Factors Behind the Emergence of

Antibiotic Resistance

Over-prescription and overuse of antibiotics

Medical culture can inadvertently promote and perpetuate unnecessary use of antibiotics or overuse of the most potent, broad-spectrum antibiotics Despite understanding the long-term risks of resistance, doctors are often focused

on treating the potential infection in front of them, in their individual patient Long-term risks are not prioritized and the judicious use of antibiotics is not valued Doctors are also commonly worried about the risk of not acting to prevent or treat

the infection, reporting an inability to accept the risk that avoiding prescribing the most potent broad spectrum antibiotic might present

In many lower and middle income countries antibiotics can be purchased without a prescription

The widespread unnecessary use of antibiotics (especially in lower and middle income countries) is largely due to the general population’s lack of knowledge of about how antibiotics work, and limited awareness of the consequences of antibiotic resistance in public health 64% of 10 000 respondents over 5 developing countries believe antibiotics can be

used to treat colds and flu, despite the fact that antibiotics have no impact on viruses

Patients not taking antibiotics as prescribed

Suboptimum patient compliance on use can contribute to resistance: Stopping taking antibiotics when feeling better when not finished

prescribed course Taking leftover antibiotics from previous treatment courses Sharing unused drugs with other people

Close to one third (32%) of people surveyed believe they should stop taking antibiotics when they feel better, rather than completing the prescribed course of treatment. For some conditions, such as tuberculosis or osteomyelitis, and other

deep-seated infections, symptoms can improve even though the bacteria might still be flourishing

Many of these practices are common in both developed and developing countries

Unnecessary use of antibiotics in agriculture

and livestock Much of the use of antibiotics in animals is not therapeutic Significant volumes of antibiotics are used prophylactically amongst healthy

animals to: Stop the development of an infection within a flock or herd Promote growth, to speed up the pace at which animals gain weight

Overuse presents the risk that drug-resistant strains are passed on through direct contact between humans and animals (notably farmers) These drug-resistant strains can then be passed on to humans more generally

through the food chain, i.e. when consumers prepare or eat the meat itself There is also a further indirect threat to human health as result of animal

excretion Huge amounts of antibiotics are used for agriculture in some countries—up

to four-times the amount used in human medicine in some cases

https://agricultureproud.files.wordpress.com/2013/11/1452174_695477840471943_52921068_n1.jpg

Poor infection control and hand hygiene in hospitals

and clinicsInsufficient infection control surveillance systems

within hospitals (especially in lower and middle income countries) can lead toSpread of nosocomial (hospital acquired) infections Outbreaks caused by resistant pathogens

Exacerbated by inherent problems: overcrowding and insufficient equipment and trained personnel

These resistant pathogens become a reservoir of resistant genes Can also be spread to the community through unsafe

water and poor sanitation

Lack of Rapid Laboratory Tests

It may not always be obvious whether an illnesses is due to infection and whether it is bacterial (and might need treatment) or viral

Tests may help, however may help, however often patients must wait some time for results

Treatment is usually then given based on clinical judgement – often influenced by the patient’s anxiety and the doctor’s intolerance of risk

Leads to overuse and overprescription

ReferencesLaxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim

HF, Sumpradit N, et al. Antibiotic resistance—the need for global solutions. The Lancet infectious diseases. 2013;13(12):1057-1098.

WHO. WHO multi-country survey reveals widespread public misunderstanding about antibiotic resistance. [News Release]. 2015 16 NOVEMBER 2015. http://www.who.int/mediacentre/news/releases/2015/antibi

otic-resistance/en/

Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiology and Molecular Biology Reviews. 2010;74(3):417-433.