Can civilization recover from antibiotic resistance?
Perhaps current generations are doomed when it comes to using antibiotics to fight disease caused by bacteria, but there seems to be a chance that such a fight can still be leveled.
Antibiotic resistance has become a nightmare in recent years. Every year, hundreds of thousands of people die worldwide because the abuse of these drugs has made many microorganisms immune.
The good news is that if the pressure of antibiotics on microbes decreases, the resistance is reversible and bacteria tend to lose their immunity.
According to a study coming from Spain, antibiotics become effective again if primary care prescription is reduced or completely avoided.
The study published in The Lancet Infectious Diseases magazine demonstrates how better use of antibiotics – not prescribing unnecessary ones and choosing those that have the least ecological impact when they are prescribed at primary care centers.
Some studies had pointed it out in the hospital setting, but it is the first time that research done on a population of two million patients shows how the efficacy of antibiotics can be recovered at the community level.
Preparation and observation periods prepared health professional to take practices to the rest of the population
The research has been carried out in four health districts in the region of Andalusia and in its 214 health centers, including five hospitals for a period of 6 years.
The first two years served to prepare the intervention and the next four to implement the measures and monitor the results. Nearly 1,400 physicians – some 1,100 family doctors and 271 pediatricians – held clinical consultations and training sessions five times a year in which they analyzed their prescription habits with a team of microbiologists, infectologists, epidemiologists and pharmacists.
The ailment chosen for the research were urinary tract infections caused by Escherichia coli, a common and even beneficial bacterium in the intestinal flora but of which the subtype called “producers of extended-spectrum beta-lactamases (ESBL) has demonstrated an increased virulence in the urinary tract.
This enzyme breaks down the antibiotics of first choice and makes them inane, forcing the use of so-called carbapenem, which in turn makes other bacteria also resistant to them.
The European Center for Disease Control and Prevention (ECDC) has warned of the “very worrying” scenario that this draws since carbapenem “is the last available treatment and when they are not effective, it is extremely difficult or impossible to treat infections”.
Researchers found abusive and inadequate prescription of antibiotics
Researchers monitored prescriptions of seven of the most common antibiotics and in parallel, Escherichia coli, involved in more than 37,000 infections.
The results show a significant reduction in the inadequate prescription according to clinical guidelines – from 36.5% to 26.3% – and a decrease in the consumption of antibiotics such as ciprofloxacin (-15.9%), cephalosporin (-22, 6%) and the combination of amoxicillin and clauvonic acid (-2.2%). In return, amoxicillin alone (22.2% more) and fosfomycin tromethamine (6.1%) increased.
“There is a notable decrease in antibiotics with a greater ecological impact on bacteria, which are those that favor resistance, and better use of the most accurate and adequate,” the report explains.
At the same time, the isolates showed that the proportion of Escherichia coli producers of ESBL was reduced from 7.1% to 5.5%, almost a third less.
In fact, the results are more promising because the incidence of resistant bacteria came from a sustained upward trend that the program managed to reverse: “On the expected values, we have achieved a reduction of 65.6%,” explain the study authors.
The virulent winter flu season of 2015, with a 21% increase in cases, had a negative impact on the results. The treatment of the disease, caused by a virus, does not require antibiotics, but several of the complications that it usually causes. That peak caused a notable temporary increase in the use of all antibiotics, which has somewhat mitigated the progress made.
The study has discovered more areas for improvement: “The fact that the program did not include training actions for patients or improving the communication skills of doctors is one of its weaknesses,” says the article, which highlights that the combination of these strategies “offers better results in the prescription of antibiotics”.
The good results obtained in the experiments have led its promoters to extend them now to “the entire public primary care network of Andalusia” and to also incorporate “doctors, pharmacists, and dentists of private health”, concludes the article.
The research, which has received funding from the Carlos III Health Institute, is part of the Comprehensive Program for the prevention and control of infections related to health care and the appropriate use of antimicrobials.