Antibiotic prescriptions against smaller ailments account for about 90 percent of antibiotic use!

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Antibiotic prescriptions against smaller ailments (tonsillitis, bronchitis, bladder infections, etc.) account for about 90 percent of antibiotic use, and so are likely to be the major driver of resistance evolution. Therefore, the focus should be on development of alternate treatments for small infections – This is the conclusion of a recently in Plos-Journal published study.
The researchers illustrate the challenge based on various examples – among others streptococcal pharyngotonsillitis as a good candidate for alternative therapeutics. The current situation looks like this: Bacterial pharyngotonsillitis is almost always of streptococcal aetiology, with group A streptococci (GAS) accounting for the majority of cases. For GAS pharyngitis, penicillins are the treatment of choice, and despite extensive penicillin use, GAS are invariably sensitive. Penicillin treatment of GAS infections may thus seem unproblematic from a resistance perspective. However, because these infections make a large contribution to antibiotic use, they may affect the evolution of resistance in other bacteria.
One potential strategy would be to develop antivirulence drugs that turn symptomatic infection into asymptomatic carriage, decrease the symptoms and risks associated with infection, or help the immune system to clear the bacteria. Another approach would be to use bacteriophages. As compared to the antivirulence approach, this would have the benefit of killing the bacteria and thus make it more similar to current treatment. A recent study in the Russian military reported promising results using phages as prophylaxis for respiratory tract infections, including tonsillitis.
Yes, the development of alternate treatments for small infections is an important contribution in the fight against resistant germs. But awareness rising is an equally important approach – What is an alternative medication worth, if it is not prescribed! As a patient unfortunately I still make the experience that doctors prescribe antibiotics very quickly.

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Carola Timmel is journalist for print and radio and professional speaker. Her focus lies on the topic Medicine & Health.