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The Emerging Threat of Antibiotic Resistance

The rate of drug resistant bacteria is dramatically increasing.²
Proportion of S. pneumoniae isolates not susceptible to penicillin or cefotaxime, identified by national surveillance from the CDC.

Over the past five years, the rate of penicillin resistance increased by more than 300 percent and the rate of cefotaxime resistance increased by more than 1,000 percent.

Some pneumococci are resistant to all oral antibiotic agents.
Pneumococci have developed resistance to cepha-losporins, erythromycin, trimethoprim-sulfamethoxazole, quinolones, and other agents.

The only remaining antibiotic that is effective against all pneumococci is vancomycin.

Increasing antibiotic use is a likely cause.
Antimicrobial prescription rate in children by office-based physicians, 1980-1992

A national office-based study suggested an increase of 48 percent in antibiotic prescribing for children.³

Antibiotics foster resistance in individual patients . . . In cases where they are not necessary, is it worth the risk?

Antimicrobial prophylaxis and carriage of penicillin-resistant pathogens⁴

Even prophylactic doses cause resistant organisms to proliferate.

Does antibiotic resistance put patients at risk for adverse clinical outcomes?
Seven studies have identified recent antibiotic use as a risk factor for invasive disease with nonsusceptible pneumococci.⁵

References

1. Dowell SF, Marcy SM, Phillips WR, Gerber MA, Schwartz B. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics 1998;101:163-165.
2. Butler JC, Hofmann J, et al. The continued emergence of drug-resistant Streptococcus pneumoniae in the United States: an update from the CDC's Pneumococcal Sentinel Surveillance System. J Infect Dis 1996; 174:986-93.
3. McCaig L, Hughes J. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA 1995; 273:214-219.
4. Brook I, Gober AE. Prophalaxis with amoxicillin or sulfisoxazole for OM: effect on the recovery of penicillin-resistant bacteria from children. Clin Infect Dis 1996;42:353-56.
5. Dowell SF, Schwartz B. Resistant pneumococci: Protecting patients through judicious antibiotic use. Am Fam Physician 1997;55:1647-54.
6. Dagan R, Abramson O et al. Impaired bacteriologic response to oral cephalosporins in acute otitis media caused by pneumococci with intermediate resistance to penicillin. Pediatr Infect Dis J. 1996;15:980-85.