WHAT IS YOUR BIGGEST CONCERN ABOUT THE MISUSE OF ANTIBIOTICS?

EDITION INQUIRY

Dr. Thor Nissen:

Everyone agrees that bacterial resistance is the most serious danger, and the reason why antibiotic use is being monitored more and more closely as time goes by. The COVID-19 pandemic has intensified this concern. The British Medical Journal recently published an article that summarizes the major alarms this viral disease is provoking. Antibiotics clearly have no effect on the causing agent, so mild cases are not indicated for antibiotic use. For those patients with progressive signs and symptoms that indicate severe cases, the risk of secondary bacterial infections and even death is present. Unlike other viral diseases, whose epidemiology and opportunistic infections are well characterized, there is a great deal of confusion and uncertainty regarding COVID-19 treatment protocols. Treating physicians have to strike a balance between the use of antibiotics in this environment and the risks of misuse, keeping up-to-date with emerging news on how and when to prescribe them.

M. en C. Aurora Escoto de Dios:

The major concern about the misuse of antibiotics is the serious problem of antimicrobial resistance. The excessive and inappropriate use of antimicrobials and the loss of their effectiveness against multiple microorganisms causes treatment failure. Another important sign of the serious problem of antimicrobial resistance is the emergence of multidrug-resistant bacteria, which are insensitive to various types of antibiotics. Examples of these “superbugs” are, among gram-positive bacteria, Staphylococcus aureus, which is resistant to oxacillin and vancomycin, Enterococcus spp., which is resistant to vancomycin, and among gram-negative bacteria, Klebsiella spp., which is resistant to third-generation cephalosporins.(1, 2)

Multidrug-resistant bacteria are spread from patient to patient by fomites. What can cause problems, however, is when they colonize people with weakened immune systems, cancer, etc., which can then be life-threatening. According to the World Health Organization, new resistance mechanisms are emerging. These are spreading globally and have jeopardized our ability to treat common infectious diseases, increasing mortality and prolonging illness. Without effective antimicrobials, interventions such as organ transplantation, infections in patients with cancer and/or diabetes, and major surgeries would become very high-risk procedures.(3)

1. B. Spellberg, R. Guidos, D. Gilbert, J. Bradley, H. Boucher, M. Scheld, et al., “The epidemic of antibiotic-resistant infections: A call to action for the medical community from the Infectious Diseases Society of America.” Clin Infect Dis, 2008; 46:155-164. 2. Knothe H., P. Shah, V. Kremery, M. Anatal, and S. Mitsuhashi, “Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens.” Infection, 1983; 11: 315-317. 3. World Health Organization, “Global action plan on antimicrobial resistance” (‎2016)‎: available online at <https://apps.who.int/iris/ handle/10665/255204>.