What can be done about Antibiotic Resistance?

What can I do?
Use good hygiene! By washing your hands often and thoroughly with soap and water, you are helping to prevent disease - and therefore the need for antibiotics (see Handwashing). Additionally, cooking meat thoroughly and handling food hygienically will help to prevent food-borne illnesses. Also, you should take antibiotics only when necessary (see When & how to take antibiotics below).

Are antibacterial agents, such as antibacterial soaps, a solution?
In institutions such as hospitals and nursing homes, these agents are useful and appropriate when used under strict guidelines for specific purposes. However, there is some concern that antibacterials could promote antibiotic resistance, (see Antibacterial agents for more information) and their usefulness by the general public is unproven.

Are antibiotics regulated?
Some institutions, such as hospitals, have 'Antibiotic Policy' guidelines and antibiotic review committees, to ensure that antibiotic use in their institution is rational and does not compound the antibiotic resistance problem.

Governmental oversight of antibiotics varies widely from country to country. In some countries, antibiotics can be purchased 'over-the-counter,' that is, without a prescription from a doctor. Other countries require a doctor's prescription before a patient is allowed to purchase an antibiotic, although these laws are not always enforced. Antibiotics have also been sold over the Internet, a commerce mechanism with little governmental oversight that reaches across national borders.

Furthermore, food animals (animals raised for human consumption) are often given long-term, low-levels of antibiotics to promote growth. This antibiotic use represents a large fraction of the total antibiotic use in the industrialized world. A few governments restrict which antibiotics can be used for food animals, with the goal of preserving the most powerful antibiotics for treating human disease. (See Antibiotics in agriculture.)

Is there any international action on the antibiotic resistance issue?
The World Health Organization (WHO) has become quite concerned about the rising levels of resistant bacteria in all areas of the world. To provide some global coordination, WHO issued its Global Strategy for Containment of Antimicrobial Resistance, a document aimed at policy-makers that urges governments to take action to help contain antibiotic resistance.

Developing nations need to focus on eliminating uncontrolled access to antibiotics and prevention measures such as improving sanitation, cleaning up water supplies and relieving overcrowding. These preventative measures, along with frequent hand washing, would ensure that people get sick less often, and would therefore pass on fewer resistant infections to others.

Industrialized countries need to focus on prevention measures such as frequent handwashing and limiting antibacterial use, developing vaccines that can protect certain vulnerable populations such as young children, controlling multi-resistant bacteria in hospitals and in the community, and reducing antibiotic use in animal farming and agriculture.

Experts agree that a global system for tracking antibiotic resistance is needed. It would serve as an indicator for recognizing "hot-spots" of resistance and measuring trends that can tell us if our educational programs or other solutions are having positive effects.

Can the effectiveness of existing antibiotics be preserved?
To preserve the potency of existing antibiotics, overall antibiotic use must be decreased. Physicians, pharmacists, and the general public must avoid careless use of these valuable drugs. Antibiotics must be prescribed only for bacterial infections and in the proper dose for the correct amount of time. Narrow spectrum drugs should be chosen by doctors whenever possible to avoid destroying populations of beneficial bacteria along with the disease-causing bacteria. In addition, non-therapeutic uses of antibiotics in farm animals and agriculture should be eliminated.

Can new antibiotics be developed?
The epidemic of resistant bacteria has spurred renewed interest in finding novel antibiotics. The process of producing a new antibiotic, however, is long and expensive, requiring approximately ten years and $300 million to bring a new antibiotic to market. Many efforts to find novel drugs in fungi and soil result in compounds that are the same or very similar to previously discovered antibiotics. Thus, resistance eventually develops to these new antibiotics. Heavy use of the latest antibiotic can lead to the emergence of resistance in as little as two years. Nonetheless, scientists are still searching for new antibiotics by looking in unusual places such as in bacteria living deep below the earth's surface, in the skin of frogs and in certain insects.

