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Antibiotic Resistance: Expert Q&A With the CDC

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What could be the global consequences of antibiotic resistance?

Srinivasan: Infections became more difficult to treat, we have to use agents that are more toxic and more expensive, and we have to use them longer. The scariest situation is one we're seeing in hospitals in America, where patients are acquiring infections and there are no antibiotic options. We have a disease that should be treatable and we now encounter situations where they are not treatable. In some cases, it's taking us back to the pre-antibiotic period.

In which patient populations is antibiotic resistance the greatest?

Hicks: We're seeing resistance among all age groups. When we look at surveillance data for certain infections like streptococcus that cause meningitis, pneumonia, and bloodstream infections, the frequency of those infections has increased over time. We're seeing a rise in antibiotic resistance for all age groups and for a number of different bacteria.

Are there bacterial infections that have become more resilient due to antibiotic overuse?

Srinivasan: In inpatient health care settings, the one most common is staph (staphylococcus bacteria) resistance. Staph causes bloodstream infections in patients with catheters.

What should be done in a situation where a patient can't fight off a staph infection?

Srinivasan: Sometimes, the infection might be due to a catheter. In that case, the catheter could be removed or an abscess could be drained. In some instances, there's nothing to do to help the patient's body fight the infection, and that could lead to death. We don't encounter it with regularity, but the concern is, these stories are becoming more common.

Which antibiotics don't work as well any more due to resistance?

Hicks: We've seen a big resistance to amoxicillin for a number of different types of infections. But that doesn't mean it's not a very important drug. What's more concerning to me is the use of broad-spectrum antibiotics (including fluoroquinolone and azithromycin) for infections that could be treated by amoxicillin or penicillin.

According to the CDC, 16 new antibiotics came to market between 1983 and 1987, but only two were developed between 2003 and 2007. Why so few?

Hicks: The number of new antibiotics in development is alarmingly low, and it's a matter of resources. Antibiotics are taken for a shorter period of time, and it's more economical for drug companies to make drugs that are taken for a long time. We're also promoting the concept of using these antibiotics judiciously, so companies and researchers don't see the economic benefit. Antibiotics are not used in volume like Lipitor or a diabetes medication. The FDA is considering incentives for companies to develop new antibiotics.

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