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Guide Health: Antibiotic stewardship – it’s everyone’s job

As many as half of the 25 million prescriptions written for antibiotics in Canada each year are unnecessary

Antibiotic stewardship refers to a bundle of strategies to reduce antibiotic resistance. The aim of this stewardship effort is, yes, to treat infections effectively resulting in better health, but also to use the right antibiotic at the right time for the right infection, since this is a key measure for curbing future resistance.

You may think this is a job just for health care professionals, but I would like to persuade you otherwise. The general public, you included, have a role to play.

The risk of antibiotic resistance rises when bacteria are exposed to antibiotics unnecessarily. Such unnecessary exposures gives them additional opportunity to screen their structure against the mode of action of the antibiotics.

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Close-up of the automatic capsule package production line.

With over 25 million prescriptions for antibiotics written each year in Canada, and an estimate that 30 to 50 per cent of them are unnecessary, bacteria definitely have a chance of being exposed to antibiotics needlessly.

Farm readers know without my telling them about concerns that antibiotics used in animals may end up in the food chain. However, there are other ways that bacteria are unnecessarily exposed to antibiotics.

Antibiotics are only effective against bacterial infections, and when they are used to treat other types of infections such as viral infections like a cold or the flu, antibiotic resistance can result. When antibiotics are taken other ways than prescribed, or when they are shared among family or friends, or even used without a prescription, bacteria can be exposed and be screened for resistance.

Ideally, you want to have a diagnosis of a bacterial infection, follow your prescription directions exactly, and/or use non-antibiotic measures for your symptoms.

Two resistant infections have become more common and more difficult to treat in recent years. Methacillin-resistant staphylococcus aureus or MRSA is the diagnosis of about one in 12 infections in a hospital setting, but of recent concern is the increased incidence in the community, that is, community-acquired MRSA.

The bacteria itself is very common, with 20 to 30 per cent of people having it normally on their skin, and sometimes in their nose without any infection.

It is when MRSA infects a wound or the blood that it becomes difficult to treat. Methacillin is ineffective because the bacteria is resistant, and more potent antibiotics need to be used, and may need to be administered intravenously.

The other infection that has become resistant to the usual treatment is vancomycin-resistant enterococcus or VRE. Enteroccoci are bacteria that normally reside in your intestines, but they can cause infections in the bowel, urinary tract, and blood stream.

A weakened immune system or a wound may result in the spread. And, again, the bacteria has developed a resistance to the normally used vancomycin. Other antibiotics need to be used.

Unfortunately, there are a finite number of types of antibiotics available, so there may be no antibiotic that is effective in treating a resistant infection. The option is to use more potent antibiotics with potential adverse effects, or even a combination of several antibiotics. Longer courses of therapy and sometimes hospitalization are needed.

You can play a role in antibiotic stewardship. Use antibiotics appropriately and reduce your risk for bacterial infections by practicing proper hygiene such as washing your hands after going to the washroom, before eating, and after coming in contact with potentially contaminated objects.

Make sure you take care of any cuts, scrapes, and wounds carefully, and remember to not use antibiotics for viral infections like coughs, colds and the flu.

About the author

Contributor

Marie Berry is a lawyer/pharmacist interested in health and education.

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