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Antimicrobial resistance

Authoring team

There is an increasing problem of antimicrobial resistance in the community. A letter from the Chief Medical Officer identified four areas which could make a significant impact on the volume of antimicrobials prescribed (1):

  • antibiotics should not be prescribed for simple coughs and colds

  • antibiotics should not be prescribed for viral sore throats

  • in cases of uncomplicated cystitis in otherwise fit young women, antibiotics should only be prescribed for three days

  • the prescribing over the telephone of antibiotics should be limited to exceptional cases

Further guidance concerning antibiotic prescribing for self-limiting respiratory tract infections in adults and children in primary care has been given (2).

A US review notes (3):

  • risk factors for the development of antimicrobial resistance include:
    • immune suppression (due to cancer, organ transplant, HIV, or immunosuppressing medications)
    • antibiotic prescribing in infants or people older than 65 years
    • conditions such as diabetes, chronic kidney disease, and chronic lung disease
    • prior treatment with antibiotics and long-term antibiotic use
    • prolonged hospital stays,
    • use of catheters

  • factors facilitating spread of antimicrobial resistance include:
    • inadequate handwashing
    • substandard hospital cleaning
    • overcrowding
    • poor sanitation
    • contaminated food or water
    • travel to areas that have high rates of antimicrobial resistance

  • common antibiotic-resistant organisms
    • antibiotic-resistant bacteria include:
      • methicillin-resistant Staphylococcus aureus (MRSA)
        • MRSA may cause skin and soft tissue infections, pneumonia, and bloodstream infections
      • drug-resistant Streptococcus pneumoniae
        • S pneumoniae is a common cause of pneumonia, ear infections, and meningitis, particularly in children and older adults
      • gram-negative bacteria such Escherichia coli, Klebsiella, Pseudomonas aeruginosa, and Acinetobacter that are resistant to carbapenem antibiotics
        • carbapenem-resistant gram-negative bacteria often cause UTIs, pneumonia, and bloodstream or intra-abdominal infections
  • notes
    • the prevalence of antimicrobial-resistant tuberculosis, malaria, and fungal infections (such as Aspergillus and Candida) are also increasing
    • some viruses that can affect immunosupressed patients (such as cytomegalovirus) can also become resistant to antiviral drugs

 

Reference:

  1. PL/CMO/98/6 (PL/CNO/98/7 PL/CDO/98/4 PL/CPHO/98/1)
  2. NICE (June 2008).Respiratory tract infections - antibiotic prescribing for self-limiting respiratory tract infections in adults and children in primary care.
  3. Arias CA, van Duin D. What Is Antimicrobial Resistance? JAMA. Published online July 17, 2025.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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