From Alzheimer’s to Zebrafish: Eclectic Science and Regulatory Stories 30
A third strategy is to chemically modify or mutate the target of the antibiotic so that no
binding occurs. For example, some bacteria become resistant to penicillin by mutating the
enzymes that penicillin inhibits, which are essential for forming the rigid cell wall.18
The Economic Impact of Bacterial Resistance
The economic impact of antimicrobial resistance is substantial. The estimated annual cost
of hospitalizations due to S. aureus infections is $122 million for nosocomial infections,
the figure approaches $5 billion.19 Enterococci are the most common cause of nosocomial
infections, and vancomycin is often the only effective agent. Of approximately 19,000
deaths directly caused by nosocomial infections in 1992, 28% were resistant to the pre-
ferred antibiotic treatment in intensive care units, making nosocomial infections the
11th-leading cause of death in the US.20 In addition, more than 90% of strains of S. aureus
in US hospitals are resistant to penicillin and beta-lactam antibiotics, and the incidence of
VRE increased 20-fold between January 1989 and March 1993.21
Is There a Solution?
Clinicians today should consider new approaches for treating patients while minimizing
excessive antibiotic use. It has been estimated that at least one half of antibiotic use in the
developed world—and perhaps more in the developing world—is inappropriate.22 To help
combat this problem, two important points should be considered. First, when treating
seriously ill patients, potentially resistant pathogens must be covered even if it is neces-
sary to use a broader range of antibiotics. Second, antibiotics should not be used in clinical
situations in which the patient will not benefit from receiving the drug (e.g., viral upper
respiratory infections).
Current research has proven that a patient’s likelihood of carrying a resistant organ-
ism is doubled if he or she has taken any antibiotic for any reason within the previous two
months.23 This study demonstrated a dose-response relationship to increasing exposure
of trimethoprim, as well as increasing amoxicillin resistance with any exposure to beta-
lactam antibiotics.24
How to Counsel Patients
Patients should be informed that most infections do not require antibiotics in fact, anti-
biotics may actually harm a patient by affecting the beneficial bacteria in his or her body
and may be detrimental to society by encouraging bacterial resistance.25 Patients should
be aware that antibiotics destroy beneficial bacteria as well as pathogens. When infections
are treated with an antimicrobial agent, all bacteria in the host are affected, including the
normal residents. This can result in the selection of resistant commensals, particularly in
children who are frequently given oral antibiotics. These conditions favor the transfer of
genes from the surviving organisms to human pathogens.26 Moreover, non-disease-caus-
ing bacteria are essential parts of the body’s natural armor against infectious bacteria.27 It
may appear that compliance with an antibiotic regimen is more likely when pharmacists
explain the root causes of resistance to patients.
The Handbook of Antibiotics, which provides a series of questions to address before
an antibiotic is selected, can help pharmacists counsel patients.28 The Centers for Disease
Control and Prevention (CDC) has sponsored several conferences to promote appropriate
antibiotic use in the community. Information on antimicrobial resistance is available on
the CDC website and can be used to enhance patient compliance.29 The US Food and Drug
Administration (FDA) has addressed the issue of bacterial resistance through a number of
initiatives, including participating in a Public Health Service Task Force on Antimicrobial
Resistance. More information on these initiatives is available on the FDA website.30
A third strategy is to chemically modify or mutate the target of the antibiotic so that no
binding occurs. For example, some bacteria become resistant to penicillin by mutating the
enzymes that penicillin inhibits, which are essential for forming the rigid cell wall.18
The Economic Impact of Bacterial Resistance
The economic impact of antimicrobial resistance is substantial. The estimated annual cost
of hospitalizations due to S. aureus infections is $122 million for nosocomial infections,
the figure approaches $5 billion.19 Enterococci are the most common cause of nosocomial
infections, and vancomycin is often the only effective agent. Of approximately 19,000
deaths directly caused by nosocomial infections in 1992, 28% were resistant to the pre-
ferred antibiotic treatment in intensive care units, making nosocomial infections the
11th-leading cause of death in the US.20 In addition, more than 90% of strains of S. aureus
in US hospitals are resistant to penicillin and beta-lactam antibiotics, and the incidence of
VRE increased 20-fold between January 1989 and March 1993.21
Is There a Solution?
Clinicians today should consider new approaches for treating patients while minimizing
excessive antibiotic use. It has been estimated that at least one half of antibiotic use in the
developed world—and perhaps more in the developing world—is inappropriate.22 To help
combat this problem, two important points should be considered. First, when treating
seriously ill patients, potentially resistant pathogens must be covered even if it is neces-
sary to use a broader range of antibiotics. Second, antibiotics should not be used in clinical
situations in which the patient will not benefit from receiving the drug (e.g., viral upper
respiratory infections).
Current research has proven that a patient’s likelihood of carrying a resistant organ-
ism is doubled if he or she has taken any antibiotic for any reason within the previous two
months.23 This study demonstrated a dose-response relationship to increasing exposure
of trimethoprim, as well as increasing amoxicillin resistance with any exposure to beta-
lactam antibiotics.24
How to Counsel Patients
Patients should be informed that most infections do not require antibiotics in fact, anti-
biotics may actually harm a patient by affecting the beneficial bacteria in his or her body
and may be detrimental to society by encouraging bacterial resistance.25 Patients should
be aware that antibiotics destroy beneficial bacteria as well as pathogens. When infections
are treated with an antimicrobial agent, all bacteria in the host are affected, including the
normal residents. This can result in the selection of resistant commensals, particularly in
children who are frequently given oral antibiotics. These conditions favor the transfer of
genes from the surviving organisms to human pathogens.26 Moreover, non-disease-caus-
ing bacteria are essential parts of the body’s natural armor against infectious bacteria.27 It
may appear that compliance with an antibiotic regimen is more likely when pharmacists
explain the root causes of resistance to patients.
The Handbook of Antibiotics, which provides a series of questions to address before
an antibiotic is selected, can help pharmacists counsel patients.28 The Centers for Disease
Control and Prevention (CDC) has sponsored several conferences to promote appropriate
antibiotic use in the community. Information on antimicrobial resistance is available on
the CDC website and can be used to enhance patient compliance.29 The US Food and Drug
Administration (FDA) has addressed the issue of bacterial resistance through a number of
initiatives, including participating in a Public Health Service Task Force on Antimicrobial
Resistance. More information on these initiatives is available on the FDA website.30