Atrium Health Navicent Infectious Disease

Antimicrobial Management

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Antibiotic resistant bacteria are a product of modernity. Prior to the mass production and availability of antibiotics, antibiotic-resistant bacteria were nearly nonexistent because of the amount of antibiotics available to rapidly mutate them was available in such a small amount. Since the 1990s, according to the World Health Organization, the number of infections by antibiotic resistant bacteria in hospitals has leaped up to 2.4%, and shows no signs of stopping. They go on to say that, "this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country." There are several methods in stemming the growth of this epidemic that all include the management of antimicrobial substances.

The use of antimicrobials in humans transformed medicine and the healthcare industry as the world knew it. Diseases that were previously incurable were now manageable by a small portion of the population. It was not until these antimicrobials were massed produced, however, that the face of medicine and health care changed. Early prescriptions of antimicrobials were profligate and haphazard, used as a panacea for just about every disease. The result was the excessive reliance on antibiotics and antimicrobials, even when they were unnecessary.

According to the Centers for Disease Control, even today, up to half of prescriptions for antibiotics are unnecessary. Owing to cautiousness and legal ramifications, physicians tend to over-prescribe rather than risk injury or illness to their patients. The result is an exacerbation of the proliferation of antibiotic-resistant bacteria. As these antibiotics speed up cycles of reproduction, these bacteria are allowed to mutate more quickly than technology can keep up with.

The other major cause of antibiotic-resistant bacteria can be traced back to veterinary use. Antibiotics are widely used for infectious disease management in animal shelters and farms. Antibiotics for livestock contribute to roughly eighty percent of all antibiotics in the United States, a number that has drastically increased from roughly half in the late nineties. This increased use of antibiotics has clear correlations with the increase in infections by antibiotic resistant bacteria in animals, which is problematic in itself, but studies have shown that resistant bacteria can also be transmitted readily from animals to humans. This can happen through consuming animal products, direct contact with animals, as well as through the environment. It is clear that the United States' reliance on meat and animal products has contributed significantly to the rise of antibiotic-resistant bacteria.

Antimicrobial management, then, must begin in reducing the number of antibiotics prescribed to humans as well as the amount given to livestock. The Hospital Infection Society claims, "the misuse of antimicrobials in the hospital setting remains a huge problem." This is usually meant to mean prescribing antimicrobials when they are unnecessary, like for the common cold. Because antibiotic-resistant bacteria are a relatively new phenomenon, there are few studies on its beginnings and few studies in reducing the introduction of new strains. However, it is clear that managerial staff in hospitals must do a better job in training staff in when antibiotics are necessary and appropriate. The role of the hospital pharmacist is particularly important in determining whether a prescription should be fulfilled and should be the gatekeeper between a patient and drugs. The management of antibiotics given to livestock can also contribute significantly toward reducing the numbers of antibiotic resistant bacteria.

On a governmental level, it is important--especially for developing countries--that patients do not have ready access to antimicrobials or antibiotics without a prescription. It is often the case that the very drugs contributing to the proliferation of antibiotic-resistant bacteria can be obtained over-the-counter at a local pharmacy without a prescription or even a consultation with a trained physician. Beyond contributing to the detriment of community health, self-diagnosis can be extremely dangerous and deadly. The Hospital Infection Society recommends that governments regulate the access to antibiotics and antimicrobials and check compliance with regulations at healthcare facilities.

The management of infectious diseases in schools is of particular import to parents are family-oriented citizens, as children are often more prone to infection that adults. Close proximity with their peers, as well, can often lead to an increased rate of sickness. It is no wonder then, that at school and other public facilities, that antimicrobial hand sanitizer is readily available. Hanging off the wall in bathrooms and hallways or in a cautious mom's purse, hand sanitizer is a much better way of handling microbes than antibiotics. The Centers for Disease Control has repeatedly stated that these alcohol-based hand sanitizers, which are similar to those used in hospitals, do not contribute to antibiotic or antimicrobial-resistant bacteria. They rely on alcohol to break down the proteins necessary for any bacteria to function rather than targeting specific ones like antibiotics do. Therefore, they do not help in selecting resistant bacteria; they decrease the rate of preventable infection, which reduces the need to be prescribed antibiotics after the fact, which can in a roundabout way prevent the proliferation of antibiotic-resistant bacteria.

With the current rate at which antibiotic-resistant bacteria are reproducing, it will only be a matter of time before diseases once thought of as manageable become incurable. Several of these already exist and are growing by the day. Without a systematic change in the way in which medicine is prescribed and managed, the problem can only continue to grow until antibiotics are no longer an effective solution to disease and the world effectively returns to a pre-antimicrobial state.