Antibiotic Resistance Can Persist for 12 Months Untitled Document

Antibiotic Resistance Can Persist For 12 Months
Article Date: 19 May 2010 - 9:00 PDT

Patients prescribed antibiotics by their GP (general practitioner, primary care physician) might develop resistance that could persist for up to 12 months, according to new research published in the British Medical Journal (BMJ) today.

Health care professionals and a significant number of lay people recognize that antibiotic resistance is a major threat to public health. However, the researchers pointed out that this does not appear to be a compelling enough reason to stop both patients and clinicians to refrain from using them. Many see the problem as a minor one.

To address a lack of systematic reviews in the area, the scientists examined 24 existing studies of resistance in individual patients prescribed antibiotics in primary care, mainly for respiratory or urinary infections.

The authors report that there is strong evidence linking antibiotic resistance to the prescribing of antibiotics in primary care for urinary and respiratory infections. The effect is greatest in the month immediately after treatment, but may last for up to a year, and this residual effect may be a driver for high levels of resistance in the community.

The authors conclude that this review provides the required evidence to quantify the association between individual prescribing decisions and the problem of resistance. They say it emphasizes that the only way to prevent the "vicious cycle of resistance" is to avoid the initial use of antibiotics wherever possible. However, they also call for more clinical trials to reinforce the evidence base.
In an accompanying analysis, two economics and health policy specialists argue that there is an urgent need for new antibiotics to tackle multi-drug resistant bacteria. They demonstrate how financial incentives might be utilized to encourage pharmaceutical companies to develop new antibiotics, and suggest that such action needs to be accompanied by efforts to address overuse of antibiotics, which is currently exacerbating the spread of resistant bacteria.

These views are reiterated in an editorial by three international experts who call for economic strategies to bring new drugs to market, and to conserve existing antibacterials. "Nothing less than the future of medicine, from organ transplants to chemotherapy, is at stake, and there will be no second chances," they conclude.

"Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis"
Céire Costelloe, Chris Metcalfe, Andrew Lovering, David Mant, Alastair D Hay
BMJ 2010;340:c2096
doi:10.1136/bmj.c2096

Analysis - "Stoking the antibiotic pipeline"
Chantal M Morel, Elias Mossialos
BMJ 2010;340:c2115
doi:10.1136/bmj.c2115

Editorial - "Tackling antibiotic resistance"
Anthony D So, Neha Gupta, Otto Cars
BMJ 2010;340:c2071
doi:10.1136/bmj.c2071

Edited by Christian Nordqvist
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