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Combatting antibiotic resistance

Antibiotic resistance continues to pose a major threat to public health. Wrong or incorrect use of antibiotics may cause bacteria to become resistant to future antibiotic treatments, leading to the growing problem of antimicrobial resistance in European hospitals and communities.

European Antibiotic Awareness Day is held on November 18 each year and aims to promote research on finding new antibiotic drugs as well as encouraging prudent antibiotic use. To raise awareness of this threat, we’ve put together the following reading list:

OIDL Antibacterial Chemotherapy: Theory, Problems, and Practice CoverAntibiotic action – general principles in OIDL Antibacterial Chemotherapy: Theory, Problems, and Practice by Sebastian Amyes

“Strictly speaking, an antibiotic is an antimicrobial drug that is derived from natural products. Thus penicillin is a true antibiotic, whereas synthetic compounds such as sulphonamides and trimethoprim are not. However, there is general usage of the term to cover all systemic antibacterial drugs and thus the term antibiotic will be used in the modern sense.”

Designed to help medical trainees, general prescribers, healthcare workers, and students understand how antibiotics work, this article also helps to demonstrate where they might be most appropriate.

Implementation of antimicrobial stewardship interventions recommended by national toolkits in primary and secondary healthcare sectors in England: TARGET and Start Smart Then Focusin the Journal of Antimicrobial Chemotherapy by D. Ashiru-Oredope, E. L. Budd, A. Bhattacharya, et al
This study aims to assess and compare the implementation of antimicrobial stewardship (AMS) interventions recommended by national AMS toolkits in English primary and secondary care settings, to determine the prevalence of cross-sector engagement to drive AMS interventions, and to propose next steps to improve implementation of AMS.

Keeping it simple: lessons from the golden era of antibiotic discovery in FEMS Microbiology Letters by Dane Lyddiard, Graham L Jones, and Ben W Greatrex
As bacteria become increasingly resistant to current antibiotics, this article puts forward the question of whether we should return to the basics, such as simple, systematic screening of natural products against bacteria, in order to recreate the ‘golden era’ of antibiotics in the early 1900’s.

Antimicrobial Chemotherapy 7th Ed. CoverMechanisms of action and resistance to modern antibacterials, with a history of their developmentin Antimicrobial Chemotherapy (7 ed.) by Peter Davey, Mark H Wilcox, William Irving, and Guy Thwaites
This article provides an introduction to the principles of antimicrobial chemotherapy, the problem of resistance and its control through policies, antimicrobial stewardship, and surveillance.

Non-susceptibility of Escherichia coli, Klebsiella spp., Pseudomonas spp., Streptococcus pneumoniae and Staphylococcus aureus in the UK: temporal trends in England, Northern Ireland, Scotland and Wales” in the Journal of Antimicrobial Chemotherapy by Rebecca Guy, Lourda Geoghegan, Maggie Heginbothom, et al
In 2013, the UK published a national five-year strategic plan to combat antimicrobial resistance. The main focuses of the plan included improving the surveillance of resistance, and focusing on better international collaboration. This study provides a geographical analysis showing the trends in antimicrobial resistance in each of the four countries in the UK as well as providing an update to the current data on pathogen trends in the UK.

Pneumoccal meningitis: antibiotic options for restraint mechanismsin Challenging Concepts in Infectious Diseases and Clinical Microbiology: Challenging Concepts in Infectious Diseases and Clinical Microbiology: Cases with Expert Commentary CoverCases with Expert Commentary, edited by Amber Arnold and George Griffin
Advances such as vaccination, introduced routinely for children and at-risk adults, has reduced the risk of invasive pneumococcal infections (including the reduction of some resistant strains) for both children and adults. However, antibiotic choices for resistant isolates continue to pose a challenge. This case study focuses on the treatment of 55-year old man with a presumed case of meningitis and the process of deciding which antibiotics to administer.

The Innovative Medicines Initiative’s New Drugs for Bad Bugs programme: European public-private partnerships for the development of new strategies to tackle antibiotic resistance in the Journal of Antimicrobial Chemotherapy by T. Kostyanev, M. J. M. Bonten, S. O’Brien, et al
Antibiotic resistance (ABR) is a global public health threat. Despite the emergence of highly resistant organisms and the huge medical need for new drugs, the development of antibacterials has slowed to an unacceptable level worldwide. To respond to this public health crisis, the Innovative Medicines Initiative Joint Undertaking programme has invested more than €660 million and this article describes the research initiatives launched to address the crisis.

Antimicrobial Stewardship CoverThe international and national challenges faced in ensuing prudent use of antibioticsin Antimicrobial Stewardship, edited by Matthew Laundy, Mark Gilchrist, and Laura Whitney
The problem of antimicrobial-resistant organisms and untreatable infections is of global concern. The aim of antimicrobial stewardship is to control antimicrobial use in order to reduce the development of resistance, avoid the side effects associated with antimicrobial use, and optimize clinical outcomes. This chapter article and its associated book provides a very practical approach to antimicrobial stewardship: a ‘how to’ guide supported by a review of the available evidence.

The ‘liaisons dangereuses’ between iron and antibiotics” by Benjamin Ezraty and Frédéric Barras, in FEMS Microbiology Reviews
This review brings together research in two fields – metals in biology and antibiotics – in the hope that collaboration between them will lead to advances in our understanding, and the development of new approaches to tackling microbial pathogens.

Transferable resistance to colistin: a new but old threat” in the Journal of Antimicrobial Chemotherapy by Stefan Schwarz and Alan P. Johnson Schwarz S, Johnson AP
Based on the widespread use of colistin in pigs and poultry in several countries and the higher number of mcr-1-carrying isolates of animal origin than of human origin, it is tempting to assume that this resistance may have emerged in the animal sector. Whatever its origin, interventions to reduce its further spread will require an integrated global one-health approach, comprising robust antibiotic stewardship to reduce unnecessary colistin use, improved infection prevention, and control and surveillance of colistin usage and resistance in both veterinary and human medicine.

Understanding the culture of antimicrobial prescribing in agriculture: a qualitative study of UK pig veterinary surgeons” in the Journal of Antimicrobial Chemotherapy by L. A. Coyne, S. M. Latham, N. J. Williams, et al
The use of antimicrobials in food-producing animals has been linked with the emergence of antimicrobial resistance in bacterial populations, with consequences for animal and public health. This study explored the underpinning drivers, motivators, and reasoning behind prescribing decisions made by veterinary surgeons working in the UK pig industry.

Use your antibiotics wisely. Consequences to the intestinal microbiome” in FEMS Microbiology Letters by Jorge Cervantes
This article presents an analysis of recent literature on how the intestinal microbiome is altered by antibiotic therapy, including potential long term consequences of antibiotic therapy.

The FEMS journals have also curated a collection to mark Antibiotic Awareness Week 2016, which aims to raise awareness of the threat to public health of antibiotic resistance through increasing the knowledge available to health care professionals.

Featured image credit: Medications 2 by Joanna M. Foto. CC0 Public Domain via Freestocks.org.

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