Penicillin was introduced in the 1940’s, and since the use of antibiotics (drugs that are antifungal and antibacterial) have become everywhere as many of the infections that have been posing threats that are immediate to the life of humans are now being treated readily. However, this extensive antibiotics use has led to consequences that are not desirable due to overuse. One of the consequences is the lethal side effects that are occasional and unpleasant that comes due to the changes in the normal microbial flora (Laxminarayan, 2010). An example is the overgrowth of the vaginal yeast for women as a consequence of the treatment they may be receiving from urinary infections and respiratory with antibiotics that are conventional.
There is a problem that is more serious that has emerged in the recent epidemics of the intestinal infections that are associated with antibiotics called Clostridium difficile and it is becoming more difficult to treat as its progressing more and has complications like removal of the colon surgically or even death (McCaig,2010). This rare organism that is producing toxins is now the enteric pathogen that is the most frequent in the countries that are developed and has the ability of proliferating levels that are clinically problematic as the ecological balance of the microbes that are in the colon are disturbed.
These consequences that are undesired and which have been reported in stories in the news and attracted discussions in the health care policy forums are due to the emergence resistance of bacterial that is due to the overuse of antibiotics with the pathogenic strains evolving and spreading as the treating drugs have lost their susceptibility. There is continued introduction of each antibiotic that is new and at the same time, the forces that are biological of the random mutations and natural selection are leading to resistance strains emerging and that are being sustained by the use of the drugs that is continuing as well. These new strains that resist to bacteria that are resistance to the classes of antibiotics that are multiple have the risks or morbidity and mortality increased in the infections that are acquired in the hospitals thus leading to long hospital stays and costs of treatment that are high (McCaig, 2010). This appearance and the resistances that have been persistence has led to an arm race between evolution and chemistry with a need to develop that is never-ending of bringing to the markets new antibiotics that are even more costly to treat the infections that are more resistant progressively thus making the problem at hand even more worse.
The epidemiologists and the public health officials have based their view of this resistance as ecologic meaning that its effect is from the events and the behaviors that are remote in distance and in time. An example is there is entry of resistance antibiotics in the farm animals through the antibiotics that are administered in them and these then enter the food webs. The entry is then direct from consuming animal products or else indirect through the contamination of water supply by runoffs and then spread to the humans with the resistance genes spreading to the bacteria that are responsible for diseases in humans.
The aggressive use of broad-spectrum antibiotics in the clinical settings can have favor on the emergence of bacteria that are resistant spreading in and between the health care organizations rapidly. In this setting, the use of antibiotics is intentioned well with some of the uses of antibiotics coming as a results of the choices that are made and which concern management of farms like overcrowding of animals and also the health care hygiene that is inconsistent like the failure to proper hand washing (Laxminarayan, 2010).
The other perspective has the expansion of the resistance being viewed by the clinicians who are on the front line in a different way. There has been a grapple with the problem by the doctors in the context of individual patients being cared for with the resistance of antibiotics being viewed as a threat to the therapeutic success. The primary obligation of the physicians is perceived not to be to the commons but to the individual patients. This means that even the possibility of a patient having exposure to the prophylaxis or having resistance organisms infections or treatments then there is an obligation by the physicians to give a prescription of an antibiotic that has the likelihood of counteracting the possibly resistant strain. This in turn has results to selections and prescriptions that are ongoing leading to the broadest and the higher levels of resistance.
There is a general believe by the physicians that the prescribe antibiotics appropriately regarding their clinical practices and the diagnosis of the individual patient but it is perceived that there is a proportion of antibiotics that are inappropriately prescribed in the United States and other countries. There have been perceptions on the increasing prescriptions of broad-spectrum antibiotics and this trend hold despite the indication for the treatment by the antibiotic or the type of infection (Carter, 2011). This has made worse the evolving of the genes that are resistance in one group of bacteria spreading to bacteria that are related distantly through gene transfer that is horizontal.
