PhotoBacteria are getting stronger and more resistant to the miracle drugs that have fought infection and saved millions of lives over the last few decades.

The World Health Organization (WHO) has blamed the prevalence of antibiotics in the environment, with doctors overprescribing the drugs and livestock producers using too many of them in animals. Some healthcare providers may have cut back on the use of the drugs, but two studies suggest there's room for improvement.

Researchers at the University of Georgia have identified sinus infections as the biggest reason doctors write a prescription for antibiotics. They contend, however, that bacteria cause only about a third of sinus infections, so many patients are taking the drugs unnecessarily.

Bacterial vs. viral

“A lot of the signs and symptoms of a bacterial sinus infection can be similar to those of a viral respiratory infection,” said University of Georgia researcher Mark Ebell. “It can be difficult to distinguish between the two just using individual signs and symptoms.”

So Ebell developed new rules for diagnosing sinus infections, or acute rhinosinusitis. The rules integrate patient symptoms and lab tests to accurately detect when bacteria is the cause of the infection.

“We need to give physicians better tools to support their decision-making, and that can include clinical decision rules and point of care tests,” Ebell said. “Using these kinds of tools, we can hopefully reduce unnecessary antibiotic use.”

When patients are prescribed antibiotics, they are instructed to take all of the pills as directed, even if their symptoms disappear and they are feeling better. That's been the standard for decades.

Researchers writing in the British Medical Journal suggest that's a misguided policy that might be contributing to antibiotic resistance.

Reducing unnecessary use

"The relation between antibiotic exposure and antibiotic resistance is unambiguous both at the population level and in individual patients," the authors write. "Reducing unnecessary antibiotic use is therefore essential to mitigate antibiotic resistance."

The study suggests stopping antibiotic treatment before the entire amount of medication has been taken does not appear to increase antibiotic resistance. On the other hand, they say taking antibiotics for a longer period than necessary could contribute to the problem. Patients prescribed antibiotics, however, should continue to follow their doctor's instructions.

The WHO says antibiotic resistance is "one of the biggest threats to global health, food security, and development today." It has found that a growing number of infections, including pneumonia, tuberculosis, and gonorrhea have become harder to treat because they are becoming resistant to antibiotics.


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