Resistance to Antimicrobial Medicines

Background

Resistance to Antimicrobial Medicines is an increasingly serious public health problem in Europe and the rest of the world.  In many countries, resistance rates keep on creeping up. Especially in Asia, multiresistent strains emerge in cattle that are even no longer sensitive for any of the existing antibiotics.These bacterial strains can (and in fact do) infect humans as well.

Antibiotic exposure of bacteria leads to emergence of resistance to antimicrobial medicines. Primary care accounts for about 80 to 90% of all antibiotic prescriptions, and communicating with patients is key for controlling the development of resistance in humans. Professional advice impacts patients’ perceptions and attitude towards their illness and perceived need for antibiotics. (source: Antimicrobial Resistance fact and figures, ECDC). Pharmacists in community and hospital can have an important role, because during dispensing they can control the relevance of antibiotic use, and also can enhance the adequate use by the patient. The role of the pharmaceutical industry in dealing with this problems seems ambivalent. They want to contribute to the prevention, but in practice they stimulate the sales of all antibiotics, and pollute whole rivers with high concentrations of antibiotics (see Rotthier and Gharabaghi).

Background material for reading

General reading

In 2015, a series of articles in the Lancet examined the access and sustainable effectiveness of antimicrobials. Below you find the links to most of the papers. The first two papers provide an insight into the mechanisms and drivers of antimicrobial resistance, its disease burden, and the potential effect of vaccines in restricting the need for antibiotics. If you click a link, you must nevertheless login to get the papers for free.

• Pamela Das, Richard Horton. Antibiotics: achieving the balance between access and excess (free)
• Timothy P Robinson, Heiman F L Wertheim, Manish Kakkar, Samuel Kariuki, Dengpan Bu, Lance B Price. Animal production and antimicrobial resistance in the clinic  (free)
• Nazira Abdula, James Macharia, Aaron Motsoaledi, Soumya Swaminathan, Krishnaswamy VijayRaghavan. National action for global gains in antimicrobial resistance  (free)
• Ramanan Laxminarayan, Precious Matsoso, Suraj Pant, Charles Brower, John-Arne Røttingen, Keith Klugman, Sally Davie. Access to effective antimicrobials: a worldwide challenge  (free)
• Alison H Holmes, Luke S P Moore, Arnfinn Sundsfjord, Martin Steinbakk, Sadie Regmi, Abhilasha Karkey, Philippe J Guerin, Laura J V Piddock. Understanding the mechanisms and drivers of antimicrobial resistance  (free)
• Osman A Dar, Rumina Hasan, Jørgen Schlundt, Stephan Harbarth, Grazia Caleo, Fazal K Dar, Jasper Littmann, Mark Rweyemamu, Emmeline J Buckley, Mohammed Shahid, Richard Kock, Henry Lishi Li, Haydar Giha, Mishal Khan, Anthony D So, Khalid M Bindayna, Anthony Kessel, Hanne Bak Pedersen, Govin Permanand, Alimuddin Zumla, John-Arne Røttingen, David L Heymann. Exploring the evidence base for national and regional policy interventions to combat resistance (free)
•  Christine Årdal, Kevin Outterson, Steven J Hoffman, Abdul Ghafur, Mike Sharland, Nisha Ranganathan, Richard Smith, Anna Zorzet, Jennifer Cohn, Didier Pittet, Nils Daulaire, Chantal Morel, Zain Rizvi, Manica Balasegaram, Osman A Dar, David L Heymann, Alison H Holmes, Luke S P Moore, Ramanan Laxminarayan, Marc Mendelson, John-Arne Røttingen. International cooperation to improve access to and sustain effectiveness of antimicrobials (2015) (free)
• Karl M F Rotthier, Mansur P. Gharabaghi. How the pharmaceutical industry is contributing to antimicrobial resistance (2015). (free)

Studies on resistance in Europe

• Cars O, Mölstad S, Melander A. Variation in antibiotic use in the European Union. Lancet 2001;357(9271): 1851-53 (not free)
• Goossens H,  Ferech M, Vander Stichele R, Elseviers M, for the ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365(9459): 579-87 (not free)
• Väänänen MH, Pietilä K, Airaksinen M. Self-medication with antibiotics--does it really happen in Europe? Health Policy 2006;77(2):166-71 (not free)
• European Surveillance of Antimicrobial Consumption Network (ESAC-Net) [website]. Stockholm: European Centre for Disease Prevention and Control; 2014 (last accessed 11-2015) (free)

Pharmacy and antibiotic resistance

• FIP statement of Policy (2008): Control for Antibiotics Medicines Resistance (free)
• PGEU Policy Statement on antibiotic resistance (2009) (free)
• The role of pharmacist in encouraging prudent use of antibiotics and averting antimicrobial resistance: a review of policy and experience (WHO Europe, 2014) (free)
• ASHP statement on the pharmacist’s role in antimicrobial stewardship and infection prevention and control (ASHP, USA, 2010) (free)
• Dickerson LM, Carek PJ. The pharmacist’s role in promoting optimal antimicrobial use. Pharmacotherapy 2000;20(6):711-23 (not free)
• Roque F, Soares S, Breitenfeld L, Lopez-Duran A, Figueiras A, Herdeiro MT. Attitudes of community pharmacists to antibiotic dispensing and microbial resistance: a qualitative study in Portugal. Int J Clin Pharm 2013;35:417-24 (not free)

Possible useful links

• WHO Antimicrobial resistance