Antibiotic Resistance

Learning Objectives
 Describe the History of Antibiotics
 Describe how resistance occurs
 What has contributed to making
resistance such a big problem
 Describe ways to combat resistance
and promote judicious antibiotic use
The History of Antibiotics

 Antibiosis was first described in 1877 in

bacteria when Louis Pasteur and Robert
Koch observed that an airborne bacillus
could inhibit the growth of Bacillus
anthracis.
 Significance to antibiotic discovery was
not realized until the work of Ehrlich on
synthetic antibiotic chemotherapy, which
marked the birth of the antibiotic
revolution.
History Continued
 In 1928 Fleming made an important
observation concerning the antibiosis
of bacteria by penicillin.
 He noticed that colonies of bacteria
growing on a germ culture medium had
been unfavorably affected by a mold,
Penicillium notatum, which had
contaminated the culture.
History Continued
 Prontosil, the first commercially available antibacterial
antibiotic (in the sulfonamide class), was developed by a
research team led by Gerhard Domagk.
 Prontosil had a relatively broad effect against
Gram-positive cocci but not against
enterobacteria.
 In 1939 Rene Dubos discovered the first naturally
antibiotic-like substance named gramicidin derived from
B. brevis.
 It was one of the first commercially
manufactured antibiotics in use during World
War II to prove highly effective in treating
wounds and ulcers.
History Continued
 March 14, 1942 John Bumstead and Orvan Hess
saved a dying patient's life using penicillin.
 June 1942, there was just enough U.S. penicillin
available to treat ten patients.[1]
 A moldy cantaloupe in a Peoria, Illinois market in
1943 was found to contain the best and highest-
quality penicillin after a worldwide search. The
discovery of the cantaloupe, and the results of
fermentation research on corn steep liquor at the
Northern Regional Research Laboratory at Peoria,
Illinois, allowed the United States to produce 2.3
million doses of penicillin in time for the invasion of
Normandy in the spring of 1944. [2]
History Continued

So when did the problems start?

The Emergence of Antibiotic
Resistance
 In his 1945 Nobel Prize Lecture,
Fleming himself warned of the danger
of resistance:
 “It is not difficult to make microbes
resistant to penicillin in the laboratory by
exposing them to concentrations not
sufficient to kill them, and the same
thing has occasionally happened in the
body… …and by exposing his microbes to
non-lethal quantities of the drug make
them resistant.”
The Emergence of Antibiotic
Resistance
 1950s:Penicillinase producing S. aureus
first appeared.
 1960s MRSA appearing
 1970s Aminoglycoside resistance among
gram negative bacilli
 1987-1990s VRE
 1990s necessity of combo therapy for
treatment of TB
 1999 Linezolid resistance even before
approved by the FDA

CME Resource 2010

How resistance occurs

Antibiotics are used to kill bacteria.

When resistance is present those
bacteria are not killed but all others
are. The resistant bacteria are then
allowed to multiply without
competition and the person harbors
a highly resistant form of bacteria.
Why is resistance a problem
 Each year there are more and more
resistant bugs to current treatment options
 Increase in morbidity and mortality as well as
the cost associated with treating super
infections.
 There are less antibiotics coming out on the
market that will combat the newly created
“super bugs”
 Without fail resistance occurs shortly after
if not prior to release of new antibiotic
Contributors to Resistance
Surface Water Antibiotic
use for
therapy and
prophylaxis
Slurry Waste
Water Culture Plants

Food
Feces Hospitalized
Animal
patients
Feed

Antibiotic use for

growth promotion, Food Meat Hospital Admission

prophylaxis, and Animals Products Feces

therapy

Humans in
Community
Selective Pressures

Main Reservoirs

Vasil, 2007
Who is contributing to the
problem?
 Patients
 Patients who do not take the antibiotics
for the full prescribed time.
 Patients who take left over antibiotics or
someone else’s whether it is warranted
or not.
 Patients who pressure doctors to
prescribe them antibiotics.
 Patients order antibiotics online for acute
symptoms.
Who is contributing to the
problem?
 Providers
 “But it has been two days and I’m just miserable…”
 Against their better judgment Providers prescribe
antibiotics to appease their patients.
 “Last time I had these symptoms Provider so and so
gave me an antibiotic”
 Providers think they may lose patients if they don’t give
them an antibiotic.
 Time
 Time to educate patients about the issue of antibiotic
overuse and bacterial resistance is usually not
reimbursed.

