alt=Infographic from CDC report on preventing antibiotic<unk>  There have been increasing public calls for global collective action to address the threat, including a proposal for international treaty on<unk> . Further detail and attention is still needed in order to recognize and measure trends in<unk>  on the international level; the idea of a global tracking system has been suggested but implementation has yet to occur. A system of this nature would provide insight to areas of high<unk>  as well as information necessary for evaluating programs and other changes made to fight or reverse antibiotic<unk> . Duration of antibiotics Antibiotic treatment duration should be based on the infection and other health problems a person may have. For many infections once a person has improved there is little evidence that stopping treatment causes more<unk> . Some, therefore, feel that stopping early may be reasonable in some cases. Other infections, however, do require long courses regardless of whether a person feels better. Monitoring and mapping There are multiple national and international monitoring programs for drug-resistant threats, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant S. aureus (VRSA), extended spectrum beta-lactamase (ESBL), vancomycin-resistant Enterococcus (VRE), and multidrug-resistant Acinetobacter baumannii (MRAB).<unk> Open is an online global map of<unk>  developed by HealthMap which displays aggregated data on<unk>  from publicly available and user submitted data. The website can display data for a radius from a location. Users may submit data from antibiograms for individual hospitals or laboratories. European data is from the EARS-Net (European<unk>  Surveillance Network), part of the ECDC.<unk> Map is a website by the Center for Disease Dynamics, Economics & Policy and provides data on<unk>  on a global level. Limiting antibiotic use Antibiotic stewardship programmes appear useful in reducing rates of antibiotic<unk> . The antibiotic stewardship program will also provide pharmacists with the knowledge to educate patients that antibiotics will not work for a virus. Excessive antibiotic use has become one of the top contributors to the evolution of antibiotic<unk> . Since the beginning of the antibiotic era, antibiotics have been used to treat a wide range of disease. Overuse of antibiotics has become the primary cause of rising levels of antibiotic<unk> . The main problem is that doctors are willing to prescribe antibiotics to ill-informed individuals who believe that antibiotics can cure nearly all illnesses, including viral infections like the common cold. In an analysis of drug prescriptions, 36% of individuals with a cold or an upper respiratory infection (both viral in origin) were given prescriptions for antibiotics. These prescriptions accomplished nothing other than increasing the risk of further evolution of antibiotic resistant bacteria. Using antibiotics without prescription is another driving force leading to the overuse of antibiotics to self-treat diseases like the common cold, cough, fever, and dysentery resulting in a epidemic of antibiotic<unk>  in countries like Bangladesh, risking its spread around the globe. Introducing strict antibiotic stewardship in the outpatient setting may reduce the emerging bacterial<unk> . At the hospital level<unk>  stewardship teams in hospitals are encouraging optimal use of<unk> s. The goals of<unk>  stewardship are to help practitioners pick the right drug at the right dose and duration of therapy while preventing misuse and minimizing the development of<unk> . Stewardship may reduce the length of stay by an average of slightly over 1 day while not increasing the risk of death. At the farming level It is established that the use of antibiotics in animal husbandry can give rise to<unk><unk> s in bacteria found in food animals to the antibiotics being administered (through injections or medicated feeds). For this reason only<unk> s that are deemed "not-clinically relevant" are used in these practices. Recent studies have shown that the prophylactic use of "non-priority" or "non-clinically relevant"<unk> s in feeds can potentially, under certain conditions, lead to co-selection of environmental<unk>  bacteria with<unk>  to medically important antibiotics. The possibility for co-selection of<unk><unk> s in the food chain pipeline may have far-reaching implications for human health. At the level of GP Given the volume of care provided in primary care (General Practice), recent strategies have focused on reducing unnecessary antibiotic prescribing in this setting. Simple interventions, such as written information explaining the futility of antibiotics for common infections such as upper respiratory tract infections, have been shown to reduce antibiotic prescribing. The prescriber should closely adhere to the five rights of drug administration: the right patient, the right drug, the right dose, the right route, and the right time. Cultures should be taken before treatment