Optimal Management of RTI – Intriguing New Results in ABECOPD in Asia

29 March, 2018

Question 27

Resistance is a growing global concern and one that requires judicious use of available antibiotics. How does this problem result in changes to prescribing?

Resistance is a serious threat. We already have resistance among respiratory pathogens, particularly in S. pneumoniae, and among the Gram-negatives, extended spectrum β-lactamase producers are a problem. In addition, Clostridium difficile is becoming more resistant to antibiotics. Unfortunately, we are our own worse enemy, with regimens prescribed in the past that were not effective, using doses that were too low or schedules that were too short – all resulting in increased resistance. In addition, patients often self-medicate or do not finish the full antibiotic course. Looking at the other side of the coin, some patients demand treatment when it is not appropriate, when they actually need symptomatic management with decongestants rather than antibiotics. In most fields of medicine, when a drug is used incorrectly, the patient suffers. If an antibiotic is used improperly, not only may the patient fail to improve, they may also develop resistant organisms which can infect others. It is therefore extremely important that we use regimens that are more targeted, such as higher-dose, shorter-course therapy when appropriate. There are fewer new antimicrobials being introduced commercially, and it is therefore imperative that the effective agents we have, such as levofloxacin, continued to be used.