Introduction | Antibiotics in Human Medicine | The Antibiotic Arsenal | Antimicrobial Use in Food Animals | Solutions to the Resistance Problem
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Antibiotic resistance is a broad-based problem that involves policy makers, patients and doctors, scientists, drug makers, farmers and consumers. |
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It is impossible to stop antibiotic resistance altogether. Resistance is a natural consequence of adaptation, an inherent factor in the evolution of organisms. Efforts to tackle antibiotic resistance focus primarily on how we can better manage and slow resistance.
Antibiotic resistance is a broad-based problem that involves not just patients and doctors in clinical settings, but drug makers and policy makers, farmers and consumers. The solutions involve a range of federal and state agencies, international governments and organizations, consumer, scientific and professional groups and individuals.
In January 2001, an interagency task force unveiled a broad plan to address the problem of increasing antimicrobial resistance among microbes that cause disease. This Action Plan outlines activities and steps that experts believe are necessary to curb the spread of drug resistance. The plan has four major components: surveillance, prevention and control, research, and product development.
Led by the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH), the task force also includes the Agency for Healthcare Research and Quality, the Centers for Medicare and Medicaid Services (CMS), the Health Resources and Services Administration, the Department of Agriculture (USDA), the Department of Defense (DOD), the Department of Veterans Affairs (DVA), the Environmental Protection Agency (EPA), and the U.S. Agency for International Development (USAID).
The task force released its first progress report in June 2002, detailing implementation efforts toward the plan's 84 steps to address antimicrobial resistance. A few examples follow.
A national surveillance plan for antibiotic resistance is being developed and implemented, using both existing standards and methods as well as new methods and involvement of health departments and facilities not currently involved in federally-sponsored surveillance systems.
Surveillance for antibiotic resistance in agricultural settings is being expanded to all 50 states and a study is being launched of resistant pathogens found on retail foods. The EPA is reviewing current scientific data on the effect of antimicrobial pesticide products.
Measuring the ability of E. coli isolates to grow on different.concentrations of antibiotics.
The interagency task force is also initiating a wide variety of education and training programs for microbiology labs, health care practitioners, and consumers. These range from training lab workers to test bacterial isolates for resistance, to educating physicians and consumers about appropriate antibiotic usage and prevention of infection through vaccination.
The FDA has been at work on a regulatory framework for antimicrobial drugs used in food-animal production, and is developing a guideline document for industry.
After a risk assessment of the use of fluorquinolones in poultry, the agency has proposed withdrawing its use in poultry.
Laboratory technician Deborah Lebo isolates E. coli bacteria from the stomach contents of cattle fed special diets. Photo by Keith Weller, courtesy of the Agricultural Research Service, USDA.
CDC Antimicrobial Resistance campaigns target preventing resistance in healthcare settings, and promoting appropriate antibiotic use in the community.
Overprescription of antibiotics for unnecessary purposes, like treating colds or other viral infections that antibiotics cannot affect, is the biggest culprit in the rise of drug resistance.
The medical community recognizes its key role in tackling the resistance problem and has embarked on several initiatives designed to curb antibiotic misuse and educate patients on why these drugs must be used judiciously.
CDC scientists have worked with members of the American Academy of Pediatrics and the American Academy of Family Physicians to draft principles to help guide physicians on using antibiotics appropriately in the treatment of upper respiratory tract infections in children. CDC has produced educational materials for physicians and parents advising that ear infections (otitis media) in children often do not require antibiotic treatment. CDC estimates that unnecessary treatment of ear infections account for 6 to 8 million courses of antibiotics each year.
CDC scientists have also collaborated with members of the American College of Physicians-American Society of Internal Medicine, the American Academy of Family Physicians, and the Infectious Diseases Society of America to develop similar principles for using antibiotics in treating adult upper respiratory tract infections.
By some measures, physicians are cutting back on their use of antibiotics. A CDC survey of some 2,500 doctors in the U.S. determined that as of 1997–98, the overall rate of antibiotic prescriptions for children (the patient group most often over-prescribed drugs) had decreased by 34% from where it was in 1989–90.
ASM has been at the forefront of efforts to increase awareness of antibiotic resistance and develop new techniques and strategies to combat the rise of resistant microbes. ASM brought together experts on antimicrobial resistance from among its member scientists to create a Task Force on Antimicrobial Resistance in 1994. The group described the major factors giving rise to resistance, strategies for monitoring resistance and future research needs to tackle the problem.
ASM member scientists have provided expert testimony to Congress concerning the threats and solutions of antimicrobial resistance (ASM Comments on Preservation of Antibiotics for Human Treatment Act of 2002; ASM Comments on the FDA Guidance Document on the the Effects of Antimicrobial Drug Residues From Food of Animal Origin on the Human Intestinal Flora). ASM scientists have also participated in forums convened by the National Academy of Sciences Institute of Medicine to explore the nature of the resistance problem and potential solutions.
ASM scientists have participated in critical issues colloquia convened by the American Academy of Microbiology to explore the problem of resistance from ecological and agricultural perspectives. (Role of Antibiotics in Agriculture; Antimicrobial Resistance: An Ecological Perspective (2000)).
Microbiologists and other scientists are working to develop new and better methods for surveillance and testing for antibiotic resistance, as well as new classes of antibiotics and vaccines.
In light of concerns that antimicrobial use in food-producing animals may contribute to the antibiotic resistance problem, the nation’s leading veterinary professional society, the American Veterinary Medical Association, has developed a series of guidelines concerning the use of antimicrobials to treat animal diseases designed to minimize indiscriminate use of these drugs.
AVMA recommends using narrow spectrum drugs when possible, limiting treatment to only sick or at-risk animals rather than dosing whole herds or flocks, and using drugs important to human health only after careful consideration. The AVMA calls for further research to determine the risks of sub-therapeutic levels in animal feed to promote growth before prohibitions are imposed.
Antimicrobial resistance is a problem without boundaries. Resistance in one part of the world affects disease treatment and prevention in other parts of the world as well.
The World Health Organization (WHO) has issued a set of recommendations on how to slow the emergence and reduce the spread of resistant microorganisms worldwide.
The WHO has also taken a stand on the issue of antimicrobial use in food animals, outlining steps to reduce the overuse and misuse of antimicrobials in food animals in order to protect human health. A number of consumer, medical, and scientific organizations and state governments have launched educational initiatives as well.
The single most important blow you can strike against the growing number of resistant microbes is to educate yourself about how antibiotics work and how resistance develops.
Ask questions whenever you or your family members seek treatment. Let physicians know that you understand that inappropriate use of antibiotics is diminishing the power of these drugs to treat illness.
Above all, never demand an antibiotic prescription from your physician if he or she does not recommend one.
Vaccinate yourself and family members against common infections like flu. Ask about vaccinating your children with the new pneumococcal vaccine against Streptococcus pneumoniae, a common cause of ear infections and pneumonia.
And finally, one of the simplest things you can do is wash your hands often. Just like your mother told you, hand washing is the best way to avoid common infections in the first place. Get your friends and family members in the habit, too.
Get into the habit of washing your hands often to avoid common infections in the home.© MicrobeWorld.
Introduction | Antibiotics in Human Medicine | The Antibiotic Arsenal | Antimicrobial Use in Food Animals | Solutions to the Resistance Problem
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