when indicated and treatment potentially changed based on the susceptibility report. About a third of antibiotic prescriptions written in outpatient settings in the United States were not appropriate in 2010 and 2011. Doctors in the U.S. wrote 506 annual antibiotic scripts for every 1,000 people, with 353 being medically necessary. Health workers and pharmacists can help tackle<unk>  by: enhancing infection prevention and control; only prescribing and dispensing antibiotics when they are truly needed; prescribing and dispensing the right antibiotic(s) to treat the illness. At the individual level People can help tackle<unk>  by using antibiotics only when prescribed by a doctor; completing the full prescription, even if they feel better; never sharing antibiotics with others or using leftover prescriptions. Country examples * The Netherlands has the lowest rate of antibiotic prescribing in the OECD, at a rate of 11.4 defined daily doses (DDD) per 1,000 people per day in 2011. * Germany and Sweden also have lower prescribing rates, with Sweden's rate having been declining since 2007. * Greece, France and Belgium have high prescribing rates of more than 28 DDD. Water, sanitation, hygiene Infectious disease control through improved water, sanitation and hygiene (WASH) infrastructure needs to be included in the<unk>  <unk>  agenda. The "Interagency Coordination Group on<unk> " stated in 2018 that "the spread of pathogens through unsafe water results in a high burden of gastrointestinal disease, increasing even further the need for antibiotic treatment." This is particularly a problem in developing countries where the spread of infectious diseases caused by inadequate WASH standards is a major driver of antibiotic demand. Growing usage of antibiotics together with persistent infectious disease levels have led to a dangerous cycle in which reliance on<unk> s increases while the efficacy of drugs diminishes. The proper use of infrastructure for water, sanitation and hygiene (WASH) can result in a 47–72 percent decrease of diarrhea cases treated with antibiotics depending on the type of intervention and its effectiveness. A reduction of the diarrhea disease burden through improved infrastructure would result in large decreases in the number of diarrhea cases treated with antibiotics. This was estimated as ranging from 5 million in Brazil to up to 590 million in India by the year 2030. The strong link between increased consumption and<unk>  indicates that this will directly mitigate the accelerating spread of<unk> . Sanitation and water for all by 2030 is Goal Number 6 of the Sustainable Development Goals. An increase in hand washing compliance by hospital staff results in decreased rates of resistant organisms. Water supply and sanitation infrastructure in health facilities offer significant co-benefits for combatting<unk> , and investment should be increased. There is much room for improvement: WHO and UNICEF estimated in 2015 that globally 38% of health facilities did not have a source of water, nearly 19% had no toilets and 35% had no water and soap or alcohol-based hand rub for handwashing. Industrial wastewater treatment Manufacturers of<unk> s need to improve the treatment of their wastewater (by using industrial wastewater treatment processes) to reduce the release of residues into the environment. Management in animal use Europe In 1997, European Union health ministers voted to ban avoparcin and four additional antibiotics used to promote animal growth in 1999. In 2006 a ban on the use of antibiotics in European feed, with the exception of two antibiotics in poultry feeds, became effective. In Scandinavia, there is evidence that the ban has led to a lower prevalence of antibiotic<unk>  in (nonhazardous) animal bacterial populations. As of 2004, several European countries established a decline of<unk>  in humans through limiting the use of<unk> s in agriculture and food industries without jeopardizing animal health or economic cost. United States The United States Department of Agriculture (USDA) and the Food and Drug Administration (FDA) collect data on antibiotic use in humans and in a more limited fashion in animals. The FDA first determined in 1977 that there is evidence of emergence of antibiotic-resistant bacterial strains in livestock. The long-established practice of permitting OTC sales of antibiotics (including penicillin and other drugs) to lay animal owners for administration to their own animals nonetheless continued in all states. In 2000, the FDA announced their intention to revoke approval of fluoroquinolone use in poultry production because of substantial evidence linking it to the emergence of fluoroquinolone-resistant Campylobacter infections in humans. Legal challenges from the food animal and pharmaceutical industries delayed the final decision to do so until 2006.
Antimicrobial resistance
Drug resistance
Antibiotic synergy
Multiple drug resistance
Opportunistic infection
Vaccine resistance
Immunocompetence
Tolerogenic therapy