While the discovery of antibiotics helped propel the world into a future of longer lives and faster recovery, it is now at a turning point – unless rising antibiotic resistance is curbed, it is on course to kill 10 million people by 2050, more than the mortality rate of cancer patients.

This has been supported by many studies including a recent one conducted by researchers at the University of California. The team assessed treatment outcomes of 251,947 people, who were first prescribed with antibiotics for community-acquired pneumonia (CAP).

Older patients more likely to be hospitalised

The researchers determined that treatment was to be considered a failure if it led to hospitalisation, admittance into the Emergency Department, a repeat prescription or another antibiotic therapy. Study lead author James A. McKinnell, MD said, “it is concerning that we found nearly one in four patients with CAP” failed the first treatment of antibiotics.

Overall, the rate of treatment failure was 22.1% of which, 20.6% required a repeat prescription, 70.7% switched antibiotics, 3.3% visited the Emergency Department and 5.4% were hospitalised. Beta-lactam antibiotics had the highest failure rate.

The researchers noted that factors such as female gender, elderly age, and pre-existing conditions such as cancer, chronic pulmonary disease and diabetes were predictors of treatment failure.

“Patients over the age of 65 were nearly twice as likely to be hospitalised compared to younger patients,” McKinnell said. He added that “elderly patients are more vulnerable and should be treated more carefully, potentially with more aggressive antibiotic therapy.”

The researchers hope their findings will be used by the American Thoracic Society and Infectious Diseases Society of America, to update their guidance on the treatment of patients with CAP.

Study reveals lack of standard diagnosis

The study has faced some criticisms, however. Dr Bushra Mina, director of the Intensive Care Unit at Lenox Hill Hospital in New York, for example, noted that with pneumonia, “a certain percentage” of cases are caused by viruses, for which antibiotics are useless, and the study did not account for this.

Dr. Alan Mensch, a pulmonologist at Northwell Health's Plainview Hospital in New York, remarked that not enough of the patients were given the “gold standard” sputum test needed to confirm the infection is bacterial and not viral.

He suggested that the guidance should be updated with tests and protocols that will help doctors better identify the cause of a pneumonia infection.

International and political intervention

In addition to patient’s efforts and doctors learning not to prescribe antibiotics just to satisfy patients – leaders are also committing to fight the problem too. The United Nations has announced its intention to create a taskforce addressing the the issue.

On 2 May 2017, health ministers from the G20 agreed to implement national action plans by the end of 2018. The group pledged to strengthen health systems, improve their ability to react to pandemics and agreed to help improve access to affordable medicine in poorer countries.

The American government is also taking concrete steps through a public-private partnership with the Wellcome Trust. The project aims to give USD450 million in funding to biotech firms and research teams – over the next five years – to develop new promising antibiotics against multi-resistant bacteria. MIMS

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