抗生素使用增加抗菌性菌種，這本來就知道，RTI up to 2.4X, UTI up to 1.3X

Resistance Tied to Antibiotic Use

Resistance to a particular antibiotic is more likely among individuals who have received that agent than among those who have not; the effect may last a year.

Infectious disease specialists have long believed that the emergence of drug-resistant bacteria is directly related to the use and overuse of antibiotics. However, antibiotic use is still not limited appropriately in the primary care setting. What does this mean for the individual patient?

Researchers reviewed data from 24 studies describing the link between antibiotics prescribed in primary care and subsequent resistance to those antibiotics at the individual level. Meta-analyses were conducted of five studies focused on bacteria in the urinary tract (involving >14,000 individuals) and seven studies focused on the respiratory tract (involving >2600 individuals). All but one study in each analysis involved symptomatic patients rather than healthy volunteers.

In each meta-analysis, patients who received a given antibiotic were about 2.5 times more likely than those who did not to have resistance to that antibiotic during the first 2 to 3 months after treatment. The effect remained significant at 1 year (pooled odds ratios, 2.4 in respiratory tract studies and 1.3 in urinary tract studies).

Data on the emergence of methicillin-resistant Staphylococcus aureus showed a variable effect of previous antibiotic treatment, with associations seen for nasal colonization but not skin colonization.


Comment: This study contributes definitively to the concept that antibiotic use promotes resistance. The greatest effect was seen immediately after therapy, but resistance sometimes persisted, particularly in the respiratory tract, for at least a year. Increased dosage and treatment duration led to increased resistance rates. An accompanying editorial acknowledges the need to limit antibiotic use but emphasizes, as does a companion article, the need to offer incentives for the development of new antimicrobial agents.

— Stephen G. Baum, MD

Published in Journal Watch Infectious Diseases May 26, 2010

Citation(s):

Costelloe C et al. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: Systematic review and meta-analysis. BMJ 2010 May 18; 340:c2096. (http://dx.doi.org/10.1136/bmj.c2096)

So AD et al. Tackling antibiotic resistance. BMJ 2010 May 18; 340:c2071. (http://dx.doi.org/10.1136/bmj.c2071)

Morel CM and Mossialos E. Stoking the antibiotic pipeline. BMJ 2010 May 18; 340:c2115. (http://dx.doi.org/10.1136/bmj.c2115)


http://docs.google.com/fileview?id=0B278nGJMQBk7NTBmMWQ0YzQtZjY0Zi00NjU0LWJjYWYtNGY3NWZmODkzODBj&hl=en

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