Data for this review were identified by searching the PubMed database (National Library of Medicine) and the Reservoirs of Antibiotic Resistance Network (ROAR) bibliography: (http://www.tufts.edu/med/apua/ROAR/biblio.htm)*. The search terms “antimicrobial resistance/consumption”, “selection”, and “overgrowth” were used. Search criteria encompassed any article, in any language, demonstrating the less obvious adverse effects of antibiotics; and also articles attempting to address inappropriate
ReviewHow antibiotics can make us sick: the less obvious adverse effects of antimicrobial chemotherapy
Section snippets
Overgrowth of resistant organisms
Naturally resistant organisms proliferate in response to antibiotic treatment.9 This proliferation can be shown in healthy volunteers and patients, and has been reviewed elsewhere.10 Perhaps the best-known examples are the overgrowth of Candida albicans after almost any antibiotic (figure 1).11 The cephalosporins, in particular, are associated with Candida and also Clostridium difficile-associated diarrhoea; these drugs also encourage overgrowth with enterococci and Pseudomonas aeruginosa (see
Are resistant organisms more virulent?
Treating an infected patient with an antibiotic that is ineffective against the causative organism can complicate clinical management. Signs and symptoms of infection can worsen if the original pathogen is not eradicated,5 not only because bacteria tend to proliferate rapidly if unchecked, but also because proliferation is further enhanced after inappropriate treatment owing to the removal of competing flora. Thus, the pathogen is allowed access to space and nutrients that it might previously
Medical education
There has been a gross reduction in the teaching of pathology, including microbiology, for undergraduate students and there is little in place for postgraduate students. It is time that the risk to public health from inappropriate prescribing was addressed.74 Above all, doctors should understand why antimicrobial agents should only be used when really needed, and why they should choose narrow-range agents. Specialist pharmacists working in conjunction with local microbiologists are helping to
Conclusion
Appropriate antimicrobial prescribing has not yet become a priority for all doctors. It is probable that such prioritisation will become mandatory, after increasing interest from government, lawyers, and the media. Patients have died because they were given the wrong antibiotic (panel).100 Any attempt to curb resistance, however, will have to take into account the fact that resistance genes might be easy to get, but they are also hard to lose.101, 102 It is possible that our generation will
Search strategy and selection criteria
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