Justification Of

This article is about the determination of Antibiotic resistance that relies on the fitness effects of resistance elements in the absence of antibiotics. Angst and Hall tentatively developed rifampicin-resistant and delicate Escherichia coli in drug-free environment, before measuring the impacts of new resistance components on fitness in antibiotic free conditions. Streptomycin resistance changes had little fitness impacts in rifampicin-resistant genotypes that had adjusts to antibiotic free environment , contrasted with the same genotypes without acclimatization. They watched a comparative impact when resistance was encoded by a plasmid. Antibiotic sensitive microorganisms that acclimated to the same conditions indicated Justification Of Antibiotic Prescription Is Justifiable Essay

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Antibiotics are chemical substances utilize to prevent and treat infections caused by microorganisms, such as bacteria, parasites and fungi. Medications play a role by suppressing or inhibiting the growth of microorganisms (Sanders et al. 2011). There are more than 150 antibiotics currently available, but only 125 are effectively used for treatment (Zuchora-Walske 2014). Antibiotics have shown to improve the health of an human being significantly (Fabbretti et al. 2011) by providing treatment for tuberculosis, gonorrhea, methicillin-resistant Staphylococcus aureus (MRSA), bronchitis, urinary infections and many others (Tindall et al. 2013). Yet, antibiotic resistance is a worldwide issue that has expanded and persisted among all the nations on earth. New strains of antibiotic-resistant microbes migrate easily from different places on the planet, and they often create a ‘worldwide threat’ among the society (Levy 2002).
Due to the pathogenic bacteria, the developing countries have been impacted on malnutrition, poor sanitary conditions and lack of medical sources much more than developed nations (Alanis 2005). Over the counter antibiotics can be obtained more easily in developing countries in comparison with other developed nations whereas their access is more restrict (Alanis 2005). Resistant strains evolved in the presence of climacteric instability, war and migrations due to the introduction of new strains in the communities. Antibiotics, that where effective prior to the environmental catastrophes, are no longer effective or efficient to treat infections (Baquero and Campos 2003).Justification Of Antibiotic Prescription Is Justifiable Essay
The biggest challenge is when the most clinical significant pathogens become resistant towards the most widely effective drugs in the medical field (Lee et al. 2013).
One of the settings in which antibiotic resistance is most concerning is a hospital. In the United States (US), numerical data for antibiotic resistance have been collected from hospitalized patients since 2002 (Collins 2008). Yearly, more than 35 million US patients require hospital care due to infection or disease (Wenzel and Edmond 2001). Additionally, exposure to antibiotic-resistant microorganisms in intensive care units exposes patients to a 60% risk of acquiring nosocomial infections (Haddadin et al. 2002). Nearly 2 million of these patients develop hospital-acquired infections during treatment, 55% of which involve antibiotic-resistant bacteria (Stone 2009).
Some infections, such as methicillin-resistant Staphylococcus aureus (MRSA), have resist and spread throughout hospitals, clinical settings, and among the society. Nowadays, there are only a few effective drugs that can control MRSA (David and Daum 2010). With restricted options to cure infections, healthcare providers propose to increase medical fees and introduce patients to medications with potentially side effects (David and Daum 2010). Without effective antimicrobial agents, the individual is approximately 70% more susceptible to die (Frieden et al. 2013).
Researchers have seen a consistent and rapid increase in antibiotic resistance, especially in recent years. Sydnor (2011) stated that hospital epidemics can be minimized if accurate surveillance of nosocomial infections are installed, best practices are implemented to prevent and treat them, and health care personnel are trained to avoid transmission of infectious microbes from patient to patient (Sydnor et al. 2011). As of 2011, Netherlands was reported to have the lowest antibiotic consumption rate compare to any other country in Europe and believe that antibiotic resistance can be prevented by reducing the dosage of antibiotics prescribed to a patient (Vandenbroucke – Grauls 2014).