Can antibiotic resistance be overcome?
One approach taken by scientists to combat antibiotic resistance is to strengthen the action of existing antibiotics by modifying them so the bacterial enzymes that cause resistance cannot attack them. Alternately, "decoy" molecules can be used along with the antibiotic, so that the bacterium's resistance enzyme attacks the decoy molecule rather than the antibiotic. Decoy molecules such as clavulanic acid or sulbactam are already in use for blocking the beta-lactamase enzymes that destroy the penicillin family of drugs.

An alternative approach to the antibiotic resistance problem is to interfere with the mechanisms that promote resistance, rather than to attempt to kill the bacteria. For example, interfering with the duplication or movement of a bacterium's genetic material would eliminate the transfer of resistance genes between bacteria.

When & How to take Antibiotics

When should you take antibiotics?
Antibiotics are prescribed for illnesses caused by bacteria, not by viruses. The common cold and flu are caused by viruses, not by bacteria. Antibiotics do not work against viruses. When used prudently, antibiotics are a powerful medical tool to thwart bacterial diseases. Prudent use includes taking antibiotics only for diagnosed bacterial infections and following the precise directions on the prescription. (See About bacteria and antibiotics.)

What is the proper dosage?
Prescriptions are written to cover the time needed to help your body fight all the harmful bacteria. If you stop your antibiotic early, the bacteria that have not yet been killed can restart an infection.

Leftover antibiotics are not a complete dose, and they will not work to kill all your disease causing bacteria. Taking partial doses can select for the bacteria that are resistant. Always talk to your doctor because your symptoms may not be caused by bacteria. If you do have another bacterial infection, a complete dose of the appropriate antibiotic is needed to kill all the harmful bacteria.

How safe are antibiotics?
Antibiotics are generally safe and should always be taken as prescribed by your doctor; however,

  •  Antibiotics may alter the effectiveness of other medications and cause side effects or allergic reactions.
  •  Antibiotics can kill most of the bacteria in your body that are sensitive to them, including good bacteria. By destroying the bacterial balance, it may cause stomach upsets, diarrhea, vaginal infections, or other problems.
  •  If you take antibiotics unnecessarily you may contribute to the development of antibiotic resistance. If you become sick and your bacteria are resistant to your prescribed antibiotic, your illness lasts longer and you may have to make return office and pharmacy visits to find the right drug to kill the germ. For more serious infections it is possible that you would need to be hospitalized or could even die if the infection could not be stopped. Also, while the resistant bacteria are still alive, you act as a carrier of these germs, and you could pass them to friends or family members.

How does a physician decide which antibiotic to prescribe?
Physicians examine patients and consider their symptoms in order to tell if they should prescribe an antibiotic and, if so, which one. Physicians can also take a culture to see if bacteria are causing a particular illness, such as a throat culture to determine the presence of "strep throat." For hospital infections and some community-acquired infections, the doctor will obtain an "antimicrobial susceptibility report" that indicates which families of antibiotic drugs are useful for the particular bacteria recovered from the infection. If the cause of the infection is unclear, but suspected to be due to bacteria, the doctor may prescribe a broad-spectrum antibiotic that is useful for controlling a wide variety of bacterial types. The physician may choose either a generic or trade-name  (non-generic) antibiotic depending on the individual circumstances. 

What should women know before taking antibiotics?

  • Antibiotics often lead to a vaginal yeast infection. Because antibiotics kill the normal bacteria in the vagina, yeast no longer have competition for foodand grow rapidly. Yeast cells begin attacking tissues in the vagina, usually causing one or all of the following symptoms: itching, burning, pain during sex and vaginal discharge. If you think you have a yeast infection, consult a physician.
  • Antibiotics may reduce the efficacy of birth control pills. 
  • As with other medications, some antibiotics may be transmitted to a fetus, and some may cause harm. Therefore, you should never take antibiotics without your doctor's knowledge if you are pregnant or nursing.