Do I need antibiotics?
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Do I Need Antibiotics?
Understanding Antibiotic Resistance
Antibiotic resistance is a growing global health crisis. Many bacterial strains have developed resistance to nearly all available antibiotics, making infections harder to treat and increasing the risk of disease spread, severe illness, and death1 3 6. This resistance is particularly problematic in hospital settings where multidrug-resistant (MDR) bacteria are prevalent1 3 6.
Appropriate Use of Antibiotics in Hospitals
The International Society for Chemotherapy emphasizes the importance of appropriate antibiotic use in hospitals to combat resistance. Key recommendations include obtaining microbiological samples before administering antibiotics, avoiding antibiotics for treating fever alone, and tailoring antibiotic treatment based on infection site and local microbiology patterns2. Additionally, it is crucial to prescribe antibiotics at optimal doses and durations, use combinations only when beneficial, and de-escalate treatment based on clinical and microbiological results2.
Short-Course Antibiotic Therapy
Overuse of antibiotics, including unnecessarily long treatment durations, contributes significantly to resistance. Best practices suggest limiting antibiotic treatment to five days for conditions like COPD exacerbations with acute bronchitis and community-acquired pneumonia, extending only if clinical stability is not achieved4. For uncomplicated bacterial cystitis, short-course antibiotics are recommended, and for nonpurulent cellulitis, a 5-6 day course is advised4.
The Need for New Antibiotics
Despite efforts to minimize unnecessary antibiotic use, resistance continues to rise, necessitating the development of new antibiotics. This is especially critical for treating multidrug-resistant Gram-negative bacteria in hospitals and community-acquired pathogens like tuberculosis and gonorrhea3 6 9. New antibiotics, such as darobactin, show promise against Gram-negative pathogens and highlight the potential of bacterial symbionts as sources for novel therapeutics9.
Strategies to Combat Resistance
Effective strategies to combat antibiotic resistance include implementing antibiotic stewardship programs in hospitals, which have been shown to reduce resistance spread and improve patient outcomes5 7. These programs involve monitoring antibiotic use, adapting clinical guidelines, and employing non-antibiotic prevention strategies like vaccines and fecal transplants7.
Conclusion
The decision to use antibiotics should be based on clinical signs of infection and microbiological evidence. Overuse and misuse of antibiotics contribute to resistance, making it essential to follow best practices for prescribing and to develop new antibiotics to stay ahead of resistant bacteria. Implementing stewardship programs and adhering to guidelines can help mitigate the spread of resistance and ensure effective treatment options remain available.
Sources and full results
Most relevant research papers on this topic
Do we need new antibiotics?
The current arsenal of antibiotics, including 'old antibiotics', is sufficient to combat new bacterial resistance and should be considered a World Heritage.
Literature Review
Rigorous Journal
Highly CitedTen key points for the appropriate use of antibiotics in hospitalised patients: a consensus from the Antimicrobial Stewardship and Resistance Working Groups of the International Society of Chemotherapy.
Antibiotic use in hospital settings should be tailored to the infection, risk factors, and local microbiology, with optimal dosing and duration, and a focus on infection control.
The need for new antibiotics.
New antibiotics are urgently needed to combat antibiotic resistance, as infections become increasingly untreatable due to resistance emerging and spreading at new sites.
Highly CitedAppropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians
Limit antibiotic treatment duration to 5 days for COPD exacerbations, community-acquired pneumonia, UTIs, and cellulitis, based on clinical stability.
Systematic ReviewRigorous JournalStrategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases
The guideline outlines strategies for enhancing rational use of antibiotics in hospitals, counteracting antimicrobial resistance, and improving patient care by maximizing clinical outcomes and minimizing toxicity.
Systematic ReviewHighly CitedResistance of Gram-Negative Bacteria to Current Antibacterial Agents and Approaches to Resolve It
New antibacterial agents are crucial for combating resistant Gram-negative bacteria, with promising strategies including deactivating resistance mechanisms and developing naturally derived agents on novel targets.
Highly CitedAppropriate use of antibiotics: an unmet need
Hospital-wide antibiotic stewardship programs and adapting clinical guidelines can effectively reduce antibiotic resistance, while vaccines and nonimmunogenic treatment options may also be effective.
Literature ReviewDiscovery and development of new antibiotics: the problem of antibiotic resistance
New antibiotics are needed to combat antibiotic resistance and address the growing health needs caused by emerging and opportunistic pathogens.
Highly CitedA new antibiotic selectively kills Gram-negative pathogens
Darobactin, a new antibiotic found in Photorhabdus symbionts of nematode microbiomes, shows potential for developing into therapeutics against drug-resistant Gram-negative pathogens.
Very Rigorous JournalHighly CitedNonmedical Uses of Antibiotics: Time to Restrict Their Use?
Nonmedical uses of antibiotics, such as in animal husbandry and horticulture, should be critically examined and halted to prevent the spread of antibiotic-resistant bacteria.
Highly Cited