Nosocomial infections have been caused by pathogens that acquired resistant to antibiotics. In the U.S., National Nosocomial Infections Surveillance (NNIS) stated that approximately 60% of S. aureus infections that derived from intensive care units were methicillin resistant, and the number of infections rose 29% from 2005 to 49% in 2009 (Sydnor and Perl 2011). Vancomycin resistance in Enterococcus faecium infections increased from 9,829 infections in 2000 to roughly 22,000 infections in 2006 (Sydnor and Perl 2011). Enterococcus faecium is also more commonly resistant to vancomycin than other species, such as Haemophilus influenza and Neisseria gonorrhea (Wisplinghoff et al. 2004).Justification Of Antibiotic Prescription Is Justifiable Essay
Community environment have also shown signs of bacterial infections that created resistance to antibiotics. For instance, Mycobacterium tuberculosis is a community-acquired pathogen responsible for tuberculosis (TB), which infects 30% of the human population and accounts for nearly 2 million deaths annually (Jensen et al. 2005). Until 2002, streptomycin antibiotic was routinely used to treat patients with tuberculosis (Gillespie 2002). Drug resistance developed because Mycobacterium tuberculosis was continuously exposed to a single drug, overcoming the power of the streptomycin. Gillespie studies (2002) showed that a combination of isoniazid, pyrazinamide, rifampin and ethambutol drugs were able to control and prevent tuberculosis from expanding (Gillespie 2002). As of 2014, a combination of multiple drugs ended up diminish the number of spontaneous mutations and increasing the treatment rate by 48% (Fonseca et al. 2015). Hence, antibiotic-resistant pathogens have become a major concern not only in the healthcare facility, but also in community settings (Tomasz 1994).
2. Mortality rate Justification Of Antibiotic Prescription Is Justifiable Essay
Mortality and morbidity rate are escalating due to the prevalence of antibiotic resistance in intensive care units patients (Hanberger et al. 2014). Non resistant strains are nonpathogenic, while antibiotic resistant strains are pathogenic, leading to an increase death rate (Hanberger et al. 2014). In the US, about 2 million people develop bacterial infections from 2005 through 2008 that were resistant to more than one antibiotic, resulting to an estimated 99,000 deaths (Kallen et al. 2010). In 2011, the EU had nearly 2 million people with acquired nosocomial infections that lead to 200,000 deaths. In the EU, the segregation of vulnerable patients within the same area increase the probability for the resistant strains to pass from one person to another more than in US, because EU does not have efficient preventive measure to minimize the spread of nosocomial infections (Guggenbichler et al. 2011).
Based on Table 1, multi-drug resistance (MDR) M. tuberculosis is one of the three organisms that cause the highest mortality in humans. Highly diverse populations and poor sanitation develops multidrug resistance which contribute to 95% of mortality rate in low and middle-income states (Drobniewski et al. 2015). Studies in Estonia showed that patients with tuberculosis are more compromised if MDR strains are present (Blondal et al. 2013). As of 2007, in India MDR TB was twice as common in TB patients living with HIV versus in TB patients without HIV because patients were showing spontaneously resistant mutants in reserve drugs, such as ofloxacin (Isaakidis et al. 2011).Justification Of Antibiotic Prescription Is Justifiable Essay
Despite the fact that MDR is curable, its treatment depends upon extensive chemotherapy that is exceptionally costly for low income nations. Efforts to prevent the spread of the infection highly depend on the socioeconomic status of the country (Olson et al. 2012). Implementation of new programs, effective screening tests, and efficient therapy options assist reducing the mortality rates in U.S. patients. According to Geiter, individuals that have contract tuberculosis outside of US and move to reside in the US are responsible for the increase of 27% in 1992 to 43% in 1999 (Geiter 2000). Non- American populations infected with TB have a higher mortality rate due to the decline of resources for TB control and due to overpopulated environments such as hospitals, prisons, and homeless shelters (Keshavjee et al. 2008). Maintaining the low mortality of TB in the U.S. will demand continued prevention and control efforts, specifically fast diagnosis, guaranteed accomplishment of treatment, efficient and complete reporting (Geiter 2000).
