Overview of strategies for overcoming the challenge of antimicrobial resistance

Abstract

The discovery of penicillin undoubtedly transformed the management of life-threatening bacterial infections. However, a less comfortable aspect of the antibiotic revolution was that within 10 years, over 80% of patients with acute bronchitis were receiving antibiotics without any evidence of clinical benefit. Antibiotic use inevitably causes collateral damage to the normal human flora and increases the risk of infection with antibiotic-resistant bacteria and Clostridium difficile. The twin aims of antibiotic stewardship are first to ensure effective treatment for patients with bacterial infection and second to provide convincing evidence and information to educate and support professionals and patients to reduce unnecessary use and minimize collateral damage. We review evidence of progress with these aims in Europe and nationally in Scotland.

Keywords::

• antibiotic stewardship
• antimicrobial management team
• antimicrobial resistance
• behavioral interventions
• Clostridium difficile infection
• collateral damage
• near-patient testing
• sepsis

Acknowledgements

The authors are grateful to Andrea Patton, Information Analyst for the Scottish Antimicrobial Prescribing Group, William Malcolm, Pharmaceutical Adviser, Health Protection Scotland and Tracey Cromwell, Information Analyst for National Services Scotland, for the data used forFigures 6 & 7. We are grateful to the other members of the Scottish Antimicrobial Prescribing Group for their support for the work described in the ‘Targets for antibiotic stewardship at the national level’ section.

Financial & competing interests disclosure

Peter Davey has received research funding from Johnson & Johnson and Pfizer and has been a member of an Advisory Board for Wyeth, all of who produce anti-infectives. He has received no fees or financial support in undertaking work related to this manuscript. Dilip Nathwani has received honoraria for serving on advisory boards or speaking at symposia supported by Wyeth, Pfizer, Astellas, Jonhson & Johnson and Novartis, all of which produce anti-infectives; he has received research funds from Bayer. He has received no fees or financial support in undertaking work related to this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Adapted from [18] and [3].

Adapted from [18].