The End Of The Antibiotic Era? (Part 1)

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Emerging Antibiotic Resistance

(VIDEO by CDCStreamingHealth)

EDITOR’S NOTE: This is Part 1 of a two part series on the emerging problem of antibiotic resistance written by Drs. Heather McCormick and Stacey Bagget, clinical pharmacologists at Holmes Regional Medical Center.

BREVARD COUNTY • MELBOURNE, FLORIDA–Antibiotic resistance has drastically increased in recent years and as a result, their effectiveness in treating bacterial infections has declined.  According to the Centers for Disease Control and Prevention (CDC), over 70% of bacteria that cause infections during patients’ hospital stay are resistant to at least one of the drugs that are used for treatment.  The CDC also reports that about 50% of antibiotic use in hospitals is either unnecessary or inappropriate. 

Antibiotic resistance is a type of drug resistance in which a genetic change results in a microorganism becoming able to survive exposure to an antibiotic.

Bacteria become resistant to antimicrobial agents by developing mutations that prevent killing of the organism.  Several different methods have been identified, including production of efflux pumps that prevent the antibiotic from entering the bacteria and also modification of the target, which inhibits the drug’s binding.  These mutations make the agents completely ineffective at treating the infection and an antibiotic that is more susceptible to the organism must be prescribed for treatment.

Inappropriate Use

The inappropriateness and widespread use of antibiotics has led to these resistance patterns.  Patients, healthcare providers, and even the environment all play a role in antimicrobial resistance.  Patients who take antibiotics other than instructed (e.g. stop the treatment course early by desire, take someone else’s medication) contribute to lack of susceptibility.  Healthcare providers may also contribute to resistance by overprescribing antibiotics, especially when the infection may be viral and not bacterial.  Antibiotics are completely ineffective at treating viral infections.

The extensive use of antibiotics in livestock is widely thought to be contributing to the rise in antibiotic-resistant infections such as methicillin-resistant Staphylococcus aureus (MRSA).

In addition to published guidelines and evidence-based medicine, licensed providers should use antibiograms created by local healthcare facilities.  The antibiogram allows the practitioner to select an antibiotic with increased susceptibility relative to the surrounding population’s resistance patterns.

The use of antibiotics in food and unintended identification of these agents in drinking water are also responsible for increased resistance rates.  Antibiotics are used in animals for growth promotion and to prevent infection from occurring at the base of the food chain.  Also, large amounts of antibiotics have been found in waters, beaches, and drinking water, which then increase widespread exposure to antibiotics leading to resistance.

Decline in Research and Development

Unfortunately, there has also been a decrease in antibiotic research and development.  No new drug classes have been in late-stage development since 2009.  The last novel systemic antibiotic classes that were approved by the FDA were the oxazolidinones (linezolid, Zyvox®) in 2000 and the lipopeptides (daptomycin, Cubicin®) in 2003.

Research and development of new antibiotics is “very expensive” and – frustratingly – potential drugs might be sidelined if they cannot deliver a viable return on investment.

Few antibiotics have been approved to add to the already existing drug classes; ceftaroline (Teflaro®) was approved in 2010 and doripenem (Doribax®) was approved in 2007.  Lack of economic incentive for antibiotic development is responsible for the small number of antimicrobial drugs presented to the FDA for approval.  These drugs are less likely to generate a significant amount of profit to drug companies due to the shorter course of treatment versus maintenance medications, which are used long-term for chronic disease states.  In addition, newly approved antibiotics are usually reserved for resistant infections, which decreases the clinical indications for and the volume of prescribing, and even further decreases profits.

Increased Cost

Antibiotic resistance is associated with an increase in cost.  Many times, a patient may develop an infection and fail treatment in the outpatient setting.  Therefore, the patient must be admitted to the hospital to be treated with a more intense regimen and is then faced with high healthcare costs.  Hospital admission places patients at an increased risk of exposure to multi-drug resistant organisms leading to a severe infection, further increasing healthcare costs and patient length of stay.  Patients may also develop resistant infections that unfortunately cannot be treated.

Campaigns and Initiatives

In an attempt to decrease antibiotic resistance, the CDC has launched a campaign called Get Smart: Know When Antibiotics Work.  The campaign provides educational materials for the community to increase awareness on antibiotic resistance and appropriate antibiotic use.  The Infectious Disease Society of America (IDSA) also developed a campaign called the 10 x ’20 initiative.  The goal is to motivate research and development to produce ten new antibiotics by the year 2020.  The IDSA publishes a monthly e-newsletter, which targets Congress and explains the need for antibiotic research and development.

Decreasing antibiotic resistance is a collaborative effort that must involve patients, physicians, pharmacists, and other healthcare providers.   Part 2 of this topic: Preventing Antibiotic Resistance will discuss specifically how the involvement of both community and hospital pharmacists and patients can help reduce resistance rates. Working together as a team to address the issue can make a significant impact around the globe, ultimately improve antibiotic effectiveness and in turn lead to cost savings opportunities.

ABOUT THE AUTHORS

Dr. Heather McCormick

Dr. Heather McCormick received her Doctorate of Pharmacy from the University of Florida in May 2011, after which she completed a Post-Graduate Year 1 Residency at Holmes Regional Medical Center.  Dr. McCormick recently had the distinction of having her Residency Research paper published in the Journal of Health-System Pharmacy Residents.  In her position now as a full-time pharmacist at Holmes Regional Medical Center she is focused on providing the highest quality, safest patient-centered care possible. 

 

Dr. Stacey Baggett

Dr. Stacey Baggett is a Clinical Pharmacist at Holmes Regional Medical Center.  In addition, she is a Clinical Assistant Professor and Regional Coordinator for Experiential Education for the University of Florida College of Pharmacy.  She received her Bachelor of Science in Biochemistry from Purdue University and her Doctor of Pharmacy degree from Midwestern University in Glendale, Arizona.  Her practice interests include Infectious Disease and Student/Preceptor Development.

 


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