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| CE article antibiotics 08 roots 4 2016 CE credit This article qualifies for CE credit. To take the CE quiz,log on to www. dtstudyclub.com. Click on ‘CE arti- cles’ and search for this edition of roots magazine. If you are not reg- istered with the site, you will be asked to do so before taking the quiz. Use and abuse of antibiotics Author: Dr Steven G. Morrow, USA Introduction For the past 80 years, antibiotic therapy has played a major role in the treatment of bacterial infectious diseases. Since the discovery of penicillin in 1928 by Fleming and sulfanilamide in 1934 by Domagk, the entire world has benefited from one of the greatest medical advancements in history. The discovery of safe, systemic antibiotics has been a major factor in the control of infectious diseases and, as such, has increased life expectancy and the quality of life for millions of people. According to the Centers for Disease Control and Prevention, life expectancy of individuals in the United States born in 1900 was 47 years, while those bornin2005isprojectedtobe78years.1 Atthebegin- ning of the 20th century, the infant (< 1 year) mortal- ity rate in the United States was 100/1,000 live births comparedto6.7/1,000in2006.2 Themajorreasonfor these phenomenal achievements has been the ability to control infectious diseases.3 Development of antibacterial drug resistance Along with the dramatic benefits of systemic anti- biotics,therehasalsobeenanexplosioninthenumber of bacteria that have become resistant to a variety of these drugs. The problem is not the antibiotics them- selves. They remain one of medicine’s most potent weapons against diseases. Instead, the problem is in thewaythedrugsareused.Theinappropriateoveruse of antibiotics has resulted in a crisis situation due to bacterial mutations developing resistant strains. Many worldwide strains of Staphylococcusaureus exhibit resistance to all medically important antibac- terial drugs, including vancomycin; and methicillin resistant S. aureus has become one of the most fre- quent nosocomial, or hospital-acquired, pathogens. The rate at which bacteria develop resistance to anti- bacterialdrugsisalarming,demonstratingresistance soonafternewdrugshavebeenintroduced.Thisrapid development of resistance has contributed signifi- cantly to the morbidity and mortality of infectious diseases, especially nosocomial infections.4 Anosocomialinfectionisahospital-acquiredinfec- tionthatdevelopsinapatientafteradmission.Itisusu- allydefinedasaninfectionthatisidentifiedatleast48 to72hoursfollowingadmission,soinfectionsincubat- ing, but not clinically apparent at admission, are ex- cluded. Nosocomial infections are costly, resulting in increasedmorbidity,requiringlongerperiodsofhospi- talizationandlimitingaccessofotherpatientstohos- pital resources. The direct costs of hospital-acquired infectionsintheUnitedStatesareestimatedtobe$4.5 billion per year. Nosocomial infections also contribute totheemergenceanddisseminationofantimicrobial- resistantorganisms.Antimicrobialusefortreatmentor prevention of infections facilitates the emergence of more resistant organisms. Patients with infections caused by antimicrobial-resistant organisms are then asourceofinfectionforhospitalstaffandotherhospi- talized patients. These drug-resistant infections may subsequentlyspreadtothecommunity.5 The British Society for Antimicrobial Chemother- apy published a review in the Journal of Antimicro- bial Chemotherapy. This review examined the contri- butions antibiotic prescribing by general dentists in the United Kingdom has made to the selection of antibiotic resistance in bacteria of the oral flora.6 The review concluded that inappropriate antibacterial drug prescribing by dental practitioners is a signifi- cant contributing factor in the selection of drug- resistant bacterial strains. The American Dental Association reported the re- sults of a survey of antibiotic use in dentistry in the November 2000 Journal of the American Dental As- sociation.7 The authors surveyed all licensed dentists practicinginCanadaandfoundthatconfusionabout prescribing antibiotics and inappropriate prescribing practices were evident, and that inappropriate anti- bioticuse,suchasimproperdosing,durationofther- apy and prophylaxis are all factors that may affect development of antibiotic resistant microorganisms. There is a glimmer of hope A report from Aker University in Oslo, Norway, strongly suggests that bacterial resistance to anti- bacterial agents can be reversed.8 While dangerous 42016