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Appropriate use of antibiotics: an unmet need.

Abstract

Increasing bacterial resistance combined with a steady decline in the discovery of new antibiotics has resulted in a global healthcare crisis. Overuse of antibiotics, for example, in the poultry and cattle industry, and misuse and improper prescription of antibiotics are leading causes of multidrug resistance (MDR). The increasing use of antibiotics, particularly in developing countries, is a big concern for antibiotic resistance and can cause other health threats such as increased risk of recurrent infections and increased risk of cardiovascular death with chronic use of macrolides. Carbapenems are the last line of defense in many cases of resistant infection, but trends show that resistance against these agents is also increasing. This narrative review is based on relevant literature according to the experience and expertise of the authors and presents an overview of the current knowledge on antibiotic resistance, the key driving factors, and possible strategies to tackle antibiotic resistance. Collectively, studies show that hospital-wide antibiotic stewardship programs are effective in decreasing the spread of antibacterial resistance. As resistance varies according to local patterns of use, it is essential to observe the epidemiology at both a regional and an institutional level. Furthermore, adaptation of clinical guidelines is necessary, particularly for inpatient care. Future guidelines should include a justification step for continued treatment of antibiotic treatments and criteria for selection of antibiotics at the start of treatment. Nonantibiotic prevention strategies can limit infections and should also be considered in treatment plans. Vaccines against MDR organisms have shown some efficacy in phase II trials in critical care patients. Nonimmunogenic and microbiologic treatment options such as fecal transplants may be particularly important for elderly and immune-compromised patients.

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  • Authors+Show Affiliations

    ,

    Department of Epidemiology, Christus Muguerza Health System, Monterrey, Nuevo León, Mexico.

    Clínica Ángel Foianini, Chuquisaca 766, Santa Cruz de la Sierra, Bolivia.

    Source

    Therapeutic advances in urology 11: pg 1756287219832174

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    31105775

    Citation

    López Romo, Alicia, and Rodolfo Quirós. "Appropriate Use of Antibiotics: an Unmet Need." Therapeutic Advances in Urology, vol. 11, 2019, p. 1756287219832174.
    López Romo A, Quirós R. Appropriate use of antibiotics: an unmet need. Ther Adv Urol. 2019;11:1756287219832174.
    López Romo, A., & Quirós, R. (2019). Appropriate use of antibiotics: an unmet need. Therapeutic Advances in Urology, 11, p. 1756287219832174. doi:10.1177/1756287219832174.
    López Romo A, Quirós R. Appropriate Use of Antibiotics: an Unmet Need. Ther Adv Urol. 2019;11:1756287219832174. PubMed PMID: 31105775.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Appropriate use of antibiotics: an unmet need. AU - López Romo,Alicia, AU - Quirós,Rodolfo, Y1 - 2019/05/02/ PY - 2018/10/08/received PY - 2019/01/29/accepted PY - 2019/5/21/entrez PY - 2019/5/21/pubmed PY - 2019/5/21/medline KW - antibiotic resistance KW - antibiotic stewardship KW - urinary tract infections SP - 1756287219832174 EP - 1756287219832174 JF - Therapeutic advances in urology JO - Ther Adv Urol VL - 11 N2 - Increasing bacterial resistance combined with a steady decline in the discovery of new antibiotics has resulted in a global healthcare crisis. Overuse of antibiotics, for example, in the poultry and cattle industry, and misuse and improper prescription of antibiotics are leading causes of multidrug resistance (MDR). The increasing use of antibiotics, particularly in developing countries, is a big concern for antibiotic resistance and can cause other health threats such as increased risk of recurrent infections and increased risk of cardiovascular death with chronic use of macrolides. Carbapenems are the last line of defense in many cases of resistant infection, but trends show that resistance against these agents is also increasing. This narrative review is based on relevant literature according to the experience and expertise of the authors and presents an overview of the current knowledge on antibiotic resistance, the key driving factors, and possible strategies to tackle antibiotic resistance. Collectively, studies show that hospital-wide antibiotic stewardship programs are effective in decreasing the spread of antibacterial resistance. As resistance varies according to local patterns of use, it is essential to observe the epidemiology at both a regional and an institutional level. Furthermore, adaptation of clinical guidelines is necessary, particularly for inpatient care. Future guidelines should include a justification step for continued treatment of antibiotic treatments and criteria for selection of antibiotics at the start of treatment. Nonantibiotic prevention strategies can limit infections and should also be considered in treatment plans. Vaccines against MDR organisms have shown some efficacy in phase II trials in critical care patients. Nonimmunogenic and microbiologic treatment options such as fecal transplants may be particularly important for elderly and immune-compromised patients. SN - 1756-2872 UR - https://www.unboundmedicine.com/medline/citation/31105775/Appropriate_use_of_antibiotics:_an_unmet_need L2 - http://journals.sagepub.com/doi/full/10.1177/1756287219832174?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -