Antimicrobial Usage & Spread of Resistance

Karl Roberts kr1 at PGSTUMAIL.PG.CC.MD.US
Mon Jan 20 21:09:52 EST 1997

Dear Alan,
	The answer to this subject is subject to debate. If a physician 
does not know the identity of the pathogen, he or she is likely to 
prescribe a broad-spectrum antibiotic. But this "shotgun approach" is 
likely to lead to the selection of antibiotic-resistant strains, since 
these will be the survivors even of a regular course of antibiotic 
therapy. It is no longer a question of using the proper antibiotic, but 
should we be using them at all. Obviously you know the detrimental effect 
such therapy has on normal flora. In my own (limited) opinion, we should 
limit use of antibiotic therapy until after testing. I hope this helps.
Karl J. Roberts

On 20 Jan 1997, Alan Junkins wrote:

> Just thought I'd ask a question of any pharmacy
> types out there.  We've all heard about how one
> of the main causes for the spread of
> antimicrobial resistance among bacteria is
> improper usage, including taking an
> antimicrobial for two days until you feel better,
> then neglecting to take the final eight days of
> the regimen.  If that's the case, then which is
> better in this scenario -  Patient goes to the
> physician with a possible infection.  The
> physician prescribes an antimicrobial, most
> likely a fairly broad spectrum drug, and sends a
> specimen to the laboratory for culture.  The next
> day culture results come back negative. 
> Obviously at this point the best thing for the
> patient's microbial health is to stop taking the
> antimicrobial.  But which is better for
> minimizing spread of antimicrobial resistance
> in the population - stop taking the drug, or
> continue through the full ten day course?  In
> other words, is it better to fully treat a
> non-existent infection and completely obliterate
> susceptible members of the normal flora, or
> expose the normal flora to an incomplete
> course of the drug?

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