How can antibiotic resilience be effectively managed and treated?

From the Guidelines

Antibiotic resilience can be effectively managed through a comprehensive approach combining proper antibiotic use, infection prevention, and surveillance, as recommended by the most recent guidelines 1. To achieve this, healthcare providers should first confirm bacterial infections through appropriate testing before prescribing antibiotics, then select the narrowest-spectrum effective antibiotic at the correct dose and duration. Some key considerations include:

• Using antibiotic sensitivity testing to guide treatment decisions, especially for patients with a history of resistant infections 1
• Implementing robust infection control measures, including hand hygiene, isolation precautions, and environmental cleaning, to prevent the transmission of resistant strains
• Optimizing antibiotic use through antimicrobial stewardship programs, which can help reduce selective pressure on bacteria and preserve the effectiveness of existing antibiotics 1
• Considering combination therapy for patients with resistant infections, guided by susceptibility testing, and using newer antibiotics like ceftazidime-avibactam or plazomicin when necessary 1
• Ensuring patients complete their full prescribed course of antibiotics, even when feeling better, to prevent resistance development By taking a comprehensive and multifaceted approach to managing antibiotic resilience, healthcare providers can help reduce the risk of morbidity, mortality, and decreased quality of life associated with antibiotic-resistant infections. Key strategies for managing infections caused by multidrug-resistant bacteria include:
• Diagnosis and management of infections caused by MDROs, as outlined in recent guidelines 1
• Use of last-resort antibiotics, such as carbapenems, for life-threatening infections caused by highly resistant organisms
• Implementation of infection control measures to prevent the spread of MDROs in healthcare settings
• Development of new antibiotics and therapies to treat MDRO infections, as highlighted in recent studies 1

From the FDA Drug Label

Antibacterial drugs including levofloxacin should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When levofloxacin is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by levofloxacin or other antibacterial drugs in the future.

Antibacterial drugs, including amoxicillin, should only be used to treat or prevent bacterial infections. Antibacterial drugs do not treat viral infections (e.g., the common cold). When amoxicillin for oral suspension is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed Skipping doses or not completing the full course of therapy may: (1) decrease the effectiveness of the immediate treatment, and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by amoxicillin or other antibacterial drugs in the future.

Antibiotic Resilience Management

• Take the medication exactly as directed
• Complete the full course of therapy
• Do not skip doses
• Antibacterial drugs should only be used to treat bacterial infections, not viral infections
• Patients should be counseled about the risks of antibiotic resistance and the importance of proper use 2, 3

From the Research

Managing Antibiotic Resilience

To effectively manage and treat antibiotic resilience, several strategies can be employed:

• Infection prevention and control measures to limit the spread of resistant species 4
• Optimization of antibiotic utilization, including appropriate diagnosis, culture and sensitivity data, and selection of the most effective antibiotic 4
• Implementation of antibiotic stewardship programs to promote responsible use of antibiotics and minimize resistance 5, 6
• Development of guidelines and policies for antibiotic use, taking into account the ecological impact of different drugs and their delivery schedules 7

Antibiotic Utilization Strategies

Various antibiotic utilization strategies can be used to limit the development of antibiotic resistance, including:

• Antibiotic cycling or rotation to reduce the selective pressure of a single antibiotic 4
• Formulary restriction to limit the use of broad-spectrum antibiotics 4
• Dose optimization to minimize the duration of exposure to sub-inhibitory antibiotic concentrations 5
• Selection of antibiotics with a narrower spectrum of activity to reduce the disruption of normal flora 8

Minimizing the Development of Antibiotic Resistance

To minimize the development of antibiotic resistance, it is essential to consider the following factors:

• The choice of antibiotic should take into account the interests of the individual patient and the ecological impact of the drug 7
• The duration of exposure to antibiotics and the number of challenges to bacterial populations should be minimized 7
• Education and awareness programs should be implemented to promote responsible use of antibiotics among healthcare professionals and patients 6