In this section, you'll find information on antibiotic resistance for physicians, nurses, public health professionals and others practicing in community-based settings in Massachusetts .
At the end of this section, you'll find additional resources with more information and articles about antibiotic resistance for healthcare professionals. In addition, you'll find more information about treating viral respiratory infections at: www.massmed.org/antibiotics.
- What is antibiotic resistance?
- Why should healthcare providers be aware of the problem of antibiotic resistance?
- What are some infections that are caused by bacteria that are resistant to common antibiotics?
- How can I help prevent antibiotic resistance?
Antibiotic resistance occurs when bacteria are subjected to environmental pressures (e.g., presence of an antibiotic) and are selected for preferential survival as a new genetic variant of the organism. Genes conferring resistance may be acquired in several ways: 1) the bacterial DNA may mutate, 2) bacteria may exchange DNA with other bacteria, through several mechanisms or 3) plasmids can move from one bacterium to another, directly or via bacterial viruses (phages). The overuse and misuse of antibiotics creates the selective pressure for resistant bacteria.
According to the National Institutes of Health "after more than 50 years of widespread use, many antimicrobials are not as effective as they used to be. Over time, widespread use of antibiotics is thought to have spurred evolutionary adaptations that enable bacteria to survive these powerful drugs. Antimicrobial resistance provides a survival benefit to microbes and makes it harder to eliminate infections from the body. Ultimately, the increasing difficulty in eliminating microbes leads to an increased risk of acquiring infections in hospitals or other settings. Heavy use of antibiotics in critically ill patients selects for changes in bacteria that bring about drug resistance. Unfortunately, this worsens the problem by producing bacteria with greater ability to survive even in the presence of our strongest antibiotics" (April 2006). Antibiotic use in animal husbandry may also contribute to this problem.
- Because antibiotic resistance can cause treatment failure:
- Infections caused by resistant microbes may fail to respond to treatment, resulting in prolonged illness and greater risk of complications or death.
- Treatment failure can also lead to longer periods of infectivity, which can increase the potential for transmission.
- Because healthcare providers can exacerbate the problem by prescribing antimicrobials when they are not necessary.
- Because patients may not understand the problem of antibiotic resistance:
- Patients may expect or even demand antibiotics, even when antibiotics are not indicated, such as with
- Most sore throats
- Most cough illnesses
- Patients may not take antibiotics as prescribed, leading to persistence of organisms and selective pressure of low, sub-inhibitory concentrations of antibiotics.
- Because the problem of antibiotic resistance is growing:
- Many important pathogenic microorganisms are becoming resistant to the most commonly prescribed and currently effective microbials.
- Antibiotic resistance is an especially difficult problem in healthcare settings because of the risk of transmission with the close proximity of potentially vulnerable patients.
- Some antibiotic resistant organisms (e.g., MRSA) that were once largely found in long-term care and hospital settings are now being identified among patients with no direct connection to hospitals and long-term care. This creates challenges for diagnosis and treatment.
- Because antibiotic resistance is expensive:
- In addition to the costs associated with increased morbidity and mortality, when infectious agents become resistant to first-line antimicrobials, treatment may require second- or third-line drugs, which may be more expensive and possibly more toxic.
|Appropriate use of antibiotics is key to controlling the spread of resistance.|
The following organisms have become resistant to certain common antibiotics. As a result, the infections caused by these organisms may now be more challenging to diagnose and/or treat than in the past:
- Staphylococcus aureus
- Methicillin-Resistant <em>Staphylococcus aureus</em> (MRSA)
- Vancomycin-Intermediate Staphylococcus aureus (VISA)
- Vancomycin-Resistant Staphylococcus aureus (VRSA)
- Mycobacterium tuberculosis (tuberculosis)
- CDC's Plan to Combat Extensively Drug-Resistant TB (MMWR 2009)
- CDC Fact Sheet on Multidrug-Resistant TB | PDF
- CDC Fact Sheet on Extensively Drug-Resistant TB (XDR-TB) | PDF
- CDC's Role in Preventing XDR-TB | PDF
- MMWR Article (3/23/2007) on XDR-TB in the US
- World Health Organization Tuberculosis Site
- MDPH Tuberculosis Prevention and Control Program
- Neisseria gonorrhoeae (gonorrhea)
- Enterococcus species
- Vancomycin Resistant Enterococci (VRE)
- Streptococcus pneumoniae
- Penicillin resistant Streptococcus pneumoniae
- Macrolide resistant Streptococcus pneumoniae
Talk to your patients about antibiotic resistance.
Educate patients to:
- Not skip doses.
- Complete the prescribed course of treatment-even if they are feeling better.
- Be aware of the expected response to treatment and notify you if that expected response is not occurring.
- Notify you if they do not feel better after completing the prescribed course of treatment.
- Discard any leftover medication once they have completed the prescribed course of treatment.
- Understand when antibiotics are effective and when they are not.
- Refrain from taking antibiotics prescribed for someone else.
When patients request (or even demand) antibiotics that are not indicated:
- Recommend therapy that is specific to symptoms.
- Offer a contingency plan if symptoms worsen or fail to improve.
- Take time to explain the diagnosis and answer questions. Effective communication can reduce patient anxiety and increase patient satisfaction.
- Educate patients and provide educational materials on appropriate antibiotic use.
Encourage patients to:
- Practice good hygiene habits to avoid infections, especially during cold and flu seasons
- Cover their mouths and noses with a tissue when coughing or sneezing
- Wash hands often, especially after coughing or sneezing
- Avoid touching their eyes, nose or mouth
- Avoid close contact with people who are ill, when possible
|When a Parent Insists on Antibiotics for a Virus (Am Fam Physician. 1999 Feb 1;59(3):687-8.)|
For more information concerning how to educate patients, see the links under Patient/Provider Education below.
For more information about antibiotic resistance, visit:
- Centers for Disease Control and Prevention. Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
- Centers for Disease Control and Prevention. Clinical Guidelines
- Centers for Disease Control and Prevention. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008
- National Institute of Allergy and Infectious Diseases
- National Library of Medicine. Antibiotics Page
- World Health Organization. Overcoming Antimicrobial Resistance
- World Health Organization. Antimicrobial Resistance Information Bank
- United States Food and Drug Administration
Patient and Provider Education Materials
CDC Campaign to Prevent Antimicrobial Resistance in Healthcare Settings
CDC Get Smart Campaign
Reducing Antibiotics for Children (REACH)
Washington State's Campaign to Fight Antibiotic Resistance