Vancomycin-resistant Enterococcus (VRE) infections are also emerging as serious health risks. A patient who contracts VRE is considered immunosuppressed because he/she has been previously exposed to the organism during a major surgery or other medical procedures which have been treated with multiple antibiotics (Collins 2008). These infections pose a 10% risk of death in patients with graft transplant, but almost 70% in those with endocarditis, tumors and liver transplants (Kapur et al. 2000). Nonetheless, some authorities are more skeptical and tend to admit that patients might have other medical conditions that could lead to the increase of mortality and not necessarily attribute to VRE infections (Cho et al. 2013). Several drugs have been used effectively against VRE, but its mortality rate (Table 1) still spiked (Cho et al. 2013). A potential reason for high mortality rates among VRE infections is because VRE can potentially transfer genetic traits to S. aureus, another organism with high fatality rates (Cetinkaya et al. 2000). According to Table 1, VRE is the fourth most common antibiotic resistant pathogen with the highest expected annual causes in the US and the third most common with the highest annual deaths.
Antibiotic- Resistant pathogens Expected annual cases of antibiotic resistant infections in the US Expected annual
deaths in the US Justification Of Antibiotic Prescription Is Justifiable Essay
Vancomycin-resistant Staphylococcus aureus (VRSA) N/A 0
Drug-resistant Mycobacterium tuberculosis 9,582 1,631
Drug-resistant Candida 3,400 220
Multidrug-resistant Acinetobacter 7,300 500
Carbapenem-resistant Enterobacteriaceae 9,000 600
Vancomycin-resistant Enterococcus 20,000 1,300
Methicillin-resistant Staphylococcus aureus (MRSA) 80,461 11,285
Drug-resistant Neisseria gonorrhoeae 246,000 N/A
Drug- resistant Campylobacter Jejuni (Gillespie et al. 2006) 310,000 120
Table 1 – Comparison of annual antibiotic resistant infections with annual deaths in U.S patients due to several types of bacteria (most data condensed from text in (Frieden 2013)).
3. Health care costs
Antibiotic resistance is a financial burden on the healthcare system. Physicians are obligated to treat individual patients with the most effective drugs for an infection. Health care institutions believe that hospital expenses is a form of reimbursing physicians for their service to the society (Roberts et al. 2009). Patients, on the other hand, demand a better healthcare service, better quality of life for them and for those around them (Roberts et al. 2009).
Antibiotics for bacterial infections are costly, and sometimes hospitalization is required until the infection is cleared, further raising costs (Roberts et al. 2009). In the US, Ventola’s (2015) statistics showed that antibiotic-resistant infections incur roughly $20 billion in annual healthcare costs (Ventola 2015). Ventola (2015) estimated that each patient with antibiotic-resistant infections from a single healthcare institution cost from $19 to $29 thousand dollars (Ventola 2015). According to a study by Dellit (2007), VRE infections required up to 17 days of hospital care with an average cost of $27,000 (Dellit et al. 2007). In the case of antibiotic-resistant Pseudomonas aeruginosa infections, the average hospital fees were $54,081 per patient, compared to $22,116 for those infected with antibiotic-vulnerable strains of P. aeruginosa (Slama 2008).Justification Of Antibiotic Prescription Is Justifiable Essay
S. aureus infections are expensive to treat, and MRSA is more costly than methicillin-sensitive S. aureus infections (Singh et al. 2006). Inpatient treatment, which includes overall/basic hospitalization costs, antibacterial drugs, preliminary exams, and imaging will total close to $35,000 for patients with resistant strains (Filice 2010). Assuming that 15% of the US patients become infected annually, the costs associated for only MRSA infections would be approximately $45 million (Filice 2010).
Currently, several elements have played a vital role in the cost of controlling infection. The cost to create a new antibiotic is recently calculated at $1 billion (Slama 2008). Not only are novel antibiotics needed, but surveillance within each hospital must be augmented (Slama 2008). Hospital administration plays a vital role on controlling resistant pathogens, as well as enforcing rules to limit resistant strains from spreading. Hospitals or medical centers can only initiate surveillance programs or policy changes to improve infection control if there is financial support. Without financial support, resistant pathogens will continue to develop and spread, and the quality of health care worldwide will be drastically affected (Slama 2008)

