Battling Antibiotic Resistance

Jon Juliano, MD, MSPH, and David van Duin, MD, PhD, are clinician-researchers who study antibiotic resistance.

Jon Juliano, MD, MSPH, and David van Duin, MD, PhD, are clinician-researchers who study antibiotic resistance.

By Josh Neal, Communications Intern, UNC Institute for Global Health & Infectious Diseases

Clinician-researchers Jonathan Juliano, MD, MSPH, and David van Duin, MD, PhD, have worked for several years with antibiotic resistance and talked about the past, present and future of this important matter.

Resistance Emerges
Clinically relevant antibiotic resistance has been known for quite some time with the first resistant bacteria identified in the late 1950s, according to Juliano, an associate professor of medicine and medical director of the UNC Hospitals Antibiotic Stewardship Team. However, it wasn’t until recently that our perceptions of the situation have changed. Overuse in medicine and agriculture and inappropriate prescribing have caused many bacteria to evolve into resistant strains.

“The first response to antibacterial resistance was to create new antibiotics,” said van Duin, associate professor of medicine and director of the Immunocompromised Host Infectious Diseases Section at UNC.“However, it is getting harder to develop antibacterials with novel mechanisms of action. In addition, the process of bringing these antibacterials to market is quite expensive and takes a long time.”

The decline in antibiotic development has caused us to take a step back from focusing on specific infections to looking at the situation more holistically, says van Duin. People realized that we couldn’t just create new antibiotics forever.

History of antibiotics and resistance courtesy of the Centers for Disease Control and Prevention.

Click to enlarge this history of antibiotics and resistance courtesy of the Centers for Disease Control and Prevention.

Improving Stewardship and Diagnostics
Protecting what we currently have is the main focus nowadays. We must do this through two main methods: stewardship and diagnostics, says Juliano.

Stewardship involves improving antibiotic use within organizations. This includes which antibiotics we are prescribing, the dosages we prescribe and whether antibiotics need to be used in each case.

Diagnostics involves changing the way we detect bacterial infections. These new tools have the potential to change how much we use antibiotics and to improve the quality of our use.

“In the last 5-10 years, the discussion of antibiotic resistance has become more focal and widespread in the medical community,” said Juliano.

Changing Behavior
Moving forward we need to focus on the most concerning bacteria first. Currently, the CDC identifies bacteria such as drug resistant Neisseria gonorrhoeae and carbapenem-resistant Enterobacteriaceae (CRE) as the most serious threats domestically. Globally, drug resistant tuberculosis and malaria are major public health threats.

“In addition to identifying the most concerning bacteria, you must also differentiate between resistant strains that are contained in hospitals and those that are out in the public to know where to put your focus,” said van Duin.

However, getting people to be more cognizant of drug-resistance is not an easy feat. There will have to be a systematic change within organizations in order to lessen its effects.

“Even if we tell medical students to only prescribe antibiotics when there are no other options, they will typically just continue to do what their mentors did in practice,” said Juliano.

The danger of drug resistance comes from its complexity and it requires the efforts of an array of groups to handle. It is an issue we should all be concerned about because anyone could get infected with an antibiotic resistant pathogen.