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