Antimicrobial Resistance
Antimicrobial resistance (AMR) causes an estimated 700,000 deaths annually worldwide, and every country is potentially affected. If not properly addressed, the number could grow to 10 million per year by 2050.Justification Of Antibiotic Prescription Is Justifiable Essay

Causes of antimicrobial resistance
AMR occurs when bacteria and other microbes adapt and become less susceptible to medical treatment.

While much attention is focused on the improper use of antimicrobials, there is increasing evidence that medicine quality is another significant factor. Medicines with a lower dose of the active ingredient can lead to resistance. Strategies aimed at addressing antimicrobial resistance include ensuring broad access to affordable medicines, proper stewardship of existing antimicrobial treatments, investments in the development of new treatments. Medicine quality underpins all three.Justification Of Antibiotic Prescription Is Justifiable Essay

The importance of quality medicine
Quality medicine is essential to address the global threat of AMR. USP is helping with:

Developing and updating quality standards for medicines including antimalarials and antimicrobials used to treat diseases such as tuberculosis, meningitis and pneumonia.
Capability building
Strengthening systems to detect and remove substandard antimicrobials from the market and help local health systems improve access to quality antimicrobial medicines.
Raising awareness and understanding of medicine quality and AMR to foster dialog, inform policy decisions, and build stakeholder coalitions to advocate for investment in regulatory systems, quality-assurance and action. Read the Ghana Declaration: Call-to-Action on Antimicrobial Resistance


Antibiotic Resistance Essay, Research Paper

Antibiotic resistance in bacteria: “The more times you use a drug,

the more it will decrease the effect it has on you.”

For about 50 years, antibiotics have been the answer to many bacterial infections. Antibiotics Justification Of Antibiotic Prescription Is Justifiable Essay

are chemical substances that are secreted by living things. Doctors prescribed these medicines to

cure many diseases. During World War II, they treated one of the biggest killers during wartime,

infected wounds. It was the beginning of the antibiotic era. But just when antibiotics were being

mass produced, bacteria started to evolve and became resistant to these medicines.

Antibiotic resistance can be the result of different things. One cause of resistance could be drug

abuse. There are people who believe that when they get sick, antibiotics are the answer. The more

times you use a drug, the more it will decrease the effect it has on you. That is because the

bacteria has found a way to avoid the effects of that antibiotic. Another cause of resistance is the

improper use of drugs. When patients feel that the symptoms of their disease have improved, they

often stop taking the drug. Just because the symptoms have disappeared it does not mean the

disease has gone away. Prescribed drugs should be taken until all the medicine is gone so the

disease is completely finished. If it is not, then this will just give the bacteria some time to find a

way to avoid the effects of the drug.

Arbeau 2

One antibiotic that will always have a long lasting effect in history is penicillin. This was the

first antibiotic ever to be discovered. Alexander Fleming was the person responsible for the

discovery in 1928. In his laboratory, he noticed that in some of his bacteria colonies, that he was

growing, were some clear spots. He realized that something had killed the bacteria in these clear Justification Of Antibiotic Prescription Is Justifiable Essay

spots, which ended up to be a fungus growth. He then discovered that inside this mold was a

substance that killed bacteria. It was the antibiotic, penicillin.

Penicillin is a group of antibiotics derived from the fungus Penicillium. Or it can be created by

using partially artificial processes. Natural penicillin was discovered by Fleming but another ten

years passed before penicillin was concentrated and studied by British biochemist Ernst Chain,

British pathologist Sir Howard Florey, and other scientists.

