors for quorum sensing mediated via small diffusible molecular (Allen et. al.
Implications for Patients
It is important to observe good hygiene in order to avoid the possibility of antibiotic resistance.
Implementing proper sanitation techniques in rural areas can reduce the risk of infection from bacteria spread through faeces, such as Salmonella typhimurium. (Narvaez Bravo et.al.
It will reduce both the infection and spread of antibiotic-resistant micro-organisms.
Public education about the increasing incidence of multi-drug-resistant bacteria (MDR), will be a key mode of awareness.
A cross-government antimicrobial strategy was initiated in the UK.
This strategy has three main components: overall improvement in infection prevention, specialised control practice in animal health and human health, proper standardisation in antibiotic prescribing practices, overall improvement in professional education, effective public engagement and the development of new age drugs.
The UK government works with the WHO and other governmental organizations to improve global antimicrobial stewardship.
Another step that must be taken is to use less antibiotics, enforce government laws that prohibit over-the counter sales of antibiotics.
Figure: Communication tips to patients in order to reduce the overuse of antibiotics
Source: Llor und Bjerrum 2014
These communication tips will help to raise awareness among the patients.
The majority of patients in third-world countries use antibiotics as any other drug.
The doctors ask them to start taking it. However, once symptoms have subsided, the patients stop taking it altogether.
The MDR bacteria can quickly develop and cause death. This leads to a second recurrent infection.
However, if they attempt to use the leftover antibiotics to treat the recurrent infection they don’t see any results. The result is an increase in mortality rates.
Communication is key to effective use of antibiotics.
This is where doctors and governmental agencies need to be involved in order to raise awareness.
Campaigns can be audio visual, like television advertisements or audio ode. These ads could also be circulated on radio and live stage shows.
The patients will learn about antibiotics and the importance of completing the prescribed dose to prevent recurrent infections.
So, the discussion above shows that there is no evidence to support the use of antibiotics in treating respiratory tract infection in primary care patients.
Doctors should serve the patient to improve their health, while adhering to the ethical principles that justice and autonomy.
Overuse of antibiotics can lead to ethical conflicts.
It is possible to reduce antibiotic use for mild infection and decrease the risk of developing antibiotic resistance.
These strategies will assist doctors in reducing the use of antibiotics.
Allen, H.K. Levine U.Y. Looft T. Bandrick M., and Casey T.A.
Treatment, promotion and commotion: antibiotic alternatives for food-producing animal species.
Trends in Microbiology, 21(3): pp.114-119.
D. Ashiru Oredope, E.L. Budd, A. Bhattacharya A. Din. N., McNulty C.A.M. Micallef C. Ladenheim, D. Beech, E. Murdan, S. Hopkins, S. and English Surveillance Programme for Antimicrobial Utilisation and Resistance, 2016.
Implementation of antimicrobial management interventions in England’s primary and second healthcare sectors: TARGET, Start Smart Then Concentrate.
Journal of Antimicrobial Chemotherapy. 71(5). pp. 1408-1414.
Boucher H.W. Talbot G.H. Benjamin Jr. D.K. Bradley J. Guidos R.J. Jones R.N. Murray B.E. Bonomo R.A. Gilbert D. and Infectious disease Society of America, 2013.
Clinical infectious diseases, 56/12, pp.1685-1694.
Caliendo A.M. Gilbert D.N. Ginocchio C.C. Hanson K.E. May. L. Quinn T.C. Tenover F.C. Alland D. Blaschke A.J. Bonomo R.A. Carroll K.C.
Improved diagnostics for infectious diseases.
Clinical Infectious Diseases.
European Centre for Disease Prevention and Control (2011) Antimicrobial resistant surveillance in Europe.
Annual report of European Antimicrobial Resistance Surveillance Network.
Farag A., Garg A.X. Li L, and Jain A.K. 2014
An analysis of a retrospective series showing the effects of medication errors on older patients with CKD.
American Journal of Kidney Diseases. 63(3). pp.422-428.
Howard, S.J. Catchpole M., Watson J., and Davies S.C.
Antibiotic resistance requires a global response.
The Lancet Infectious Diseases 13, 12 pp. 1001-1003.
Kessel A.S. and Sharland M. (2013)
The UK’s antimicrobial resistance strategy.
BMJ (Clinical researcher ed), 346.
An insight from a qualitative study done in New Delhi (India) on the irrational use antibiotics and the role of the pharmacist.
Journal of clinical pharmacist and therapeutics 37(3), pp.308-312.
Legare F. Labrecque M. Cauchon M. Cauchon M. Castel J. Turcotte S. Grimshaw J.
Cluster randomized trial to train family doctors in sharing decision-making to reduce antibiotic overuse in acute respiratory infections.
Canadian Medical Association Journal 184(13), E726-E734.
Current epidemiology and rising resistance to gram negative pathogens.
Korean journal for internal medicine, 27(2) p.128.
Llor (C.) and Bjerrum (L.), 2014.
Antimicrobial Resistance: Risk associated with antibiotic overuse, and initiatives to reduce this problem.
Therapeutic advances and drug safety, 5(6) pp.229-241.
Narvaez-Bravo C. Rodasgonzalez A. Fuenmayor Y. Flores Rondon C. Carruyo G. Moreno M. Perozo Mena A. and Hoet A.E.
Salmonella was found in the feces and carcasses of beef slaughterhouses in Venezuela.
International journal for food microbiology, 162(2), pp.226-230.
National Collaborating Centre for Infectious Diseases (2010) Proceedings of Community Acquired antimicrobial Resistance Consultation Notes. Winnipeg (MB), Canada, 10-11 Feb 2010.
Owen, J.A. Punt and Stranford S.A.
Kuby immunology (pp.
New York: WH Freeman.
Oxford, J. & Kozlov R. (2013)
Antibiotic resistance-a call for action for primary healthcare providers.
International Journal of Clinical Practice 67(s180), 3-4.
Sibley C.D., Peirano G., and Church D.L. (2012).
The current and potential applications of molecular methods in diagnostic microbiology.
Infection, Genetics and Evolution, 12, (3), pp. 505-521.
Society for Healthcare Epidemiology of America. Infectious Diseases Society of America. Pediatric Infectious Diseases Society. (2012). Policy Statement on Antimicrobial Stewardship.
Van Duin D. Kaye K.S. Neuner E.A.
Bonomo R.A. (2013).
Carbapenem resistant Enterobacteriaceae. Review of treatment and outcome.
Diagnostic microbiology and infectious diseases, 75(2) pp.115-120.
World Health Organization (2013) Antimicrobial resistance.
Fact sheet ndeg194.
Mai 2013. Updated.
(Accessed November 2017)
World Health Organization (2014) WHO’S global report on anti-biotic resistance has revealed a grave threat to public and international health.
Virtual Press Conference.
30 April 2014.
pdf?ua=1 (Accessed on November 2017,