Reducing Antibiotic Use Lowers Rates Of Drug-resistant Bacteria

Drug-resistantbacteria, commonly called “superbugs,” are fast becoming a problem dueto overuse and inappropriate prescribing of antibiotics. Streptococcuspneumoniae bacteria, also called pneumococci, are commonly found inchildren’s noses and throats, and can result in ear infections,sinusitis, pneumonia and even meningitis. Many pneumococcal infectionsare treated with penicillin, but resistance to the drug is making themicrobes more difficult to control.

Researchers in France testedtwo intervention methods intended to reduce the rate of carriage ofpenicillin-resistant pneumococci in kindergarteners. Theprescription-reduction method involved not prescribing antibiotics forrespiratory tract infections that were thought to be viral, sinceantibiotics work against bacteria, not viruses. The dose/durationmethod involved using only recommended doses of antibiotics for nolonger than 5 days. The researchers also targeted physicians,pharmacists, parents, and children in the groups receiving bothinterventions with an information campaign about antibiotic resistanceand appropriate antibiotic use. A control group of children and theirdoctors received no specific information about antibiotic use.

Thestudy was conducted from January through May of 2000. By the end of thestudy, antibiotic use had declined by more than 15 percent in bothintervention groups, compared to less than 4 percent in the controlgroup. Although colonization by regular pneumococci was higher in theintervention groups than in the control group, colonization bypenicillin-resistant pneumococci was lower in the intervention groupsthan in the control group. The prescription-reduction group saw thegreatest decline in penicillin-resistant colonization (from 53 percentto 35 percent), and the dose/duration group dropped from 55 percent to44 percent. The control group remained nearly unchanged. This suggeststhat reduced antibiotic pressure allows drug-susceptible bacteria tore-establish themselves as dominant colonizers of the respiratory tract.

Implementingintervention programs that are “focused on populations most exposed toantibiotics”--that is, children--is the first step in reining insuperbugs, said lead author Didier Guillemot, MD, PhD, of InstitutPasteur.

Intervention methods such as reducing the number ofprescriptions and, when ordered, the dose and duration of antibiotics,“can induce significant and rapid reductions” of penicillin-resistantpneumococcal colonization in areas that have high rates ofdrug-resistant bacteria, according to the study. In essence, doctorscan make their own jobs easier by prescribing antibiotics morejudiciously, thus slowing the spread of superbugs.

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