Thoughtful approach to antibiotic resistance

I spent a good chunk of last week in a hospital where my mother was undergoing surgery, so I had a chance to see, firsthand, some of the double-checking that doctors and nurses use to avoid making simple mistakes. They repeatedly asked my mom her name, her date of birth, what surgery she was there for and which side of her body doctors were supposed to operate on. All went well, but the experience reminded me of Atul Gawande’s 2007 New Yorker article (and 2009 book) about how using checklists could improve medical outcomes. Gawande discussed a list designed to combat the spread of bacterial infections in intensive care units. First was a reminder for doctors to wash their hands with soap — a low-tech, common sense approach similar to asking a patient whether her right or left side is slated for surgery. That same approach may help ebb the tide of antibiotic resistance.

As biomedical writer Nathan Seppa describes in “Doctors enlisted to turn the tide on antibiotic resistance,” some strains of staph, strep, salmonella, gonorrhea and other pathogens now routinely evade antimicrobial drugs, leading to some 23,000 U.S. deaths each year. One way to deal with the problem is simple but counterintuitive: use fewer antibiotics. Reducing unnecessary use, Seppa explains, will help keep the drugs effective for longer. Antimicrobial stewardship programs that encourage more strategic prescribing of antibiotics and remind doctors (and patients) of appropriate uses are on the rise. Changing how people think about antibiotics is already showing promise in reducing antibiotic use and costs. It may also help with the problem of resistance.

It’s doubtful, however, that any single strategy will be enough. As game theory demonstrates, multiple strategies usually give you the best chance of winning. We’ll need a slew of approaches, from thoughtful prescription guidelines, to the rollout of new antibiotics, to radical new ways of treating infection (perhaps by modulating signaling between bacterial cells, or by recruiting other microbes to assist in our defense). And, of course, there’s good old hand washing. Even as more cutting-edge strategies are developed, one can be implemented now: seeing antibiotics as a valuable, and vulnerable, resource and using them accordingly. That should improve everyone’s outcome.

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