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Antibiotic Overuse – how much does it matter?

Antibiotic Overuse – how much does it matter?. Thursday 1/17/08 . Spread of resistance. Antibiotic pressure. Human to human transmission. Mechanisms by which Antibiotic use can induce resistance. Lipsitch & Samore EID 2002.

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Antibiotic Overuse – how much does it matter?

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  1. Antibiotic Overuse – how much does it matter? Thursday 1/17/08

  2. Spread of resistance Antibiotic pressure Human to human transmission

  3. Mechanisms by which Antibiotic use can induce resistance Lipsitch & Samore EID 2002

  4. Antibiotic selection of resistant mutants Ab treatment => outgrowth of resistant subpopulations or acquire de novo resistance

  5. Antibiotic pressure => increased load or resistant bacteria

  6. By eradicating a susceptible strain making the host more susceptible to new acquisition of strains

  7. Indirect effect – reduced transmission of susceptible strains to other susceptible hosts

  8. Antibiotics are drugs with externalities (like pollutants) • By treating an individual with antibiotics – other individuals in the society are influenced • Antibiotic treatment – maybe beneficial for an individual but deleterious for society.

  9. Types of studies that examine the relationship between Ab use and Ab resistance • Ecological studies • Individual level studies • Case-control • Quasi-experimental studies • Longitudinal studies • Mathematical models

  10. Total Ab use in 26 European countries in 2002/ Goosens et al. Lancet 2005

  11. Total Ab use in 2004 / Goosens CID 2007

  12. Correlation between Pen use and PRSP / Goosens et al. Lancet 2005

  13. Do all antibiotic classes induce resistance similarly?The pneumococcus paradigm / Dagan et al. PIDJ 2006

  14. Antibiotic use as a risk factor for MRSA (in ED)/ Moran et al. NEJM 2006

  15. Antibiotic consumption and MRSA, an ecologic study (EID 2004)

  16. FQ use and FQ-R MRSA and E. coli (community and HA)/ MacDougall et al. CID 2005

  17. Is there overuse/non-judicious use of antibiotics? • ~50% of Ab prescriptions are non-judicious • What is non-judicious use? • Ab for viral infections • Wrong dose • Wrong duration • Wrong Ab class • Broad ab class when narrow is as good

  18. Why is there non-judicious use? • Lack of knowledge • Patient demand • Uncertainty (of Dx, of risks and benefits) • Medico-legal issues – fear from lawsuit • Low awareness to Ab resistance problem

  19. Effect of antibiotic use in agriculture • Over 50% of Ab produced in US are used for agricultural purposes • Use for growth promotion and treatment of food animals • FQ used to treat chicken: • Identical strains of FQ-R Campylobacter found in raw chicken as those in humans

  20. Agriculture use and Ab resistance: Quantifying the effect • Animal use can be a selective force responsible for the assembly of resistant gene clusters • Reservoir for resistance-encoding plasmids (or other genetic elements) in animal commensal bacteria • Bacteria that are shared by food animals and humans (VRE).

  21. Is it not too late? • Regulation now may have little or no effect. • Waiting for conclusive evidence may result in a missed opportunity to prevent damage!

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