Belongia, 1998
What can I do
 Hundreds of organizations are trying
to combat the problem around the
world.
 Posters, Pamphlets, Videos, Radio, etc
are being used to try to educate the
population.
 The problem:
 No personalized approach.
 Education about communication to
patients lacking regarding antibiotic use.
Huttner, 2010
What can I do

English Campaign New Zealand Campaign

What can I do

There are educational materials

available to both providers and
patients.
The CDC’s Get Smart campaign
has materials online to print out
for educational purposes.
These include posters,
brochures, and one sheet
handouts
Clinical guidelines are also
available for providers.
What can I do
 Become part of the healthcare team
 Ask questions of your provider and ask
for resources to read later
 Take care of yourself
 Flu shots, medicine cabinet care kits
 Work towards educating others
 Antibiotic free foods, avoid getting any
medications online
 Educators and daycare centers
What can I do
What can I do
The bottom line
 Colds, flu, and sore throats are most likely
caused by a virus and do not require an
antibiotic
 Treating these conditions with antibiotics
will not make any difference
symptomatically and may contribute to
resistance later
 There are guidelines for providers as to
when antibiotics should be used.
 By using these guidelines the surge of resistant
bacteria will be decreased as well as the cost
associated with treating these infections.

Huttner, 2010
Works Cited
 Mailer J, Mason B. "Penicillin : Medicine's Wartime Wonder Drug and Its
Production at Peoria, Illinois". lib.niu.edu.
http://www.lib.niu.edu/ipo/2001/iht810139.html. Retrieved 2008-02-11.
 Shenold C. Basics of Bacterial Resistance, Including MRSA. CME Resource
s2008
 Noskin GA, Rubin Rj, et al. The burden of Staphylococcus aureus infections
on hospitals in the United States an analysis of the 2000 and 2001
Nationwide Inpatient Sample Database. Arch Intern Med. 2005;165:1756-
1761.
 Vasil Lecture Immunology 2007.
 Belongia E, Schwartz B. Strategies for promoting judicious use of antibiotics
by doctors and patients. BMJ 1998;317:668-71.
 Huttner B, Goossens H. Characteristics and outcomes of public campaigns
aimed at improving the use of antibiotics in outpatients in high-income
countries. Lancet infect Disease 2010;10:17-31.
 Leung A, Newman R, et al. Rapid antigen detection testing in diagnosing
group A beta-hemolytic streptococcal pharyngitis. Expert Rev Mol Diagn.
2006 Sep;6(5):761-6.
 Klevens RM et al. Changes in the epidemiology of methicillin-resistant
Staphylococcus aureus in intensive care units in US hospitals, 1992-2003.
Clinical Infectious Diseases 2006;42:389-91
Works Cited
 Klevens RM, Morrison MA, Nadle J, et al. Invasive Methicillin-Resistant
Staphylococcus aureus Infections in the United States. JAMA.
2007;298(15):1763-1771.
 Gorwitz RJ et al. Prevalence of Staphylococcus aureus nasal colonization in
the United States, 2001-2002. Journal of Infectious Diseases.
2008;197:1226-34.
 Noskin GA, Rubin RJ, Schentagg JJ, et al. The burden of Staphylococcus
aureus infections on hosptials in the United States an analysis of the 200
and 2001 Nationwide Inpatient Sample Database. Arch Intern Med.
2005;165:1756-1761.
 Avorn J, Solomon D. Cultural and Economic Factors that (Mis)shape
antibtiotic Use: The Nonpharmacologic Basis of Therapeutics. Ann Intern
Med. 2000;133:128-135.