By: Katharine Russo, PharmD Candidate c/o 2021
With the continued increase of antibiotic resistant diseases, scientists are calling this current healthcare climate a pre-antibiotic era. β-lactam antibiotics, the most common class of antibiotics globally, include penicillins, cephalosporins, and carbapenems. They all act on the human body through the same mechanism of action (MOA) – inhibiting the synthesis of the bacterial peptidoglycan cell wall of gram (+) bacteria. Resistance can occur through many mechanisms. The most common MOA is the production of β-lactamases. Other less common MOA’s include alterations in or acceptance of penicillin-binding proteins (PBPs) and a decreased entry and/or active efflux of the antibiotic. Mutations decrease the affinity β-lactam antibiotics have for several PBPs thus increasing resistance through the inability of agents to penetrate its specific site of action.1
In 2016, the CDC gave funding to all 50 states to increase the quality and number of laboratories focusing on antibiotic resistance (AR) research as well as public health initiatives. While research is being done on ways to prevent resistance, the CDC has provided a containment protocol to every state to isolate rare or deadly infections at the point of onset in order to lessen the spread of the disease. This process allows the CDC to be contacted immediately at the onset of the protocol to begin research of the underlying bacterial cause. In January of 2018 the CDC reported that their protocols have enabled multiple states to isolate and contain disease.2 As a hub for international travelers, New York received a higher level of aid from the CDC to enhance testing and technology which helps detect, support, respond to and prevent AR threats across the nation and internationally. New diagnostic technology allows bacteria to be identified more accurately to ensure proper treatment from the beginning of disease onset. 3
Pharmacists continue to play a major role in the fight to prevent AR. The International Pharmaceutical Federation (FIP) published an article in 2015 regarding the role pharmacists will play in fighting AR. Counseling patients prior to starting antibiotics is one of the most important things pharmacists can do in this public health pursuit. Reminding patients that fully completing a course of antibiotics is imperative to fighting resistance. Additionally, it is pertinent they are reminded of the bad effects of self-treating future disease with leftover medication or sharing it with family and friends as this easily allows for a rapid increase of AR. Finally, advocating for immunizations is the most direct way to avoid subsequent bacterial superinfections thereby eliminating the need or use of antibiotics to treat patients.4
- Penicillins, Cephalosporins, and Other β-Lactam Antibiotics. In: Hilal-Dandan R, Brunton LL. eds. Goodman and Gilman’s Manual of Pharmacology and Therapeutics, 2e New York, NY: McGraw-Hill; . http://accesspharmacy.mhmedical.com/content.aspx?bookid=1810§ionid=124495847. Accessed January 18, 2018.
- U.S. Department of Health and Human Services. Fighting antibiotic resistance: CDC tool maps progress in every state, but still more to be done. Center for Disease Control and Prevention. https://www.cdc.gov/media/releases/2018/p0110-fighting-antibiotic-resistance.html. Published 01/10/2018. Accessed January 16, 2018.
- U.S. Department of Health and Human Services. CDC’s investments to combat antibiotic resistance threats nationwide. Center for Disease Control. https://wwn.cdc.gov/ARInvestments/PDFDocs/2017/New-York-2017-CDC-AR-Investments.pdf. Published 08/18/2017. Last Updated 01/08/2018. Accessed January 16, 2018.
- International Pharmaceutical Federation (FIP). Fighting antimicrobial resistance: the contribution of pharmacists. The Hague:International Pharmaceutical Federation. https://fip.org/files/fip/publications/2015-11-Fighting-antimicrobial-resistance.pdf. Published 11/30/2015. Accessed January 15, 2018.