December - Antibiotic Resistance: An Increasing Problem Meriting Immediate Attention
Margo Kerrigan, M.P.H, Area Director
Indian Health Service California Area Office
An Increasing Problem Meriting Immediate Attention
Until recently, most of us felt confident an antibiotic prescribed by a healthcare provider could successfully remedy an infection we acquired. Unfortunately, we are now faced with an urgent need to increase awareness regarding the increasing threat of antibiotic resistance. Recent estimates from the Centers for Disease Control and Prevention (CDC) reveal that “more than two million people are sickened every year with antibiotic-resistant infections, with at least 23,000 dying as a result.” After thorough and careful assessment, leading scientists and policy makers have delineated four key strategies to prevent antibiotic resistance:
- Preventing infections and the spread of resistance
- Tracking resistance patterns
- Improving antibiotic stewardship
- Development of new antibiotics and diagnostic tests
Enhancing our primary prevention efforts is a critical component of reducing the incidence and spread of antibiotic resistance. Clearly, if an infection does not occur in the first place, and fewer antibiotics are used, the likelihood that resistance might develop during antibiotic therapy is reduced. Ensuring that the patients we serve receive recommended immunizations in a timely manner is one of our fundamental strategies in this arena. Other routine work our public health personnel perform is also important, including promotion of safe food preparation and handwashing.
An additional public health staple – surveillance – also greatly aids our efforts in preventing infections. This is particularly true in healthcare settings, the focus of CDC’s National Healthcare Safety Network. Hospitals are encouraged to provide detailed information that enables epidemiologists to track antibiotic resistance patterns. This data is also helpful in identifying practices that may be facilitating development and spreading of antibiotic resistance, enabling creation of recommendations that can further reduce this serious problem.
Many experts in this field feel that antibiotic stewardship is the most important aspect of our national/international efforts to thwart antibiotic resistance. Basically, this boils down to using antibiotics only when clearly indicated in our patients. Some estimates indicate that up to 50% of antibiotic prescriptions are not clinically indicated. In addition, even when use of antibiotics is deemed appropriate, recommendations for administration are not always followed. Thus, patient education is also important. Though it is something that is largely out of our control, it also important to realize that indiscriminate use of antibiotics in animals is a major contributor to this problem.
Sustaining our medication pipelines is also critical. That is, it is essential that research and development is maintained to create new medications as new antibiotic-resistant bacterial strains develop. This is true even in the best case scenario, one in which antibiotics are always used appropriately, as antibiotic resistance is a natural process as bacteria adjust to new environments. On a related note, we need to make continuous improvements in diagnostic tests so we can promptly detect new resistance as it develops.
In California, our tribal and urban clinics can play a key role in reducing the incidence of antibiotic resistance development. First and foremost, we can ensure that children and adults receive immunizations on schedule. We can also make certain that standard infection control practices are taught and implemented. Perhaps most importantly, medical directors can carefully examine current clinic protocols for prescribing antibiotics and encourage more prudent practices as needed. There is no time like the present to begin these new practices.