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Antibiotic Resistance: Expert Q&A With the CDC

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.

What is a more judicious use of antibiotics?

Srinivasan: From a public health perspective, the definition of judicious is ensuring the antibiotic is used in the right circumstance, is being used at the right dose, and is given for the right duration. Broadly, that's how we would define the most judicious use of antibiotics.

What are potential side effects of taking an antibiotic?

Hicks: Adverse drug events can range from minor stomach ailments, like nausea and vomiting, to more serious consequences that may be life-threatening and require hospitalization. In children, antibiotics are the most common cause of emergency department visits for adverse drug events. Using antibiotics responsibly is the best way to avoid an adverse drug event.

What should a health care provider do if a patient or a parent insists on antibiotics, even if the illness isn't treatable with antibiotics?

Hicks: It falls on the health care provider to prescribe only when needed. The health care provider does have to take all the factors into consideration: how sick the patient is, what the likeliest diagnosis is, what their findings are on physical exam. If it's an upper respiratory infection, it's not always obvious whether (the illness) is viral or bacterial, but the vast majority of time it's viral.

If the patient still wants an antibiotic, the most important approach for a health care provider is to validate the patient's concerns, discuss why they don't need an antibiotic, tell them that just because they don't need an antibiotic doesn't mean they aren't sick. They can suggest an over-the-counter product or other medicine to treat symptoms.

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