Antimicrobial resistance

There is an increasing problem of antimicrobial resistance in the community. A letter from the Chief Medical Officer identified four areas which could make a significant impact on the volume of antimicrobials prescribed (1):

• antibiotics should not be prescribed for simple coughs and colds
  
  
• antibiotics should not be prescribed for viral sore throats
  
  
• in cases of uncomplicated cystitis in otherwise fit young women, antibiotics should only be prescribed for three days
  
  
• the prescribing over the telephone of antibiotics should be limited to exceptional cases

Further guidance concerning antibiotic prescribing for self-limiting respiratory tract infections in adults and children in primary care has been given (2).

A US review notes (3):

• risk factors for the development of antimicrobial resistance include:
  • immune suppression (due to cancer, organ transplant, HIV, or immunosuppressing medications)
  • antibiotic prescribing in infants or people older than 65 years
  • conditions such as diabetes, chronic kidney disease, and chronic lung disease
  • prior treatment with antibiotics and long-term antibiotic use
  • prolonged hospital stays,
  • use of catheters
    
    
• factors facilitating spread of antimicrobial resistance include:
  • inadequate handwashing
  • substandard hospital cleaning
  • overcrowding
  • poor sanitation
  • contaminated food or water
  • travel to areas that have high rates of antimicrobial resistance
    
    
• common antibiotic-resistant organisms
  • antibiotic-resistant bacteria include:
    • methicillin-resistant Staphylococcus aureus (MRSA)
      • MRSA may cause skin and soft tissue infections, pneumonia, and bloodstream infections
    • drug-resistant Streptococcus pneumoniae
      • S pneumoniae is a common cause of pneumonia, ear infections, and meningitis, particularly in children and older adults
    • gram-negative bacteria such Escherichia coli, Klebsiella, Pseudomonas aeruginosa, and Acinetobacter that are resistant to carbapenem antibiotics
      • carbapenem-resistant gram-negative bacteria often cause UTIs, pneumonia, and bloodstream or intra-abdominal infections
• notes
  • the prevalence of antimicrobial-resistant tuberculosis, malaria, and fungal infections (such as Aspergillus and Candida) are also increasing
  • some viruses that can affect immunosupressed patients (such as cytomegalovirus) can also become resistant to antiviral drugs

Reference:

1. PL/CMO/98/6 (PL/CNO/98/7 PL/CDO/98/4 PL/CPHO/98/1)
2. NICE (June 2008).Respiratory tract infections - antibiotic prescribing for self-limiting respiratory tract infections in adults and children in primary care.
3. Arias CA, van Duin D. What Is Antimicrobial Resistance? JAMA. Published online July 17, 2025.