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Responsible antibiotic stewardship

By Prof. Scott Glickman

 

If a drug treatment for #cystitis is approved by a patient safety regulatory agency, without evidence that it can produce cure, who, if anyone, actually is, or should be responsible for an infection recurrence with it? I ask because I see no convincing evidence that any approved oral #antibiotic treatment has ever come with evidence that it reliably cures cystitis (i.e. produces pathogen annihilation). Of course, I see symptom recovery, but notwithstanding that, there is good circumstantial evidence that such treatments provide bacteria with great opportunities to develop resistance (AMR). That predisposes to recurrences, because that’s what bacteria tend to do when exposed to a sublethal threat. Patients and healthcare services both suffer plenty of #UTI while #AMR relentlessly progresses.

 

An antibiotic, drip-fed via ureters into an infected urinary pool of substantial volume, takes time to reach even a minimum inhibitory concentration. That delay is a window of opportunity for bacteria to muster their defences. If they can produce an adequate one during that time, then the drug’s therapeutic threshold (MIC) could rise too high above that provided by the standard approved treatment regimens. That would render them unable to cure. That’s quite a glitch!

 

Blaming prescribers rather than the treatments closely resembles blaming British sub-post office staff for the Horizon computer glitch. I suggest we should dive a little deeper into pharmacology and antimicrobial stewardship with a focus on these treatments rather than the provider healthcare staff.

 

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