Are questionable dosing practices fueling antibiotic resistance?

Oct 11, 2009, 11:34 AM, Posted by Susan Promislo

This post comes to us from Patricia Geli Rolfhamre over at Extending the Cure.  More in-depth conversation about antibiotic resistance and the future of our nation's supply of antibiotics is happening on the ETC blog.

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Are there ways in which we can reduce the spread of antibiotic resistance by treating patients more strategically? The dosing and duration of antibiotic treatment have been shown to be critical determinants of the likelihood of curing an infection and of the emergence of resistance.   Adjusting these factors to a patient’s individual condition instead of treating every patient with the same antibiotic regimen may be an easy step toward fighting resistance.

Research reports from the American College of Emergency Physicians annual meeting in Boston earlier this week revealed that doctors who work in hospital emergency rooms rarely adjust antibiotic doses for obese patients. The consequences are an increased risk of treatment failure and resistance development. Yet it is unclear how much this will spur the growing resistance epidemic. Given the fact that more than a third of the US population is obese - this trend is worrying. But solving the obesity problem or adjusting the doses for obese patients is only a part of the answer. The other important parameter for successful treatment and for which a one-size-fits-all approach has generally been applied is the duration of treatment.

Antibiotic guidelines have historically been developed to maximize treatment efficacy and minimize toxicity – without the consideration of resistance development. This has led to the creation of duration guidelines that are unnecessarily long. One example is the treatment of otitis media, which results from a middle ear infection caused by Streptococcus pneumoniae (by volume, the leading cause of antibiotic resistance). For this specific case, three days with antibiotic treatment has been shown to be no less effective than ten days. Despite this fact, we continue to recommend that patients complete the full ten day course of antibiotic treatment, thereby accelerating the rate with which resistance evolves and spreads.

Regardless of the fact that antibiotic drugs have been used for some 70 years to cure bacterial infections, knowledge on how to use these drugs is still incomplete. And with lack of knowledge, we tend to fit the same approach for treating all infections among all patients. With resistance growing, it is time to ask ourselves: how long can we wait before we change the way we use antibiotic drugs, and are we willing to risk the consequences?

This commentary originally appeared on the RWJF Pioneering Ideas blog.