Use of antibiotic that is judicious has the emergence of resistance delayed and there are debates on whether the reversal of the excessive use reduces resistance. In context to this, there are two studies that are uncontrolled that have been cited in justification of the current over prescription of antibiotics being modified. One suggests that the reduction in the use of macrolides that are a class of antibiotics had an association with decrease in the resistance of erythromycin among the Group A streptococci. The other one suggested that the reduction in cotrimoxazole and macrolides use had an association in the reduction that was 10% in penicillin resistance in Salmonella Pneumoniae (Carter, 2011).
There are factors that may play roles making determinations on whether there can be reversal of the established patterns of resistance being reduced and the reversal of the virulence of the strains that are resistance. These include; lack of substitutions, continuing selection by other drugs, the fitness costs, extent and the duration of reduction (McGowan, 2013). Even when the use is decreased, the resistance may not decrease but then it can be at lease expected that the rise of resistance will slow and this is a goal that is worthwhile in itself.
A major focus has been there on the guidelines for the antimicrobial therapy by the professional societies who have interests in the diseases that are infectious. These guidelines have benefits, those of provision of expert recommendations that are operationalized as decisions tress that are structured to the pharmacists, the practitioners, and the formulary committees (McGowan, 2013). With the mechanisms of drug selection that are heterogeneity being in place, these guidelines outline the selections of antibiotics that are the first line and there is provision of level of administrative control that is minimum over the specific agents being selected.
The professional guidelines that are concerned with the therapy of antibiotics do not limit the decisions specifically in treating and the decisions to treat are not limited. There is an important step that has been taken by the surgeons as they refine their use of antibiotics prophylatically. There is establishment of performance measures for administration of antibiotics preoperatively that is appropriately and timely selected by the Surgeon Care fImprovement Project and its successor (Bratzler, 2011). This audit has suggested that there is a substantial improvement in the performance in the predictable elective preoperative setting. There is encouragement by the government of the United States on the surgical teams optimizing the administration of antibiotics through the incentives that are pay-for-performance.
The norms on the prescribing behaviors can be changed or modified but there will be persisting concerns within each specific physician-patient relationship that norms that are shifting to favor lower prescribing might lead into denial from these patients who are in actual need of the antibiotics. With these constraints, the strategy that maybe the most effective and the initial one in the reduction of resistance of antibiotics to do their overuse would be focusing in preventing the transmission or organisms that are resistance. The reduction of the transmission will mean that whatever present strains that are resistant then they should cause infections that are reduced (Bratzler, 2011). The other strategy is by use of strict infection control efforts so as to have the resistance organisms targeted deliberately as has been the case of the search and destroy that has been highly successful in Netherlands for Staphylococcus aureus that is methicillin-resistance (Vos MC, 2009). In contrast to the modifications on the use of antibiotics, there is no involvement of tradeoffs by these interventions between the well being of the individual and resistance risk to others but in general there is a benefit for all the patients from the reductions in the transmissions.
Laxminarayan R, Malani A (2010) Extending the cure: policy responses to the growing threat of antibiotic resistance. Washington DC: Resources for the Future
Carter RJ, Sorenson G, Heffernan R, et al.( 2011) Failure to control an outbreak of multidrug-resistant Streptococcus pneumoniae in a long-term-care facility: emergence and ongoing transmission of a fluoroquinolone-resistant strain. Infect Control Hosp Epidemiol;26:248’255
McCaig LF, Besser RE, Hughes JM.(2010) Antimicrobial drug prescription in ambulatory care settings, United States, 2002’2010 Emerg Infect Dis;9:432’437.
McGowan JE. (2013)Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis;5:1033′ 1048
Bratzler DW, Hunt DR.(2011)The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis;43:322’330
Vos MC, Ott A, Verbrugh HA, et al.(2009) Successful search-anddestroy policy for methicillin-resistant Staphylococcus aureus in The Netherlands. J Clin Microbiol;43:2034’2035.
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