From the Guidelines
Antibiotic resistance in the USA has reached concerning levels, with approximately 2.8 million antibiotic-resistant infections occurring annually, resulting in over 35,000 deaths. The most problematic resistant pathogens include methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and drug-resistant Neisseria gonorrhoeae.
Key Points
- For MRSA infections, vancomycin (15-20 mg/kg IV every 8-12 hours) or daptomycin (4-6 mg/kg IV daily) are typically used 1.
- CRE infections often require combination therapy with medications like meropenem (2g IV every 8 hours) plus polymyxin B or colistin.
- Resistant gonorrhea may be treated with ceftriaxone (500 mg IM single dose) plus azithromycin (1g oral single dose) 1.
Recommendations
- Healthcare providers should practice antibiotic stewardship by prescribing antibiotics only when necessary, using narrow-spectrum agents when possible, and ensuring proper duration of therapy 1.
- Patients should complete their full antibiotic course as prescribed, never use leftover antibiotics, and practice good hygiene to prevent infection spread. The resistance crisis stems from antibiotic overuse in healthcare and agriculture, horizontal gene transfer between bacteria, and insufficient development of new antibiotics 1.
Prevention Strategies
- Judicious use of antimicrobial agents in both the inpatient and ED settings will likely receive increased emphasis given recent provisions to eliminate payments for hospital-acquired infections.
- ED clinicians play a vital role in obtaining relevant cultures and making the decision regarding first antibiotic dose for inpatients.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Current Status of Antibiotic Resistance in the USA
- The current status of antibiotic resistance in the USA is a growing concern, with methicillin-resistant Staphylococcus aureus (MRSA) infections becoming increasingly prevalent in both community and hospital settings 2.
- MRSA is a particularly virulent, rapidly adaptive pathogen that is becoming increasingly difficult to combat with existing antibiotics, with resistance to antibiotics such as clindamycin and trimethoprim/sulfamethoxazole increasing over time 2.
- The rise of antibiotic resistance is a global threat, projected to cause more deaths than all cancers combined by 2050, with nosocomial infections playing a significant role in the spread of multi-drug resistant bacteria 3.
Antibiotic Resistance Trends
- Studies have shown that the clinical cure rates for uncomplicated urinary tract infections (uUTI) treated with nitrofurantoin range from 51 to 94%, with bacteriological cure rates ranging from 61 to 92% 4.
- However, the evidence on the clinical and bacteriological efficacy of nitrofurantoin is sparse, with a lack of new data and a high risk of bias, highlighting the need for more robust research 4.
- The use of combination therapy, such as daptomycin plus a β-lactam, has been shown to be effective in treating MRSA bloodstream infections, with improved clinical outcomes compared to treatment with daptomycin alone 5.
Mechanisms of Resistance
- Bacteria use various mechanisms to overcome the effectiveness of antibiotics, including distinct types of resistance mechanisms, highlighting the need for a better understanding of these mechanisms to develop effective treatment strategies 6.
- The global burden of antimicrobial resistance is significant, with major clinical implications, and strategies are needed to address the issue, including prudent use and misuse of antimicrobial agents, and the development of new antimicrobials 6.