Lauri A. Hicks
DO, Director, Office of Antibiotic Stewardship, Centers for Disease Control and Prevention
In health care, antibiotics are one of the most powerful drugs for fighting life-threatening bacterial or fungal infections. However, too many antibiotics are being used unnecessarily and misused, which threatens the usefulness of these important drugs.
Antibiotic resistance is one of the greatest public health challenges of our time as there are limited treatment options available for people infected with antibiotic-resistant bacteria or fungi.
Antibiotic resistance jeopardises advancements in modern health care that we have come to rely on, such as joint replacements, organ transplants and cancer therapy. These procedures and treatments have a significant risk of infection and patients won’t be able to receive them if effective antibiotics are not available.
What causes antibiotic resistance?
Antibiotic resistance happens when the germs no longer respond to the antibiotics designed to kill them. That means the germs are not killed and continue to grow. It does not mean our body is resistant to antibiotics.
Bacteria and fungi are constantly finding new ways to avoid the effects of the antibiotics used to treat the infections they cause. Infections caused by antibiotic-resistant germs are difficult, and sometimes, impossible to treat.
Antibiotic resistance occurs naturally and is not a new problem. In fact, in 1942, one year after penicillin was introduced, resistant Staphylococcus aureus, Streptococcus pneumoniae and gonorrhea were reported.
But antibiotic resistance is accelerated when germs are exposed to antibiotics and when those germs spread. Therefore, antibiotics should be used only when necessary and only for appropriate durations.
Antibiotic resistance happens when the germs no longer respond to the antibiotics designed to kill them.
Antibiotic use during the pandemic
Antibiotics are not effective against COVID-19, because antibiotics do not treat infections caused by viruses. Antibiotic use varied across healthcare settings during the pandemic:
- In hospitals, antibiotic use increased for some specific antibiotics like azithromycin and ceftriaxone, which are often used to treat community-onset respiratory infections. This use likely reflects difficulties in distinguishing COVID-19 from community-acquired pneumonia caused by bacteria when patients first arrive for inpatient healthcare.
- In outpatient settings, such as doctor’s offices, antibiotic use has dropped significantly. This is likely because outpatient healthcare use declined during the pandemic. Azithromycin prescribing was higher than expected, especially in geographic areas with high numbers of COVID-19 cases. This might be a reflection of its early promotion as a potential therapy, despite its ineffectiveness against viruses.
- In nursing homes, antibiotic use spiked with changes in the pandemic, but remains lower overall compared to pre-pandemic measurements. In nursing home settings, azithromycin prescribing remained elevated through October 2020.
Another way to improve antibiotic use is through vaccination. Vaccines are one tool to improve antibiotic use and prevent infections, including resistant infections. Getting vaccinated for illnesses like COVID-19 and the flu helps prevent hospitalisations and secondary bacterial infections, reducing antibiotic treatment.
How to help reduce the threat of antibiotic resistance
Protect yourself and patients from antibiotic resistance:
- Prescribe antibiotics following clinical and treatment guidelines.
- Use diagnostic tests (when available) to guide antibiotic therapy, including correct drug, dose, and duration.
- Keep your hands clean by handwashing or using hand sanitizer.
- Follow infection prevention and control guidelines.
- Educate patients on when antibiotics are and are not needed.
- Get recommended vaccines and encourage patients to do so, too.
Appropriate antibiotic use helps fight antibiotic resistance and ensures these lifesaving drugs will be available for future generations. Everyone has a role to play.