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Can better prescribing turn the tide of resistance?

Nature Reviews Microbiology volume 2, pages 73–78 (2004)Cite this article

Abstract

In the wake of concerns about the level of antibiotic resistance, governments worldwide are pressing for reduced antibiotic use, hoping thereby to reverse resistance trends. Is success likely? The evidence is mixed, and expectations should be tempered by the growing realization that many resistant bacteria are biologically fit, making them difficult to displace. If resistance is unlikely to be reduced significantly by changing prescription practices, how can clinicians outpace increased resistance, particularly when much of 'big pharma' is abandoning antibiotic development?

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Figure 1: Resistance trends among bacteraemia isolates in Europe (1999–2002).
Figure 2: Macrolide prescribing trends and macrolide resistance trends in Streptococcus pyogenes in Finland.
Figure 3: Sulphonamide prescribing trends in the United Kingdom.

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Acknowledgements

The author is grateful to many colleagues past and present whose collaboration has enabled his own work and the development of the views expressed here.

Author information

Authors and Affiliations

  1. Specialist & Reference Microbiology Division, Antibiotic Resistance Monitoring & Reference Laboratory, Health Protection Agency, London, NW9 5HT, UK

    David Livermore

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  1. David Livermore
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Ethics declarations

Competing interests

D. Livermore, and his laboratory staff, are employed by the Health Protection Agency, and so have an interest in it's (and ultimately the state's) continued interest in resistance. He has received sponsorship and research grants from numerous pharmaceutical, biotech and diagnostics companies. Directly, or as attorney, he manages personal and family shareholdings, including in pharmaceutical companies.

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FURTHER INFORMATION

EARSS

Glossary

COMMUNITY PRESCRIBING

The prescription of antibiotics outside hospitals.

BACTERAEMIAS

A bacterial infection of the bloodstream.

COMMUNITY-ACQUIRED INFECTIONS

An infection that is acquired outside of a hospital.

EPIDEMIC CLONES

Bacterial strains that have spread widely among communities or hospitals.

FORMULARY CHANGE

A change to standard therapies in hospitals.

EMPIRICAL ANTIBIOTIC TREATMENT

A treatment that is based on the pathogens that are likely to be present on the basis of the clinical condition, but before confirmation by culturing bacteria in the laboratory.

STEP-DOWN THERAPY

A switch from powerful to less powerful antibiotics — for example, because the patient is recovering well or a highly sensitive pathogen has been isolated.

COMPENSATION

Adaptations or mutations that enable bacteria to adjust to the fitness burden that is caused by acquired resistance.

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Livermore, D. Can better prescribing turn the tide of resistance?. Nat Rev Microbiol 2, 73–78 (2004). https://doi.org/10.1038/nrmicro798

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