“Use and Abuse”

You can produce sophisticated and comprehensive antimicrobial resistance surveillance data.

You can adhere to the best infection control policies in the country.

You can have a “search and destroy” policy for multi-resistant organisms.

and you can even develop and bring out a new antibiotic every couple of years….

But unless you control antibiotic consumption (usage), you will always be fighting an uphill battle.

In order to control antibiotic consumption you need to know how  many antibiotics are being used in the first place.

One of the problems is that antimicrobial resistance surveillance data is produced by microbiologists. Antibiotic consumption data is produced by pharmacists. Antibiotic consumption data even in this day and age can still be difficult to get hold of. Sometimes I wonder if the companies selling the antibiotics to the hospitals have a much better handle on consumption data than the microbiologists do!

Microbiologists and pharmacists need to talk to each other more. It is such a key relationship in the antimicrobial stewardship world.

Antibiotic usage needs to be surveyed and controlled not only at an individual level, but at a national level. Communities and hospitals, humans and animals. It all adds up… Too often I have sat in conferences and seen pretty graphs of antimicrobial resistance data, without complementary antibiotic consumption data to put the resistance data into context. I find it all a bit frustrating…

If reducing antibiotic usage was easy it would already have happened. It’s not easy , and there are good reasons for this. (See this article). This is where objective data is key to monitoring and measuring change. Feedback to the “prescriber” is critical.

Every antimicrobial stewardship committee in the world needs to be aware of their consumption data. Otherwise they are simply not doing their job. Surveillance of antibiotic consumption does not seem to get the same profile as resistance data. This is a shame. I would actually argue that it is the more important of the two….

Michael

5 thoughts on ““Use and Abuse”

  1. You have made a very important point. The presentation of these data to prescribers is vital, but it becomes so complicated when trying include particularities of different infections.

    On a related point, it was a revelation to me when I saw the veterinarians’ data on antibiotic consumption in animal husbandry and the antimicrobial resistance in animals. The antimicrobial resistance from farm to hospital is truly a single problem — one health. Maybe there are moats between prescribers, pharmacists and microbiologists “for humans”, but there certainly is a canyon between the respective professionals tending the humans and those tending the animals.

  2. I know tradition and history are important considerations, but we also need to read the signs of the times. The times we are living in have more and more virulent viruses that only require a small amount of viral material to infect. We also have the issue of the “ super bugs” that are resistant to almost all antibiotics. To engage in a practice where there is significant potential for contact with another person’s potentially infective body fluids ( saliva ) and then carrying that to the next orrson in the communion line is dangerously irresponsible. I have observed this happening. Just recently I had a conversation with a priest who told me he often encounters this when someone wants communion on the tongue: his fingers come in contact with someone’s tongue. Bless him that he says he will then reach down to his alb to wipe off his fingers, but that is not a totally effective way to sanitize the hand. Believe me I know because I worked as a clinical lab scientist in hospitals for 40 years. Bad hand sanitizing is a big issue in hospital contracted Infections. The cup is surprisingly not as big of an issue because of the presence of alcohol in wine and IF the EM’s are trained to wipe the cup properly. I know a microbiologist who studied this extensively. Also the CDC has apparently studied it. Imho, we should not engage in the practice of communion on the tongue for any reason because of the serious potential for spreading disease.

    1. Thanks for your comment. I think churches do recognise there is some sort of risk here, and many changed their communion practice, albeit temporarily, during the influenza pandemic in 2009.

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