Despite technological advances, new antibiotics, and pharmacists’ involvement, antibiotic resistance is still a major health care challenge in the United States.

The Scope of the Problem

Although data on antibiotic resistance are hard to pin down and underreported, experts estimate the problem has increased in recent years.

“The number of [antibiotic] prescriptions that are going out and the number of prescriptions that are inappropriate in the ambulatory setting are increasing,” said Lucas T. Schulz, PharmD, BCIDP, clinical coordinator for infectious diseases at University of Wisconsin Health and clinical associate professor at University of Wisconsin-Madison School of Pharmacy.

“Antibiotic resistance is the next COVID-19 if we ignore it or [if we] choose not to focus on it. We know it’s here. If we don’t make more people and more legislators aware—and we don’t do something about it now—there are going to be bad outcomes,” Schulz added.

The prevalence of some resistant organisms, like extended-spectrum β-lactamases (ESBLs), is increasing, according to Athena Hobbs, PharmD, BCIDP, infectious diseases clinical pharmacy coordinator at Methodist University Hospital in Memphis, Tennessee.

The spike in ESBLs is “a huge concern because this means that patients may not receive the correct antibiotic initially before we know what organism is causing the infection,” Hobbs explained. “This will also force clinicians to use more broad-spectrum antibiotics up front, which will lead to worse antimicrobial resistance down the road.

“We need to continue to be vigilant in the health care field as well as in the community to only prescribe or take antibiotics when they are needed.”

In a large study published in JAMA Network Open, investigators found that antimicrobial use deviated from recommended practices for 55.9% of patients who received antimicrobials for community-acquired pneumonia or urinary tract infection present at admission or who received fluoroquinolone or intravenous vancomycin treatment.1

In addition, infections caused by bacteria resistant to multiple antibiotics led to $1.9 billion in health care costs and more than 10,000 deaths among older adults across the US in 2017, according to a recent study published in Clinical Infectious Diseases.2

These findings are a “stark reminder of the incredible and costly burden of antibiotic-resistant infections on our patients and our nation’s health care system,” said Daniel McQuillen, MD, president of the Infectious Diseases Society of America (IDSA), in a news release.3 “We must respond to this growing public health threat with strong federal investments in key areas to ensure that safe and effective antibiotics, upon which modern medicine relies, are available when patients need them.”

IDSA is calling for government investment in antibiotic stewardship, antibiotic innovation, surveillance, research, diagnostics, infection prevention, the infectious diseases workforce, and global coordination. In particular, the bipartisan Pioneering Antimicrobial Subscriptions to End Upsurging Resistance Act,4“which would change the way the federal government pays for novel antibiotics to revitalize the pipeline and promote stewardship,” is a critical piece of the solution, the organization said.3

The CDC’s 2019 antibiotic resistance threats report5 found that nearly 3 million people in the United States each year experience an infection due to an antimicrobial-resistant pathogen, said Monique Bidell, PharmD, BCPS, a medical science liaison for Ferring Pharmaceuticals who was previously a clinical pharmacy specialist at Massachusetts General Hospital in Boston.

“However, this number is likely even higher due to underreporting,” she said.

At the same time, antibiotic prescribing practices have improved during the past two years due to COVID-19. Between April 2020 and February 2021, there was a marked decrease in respiratory virus detections, which resulted in a 79% decline in ambulatory antibiotic prescribing rates for respiratory infections.6

“This is probably because physicians and patients knew that their respiratory symptoms were due to COVID-19, and we could do rapid diagnostics [to determine if patients were positive for it],” Schulz said, adding that patients also understand that COVID-19 is a virus and that antibiotics are not typically prescribed to treat a virus.

Advances and Best Practices

Pharmacists have been making great headway in the antibiotic resistance conundrum for several years by serving as valuable leaders and members of antibiotic stewardship teams and through educating patients and other health care providers on appropriate prescribing.

“We have certainly increased awareness of antimicrobial resistance and [it being] a driver of negative patient outcomes,” said Ronak G. Gandhi, PharmD, BCPS, senior attending clinical pharmacist of infectious diseases at Massachusetts General Hospital in Boston.

The advances made by the infectious disease community during the past 10 to 15 years in terms of diagnostics, software, and other resistance mechanisms are invaluable, Gandhi said.

Schulz noted: “Pharmacists should be encouraging the use of rapid diagnostic testing, which [helps] us identify the right patient [for antibiotics], and you will see improved patient outcomes.”