Penicillin acts both by killing bacteria and by inhibiting their growth. It does not kill organisms

in the resting stage but only those growing and reproducing. Penicillin is effective against a wide

range of disease bearing microorganisms, including pneumococci, streptococci, gonococci,

meningococci, the clostridium that cause tetanus, and the syphilis spirochete. The drug has been

successfully used to treat such deadly diseases as endocarditis, septicemia, gas gangrene, gonorrhea,

and scarlet fever. Side affects produced by penicillin are limited largely to allergic reactions that can

be anticipated by the use of scratch tests before administration of the drug.

Penicillin became the most powerful germ killer known at that time. Antibiotics kill disease

causing bacteria by interfering with their processes. Penicillin kills bacteria by attaching to their

cell walls. Then it destroys part of the wall. The cell wall breaks apart and bacteria dies.

After four years, when drug companies started to mass produce penicillin, in 1943, the first signs

of penicillin resistant bacteria started to show up. The first bacteria that fought penicillin was

Arbeau 3

called Staphylococcus aureus. This bug is usually harmless but can cause an illness such as

pneumonia. In 1967, another penicillin resistant bacteria formed. It was called pneumococcus and

it broke out in a small village in Papua New Guinea. Other penicillin resistant bacteria that formed

are Enterococcus faecium and a new strain of gonorrhea.

Antibiotic resistance can occur by a mutation of DNA in bacteria or DNA acquired from

another bacteria that is drug resistant through transformation. Penicillin resistant bacteria can alter Justification Of Antibiotic Prescription Is Justifiable Essay

their cell walls so penicillin can not attach to it. The bacteria can also produce different enzymes that

can take apart the antibiotic.

Since antibiotics became so prosperous, all other strategies to fight bacterial diseases were put

aside. Now since the effects of antibiotics are decreasing and antibiotic resistance is increasing,

new research on how to battle bacteria is starting.

Antibiotic resistance spreads fast but efforts are being made to slow it. Improving infection

control, discovering new antibiotics, and taking drugs more appropriately are ways to prevent

resistant bacteria from spreading. In developing nations, approaches are being made to control

infections such as hand washing by health care people, and identifying drug resistant infections

quickly to keep them away from others. The World Health Organization has began a global

computer program that reports any outbreaks of drug resistant bacterial infections.

In the early 1900’s, the discovery of penicillin began the antibiotic era. People thought they

have finally won the battle with bacteria. But now since antibiotic resistance is increasing rapidly,

new strategies must be developed to destroy these microbes.

Antibiotics use to be the talk of the medical world just fifty years go, now the talk is about trying to find a better antibiotic than the ones they came up with less than a five decades ago. Antibiotic Resistance has taking the world by storm. The abuse and excessive use of antimicrobials may be driven by ignorance, by not enough surveillance for resistance and by the error of suitable use by health care suppliers, patients, and families
These days’ physicians rely on antibiotics to make effective recoveries for peoples infections and viruses. There presently are more than 100 antimicrobial agents available in the U.S. They do away with infections by either destroying microorganisms, or by undermining the ability of these microorganisms to reproduce. [2] Antimicrobials have transformed our ability to treat many infectious diseases that were killers only a few decades ago. The increasing use of antimicrobials in humans, animals, and agriculture has resulted in many pathogens developing resistance to these powerful drugs. All viruses, fungi, parasites, and bacteria can become resistant to antimicrobials. [3] In using Antimicrobial Products, the public presumes that antibacterials can sterilize the home environment and perhaps even fight off infections. On the other hand, studies have shown that these agents can produce changes in hospital flora; therefore their presence in many household products may be contributing to antibiotic resistance.Justification Of Antibiotic Prescription Is Justifiable Essay  [2]
STDs are among the many infectious diseases in which antimicrobial resistance has a clinically significant impact. [5] More than 15 million Americans acquire at least one new STD each year, many of which may acquire more than one STD, are unaware of their infection, or both. Gail Bolan, MD, of the San Francisco Department of Public Health has said that patients with a recurring STD have been reinfected by an untreated partner, where as it may be a case of resistance-related treatmen.. Justification Of Antibiotic Prescription Is Justifiable Essay

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