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Rev Electron Biomed / Electron J Biomed 2004;1:2-3.
Editorial: THE ANTIBIOTERAPHY
Antibiotics are one of the most effective drugs in the fight against the diseases that science has created. Its discovery constituted a medical revolution. Nevertheless, sometimes we forget that the antibiotics really act modifying the environment in which the germs live, not destroying all of them. It creates therefore a new environment where only some of them adapt (in the sense that it gives to this term for the synthetic theory of the evolution), the most resistant ones. This forces us to continue investigating and producing new antibiotics to fight against these adapted germs, and to participate in a race that we might never win.
Despite of this knowledge, antibiotics are still prescribed unnecessarily in all the medical sceneries, not only in primary care but also in critical care. Although there are not many information on the reduction of bacterial resistance by means of the reduction of the antibiotic prescription, there are some studies that demonstrate that that is possible. In Finland, the proportion of infections by
macrolides resistants streptococci was reduced almost to half after a campaign to reduce the use of this antibiotic family. Another study in Iceland demonstrated that
the number of penicillin resistants neumococci carriers
is closely related to the usege of antibiotics at individual and communitarian level.
Fighting against the indiscriminate usage of antibiotic is not an easy task, its necessary to educate not only the patient but also the doctor. The typical case is the one of the infections of the superior respiratory tract. The patient requests an antibiotic or obtains it without prescription and
few days after that is cured. It is difficult, if one does not have a solid formation, to avoid to fall in the fallacy "post hoc, ergo propter hoc"; so the next time patient gets sick, he/she will want the antibiotic again. Something similar happens with the doctor, against an uncertain diagnosis,
it is difficult to him/her to resist to prescribe an antibiotic "in case it is a bacterial infection".
And if this happens in primary care, in the setting of the critical ill patients, whose diagnosis can be complex or to be delayed while the disease threatens the life, is also difficult to resist the usage an antibiotic "just in case". In the closed units, this causes a greater number of resistance, with the appearance of smalls outbreaks of multiresistant bacteria, and the antibiotics rotate is needed.
To fight against this is not easy. It is necessary to begin with educating the actors, patient and doctors. In the case of the patients, institutionals educatives campaigns can be very useful. In the case of the doctors it is fundamental to know the microrganisms that more probably cause the infectious syndroms in the environment of each one, to know his resistance and to elaborate clinical guides based on the evidence and to rely on them.
In an article of this number, Dr Moisés Morejón García reviews the bases for a correct use of the antibiotics, whose knowledge is essential for his suitable use, limiting therefore the appearance of resistance.
Editorial: THE ANTIBIOTERAPHY
Antibiotics are one of the most effective drugs in the fight against the diseases that science has created. Its discovery constituted a medical revolution. Nevertheless, sometimes we forget that the antibiotics really act modifying the environment in which the germs live, not destroying all of them. It creates therefore a new environment where only some of them adapt (in the sense that it gives to this term for the synthetic theory of the evolution), the most resistant ones. This forces us to continue investigating and producing new antibiotics to fight against these adapted germs, and to participate in a race that we might never win.
Despite of this knowledge, antibiotics are still prescribed unnecessarily in all the medical sceneries, not only in primary care but also in critical care. Although there are not many information on the reduction of bacterial resistance by means of the reduction of the antibiotic prescription, there are some studies that demonstrate that that is possible. In Finland, the proportion of infections by macrolides resistants streptococci was reduced almost to half after a campaign to reduce the use of this antibiotic family. Another study in Iceland demonstrated that the number of penicillin resistants neumococci carriers is closely related to the usege of antibiotics at individual and communitarian level.
Fighting against the indiscriminate usage of antibiotic is not an easy task, its necessary to educate not only the patient but also the doctor. The typical case is the one of the infections of the superior respiratory tract. The patient requests an antibiotic or obtains it without prescription and few days after that is cured. It is difficult, if one does not have a solid formation, to avoid to fall in the fallacy "post hoc, ergo propter hoc"; so the next time patient gets sick, he/she will want the antibiotic again. Something similar happens with the doctor, against an uncertain diagnosis, it is difficult to him/her to resist to prescribe an antibiotic "in case it is a bacterial infection".
And if this happens in primary care, in the setting of the critical ill patients, whose diagnosis can be complex or to be delayed while the disease threatens the life, is also difficult to resist the usage an antibiotic "just in case". In the closed units, this causes a greater number of resistance, with the appearance of smalls outbreaks of multiresistant bacteria, and the antibiotics rotate is needed.
To fight against this is not easy. It is necessary to begin with educating the actors, patient and doctors. In the case of the patients, institutionals educatives campaigns can be very useful. In the case of the doctors it is fundamental to know the microrganisms that more probably cause the infectious syndroms in the environment of each one, to know his resistance and to elaborate clinical guides based on the evidence and to rely on them.
In an article of this number, Dr Moisés Morejón García reviews the bases for a correct use of the antibiotics, whose knowledge is essential for his suitable use, limiting therefore the appearance of resistance.
Editorial: ANTIBIOTERAPIA
A pesar de este conocimiento, se siguen prescribiendo antibióticos innecesariamente en todos los escenarios médicos, tanto en atención primaria como en cuidados intensivos. Aunque no hay muchos datos sobre la reducción de resistencias bacterianas mediante la reducción de la prescripción antibiótica, hay algunos estudios que demuestran que eso es posible. En Finlandia, la proporción de infecciones por estreptococos resistentes a los macrólidos se redujo a casi la mitad tras una campaña para reducir el uso de esta familia de antibióticos. En otro estudio en Islandia se demostró que el número de portadores de neumococos resistentes a la penicilina está estrechamente relacionado con el uso de antibióticos a nivel individual y comunitario.
Contra el uso indiscriminado de antibióticos no es fácil luchar, es necesario educar tanto al paciente como a su médico. El caso típico es el de las infecciones del tracto respiratorio superior. El paciente pide un antibiótico o lo consigue sin receta y pocos días después de comenzar a tomarlo se cura. Es difícil, si uno no tiene una sólida formación, evitar caer en la falacia "post hoc, ergo propter hoc"; la próxima vez que enferme, el paciente querrá de nuevo antibióticos. Otro tanto pasa con el médico al cual, ante un diagnóstico incierto, le es difícil resistirse a recetar un antibiótico "por si es una infección bacteriana".
Y si esto ocurre en atención primaria, en la atención del paciente grave, cuyo diagnóstico puede ser complejo o retrasarse mientras que la enfermedad amenaza la vida, es también difícil resistirse a usar un antibiótico "por si acaso". En las unidades cerradas, esto ocasiona un mayor número de resistencias, con la aparición de pequeñas epidemias de bacterias multirresistentes, y la necesidad de rotar el uso de determinados antibióticos.
Luchar contra esto no es fácil. Es necesario empezar con educar a los implicados, tanto pacientes como médicos. En el caso de la población, las campañas educativas institucionales pueden resultar de utilidad. En el caso de los médicos es fundamental conocer los gérmenes que más probablemente ocasionan los cuadros infecciosos en el medio de cada uno, conocer sus resistencias y elaborar guías clínicas basadas en la evidencia y atenerse a ellas.
En un artículo de este número, el Dr. Moisés Morejón García revisa las bases para un correcto empleo de los antibióticos, cuyo conocimiento resulta imprescindible para su uso adecuado, limitando así la aparición de resistencias.