The development of antibiotics less than a century ago transformed medicine and proved a boon for human mortality. But in a few short generations, the overuse of these lifesavers - in medicine and agriculture - threatens a major setback in human health.
Antibiotic resistance - when bacteria change to circumvent the effectiveness of the drugs - is growing worldwide and constitutes one of the biggest threats to global health, according to the World Health Organization, an agency of the United Nations. WHO warns that without action the world is headed for "a post-antibiotic era, in which common infections and minor injuries can once again kill."
The phenomenon already has made a growing number of infections harder to treat, including those related to burns, pneumonia, tuberculosis and sexually transmitted diseases.
Health organizations around the globe have mobilized to address the problem. In New Jersey, the state Department of Health in partnership with the federal Centers for Disease Control and Prevention implemented stewardship programs to ensure that patients in hospitals and other inpatient health care facilities (such as nursing homes and rehabilitation centers) receive the right antibiotic, at the right dose, at the right time and for the right duration.
Leading the Way
Our team at Holy Name Medical Center recently was recognized for its leadership in this area, receiving a Silver Award from the New Jersey Department of Health for Antimicrobial Stewardship. Antimicrobials include the bacteria-fighting antibiotics as well as other drugs that fight viruses, parasites and fungus. In receiving the inaugural annual award, Holy Name was lauded for "impressive work in fostering antibiotic awareness in 2019."
"We're not developing new treatments nearly fast enough to deal with worldwide antibiotic resistance so it's essential to make appropriate use of the ones we have," said Thomas Birch, MD, medical director of clinical research at Holy Name and an expert in infectious diseases.
The protocols developed are imperative, said Dr. Birch, given that "everything we do in the hospital is dependent on antibiotics." Indeed, in addition to making once deadly infections treatable, antibiotics have made other medical advances possible, such as organ transplants and chemotherapy.
Dr. Birch co-chairs Holy Name's committee on antibiotic stewardship with Lori-Ann Iacovino, MS, RPh, clinical pharmacy specialist in infectious diseases. The committee works closely with physicians to ensure antibiotics are properly prescribed. "There are five core elements for successful stewardship: accountability, drug expertise, tracking, reporting and education," Ms. Iacovino said.
The Biggest Factor
Physicians are made aware of the over-prescribing of certain classes of antibiotics and health care workers are instructed on effective protocols to lessen the spread of infection, including the simple but essential hand-washing.
However, in the United States, Dr. Birch said the use of antibiotics in animal agriculture looms as the biggest factor in growing resistance – a problem that will need systemic changes in the food system.
In the meantime, progress can be made. "There is trouble on the horizon, but there are things we can do. We need to use the tools we have effectively and appropriately, and new tools will become available," said Dr. Birch.
The awareness exemplified by the stewardship program is cause for optimism. The state says measures taken as part of the program have led to better patient outcomes and saved health care dollars. "We continue to look for ways to improve," said Ms. Iacovino.