Anti-infectives, essentials, resistance

 

Introduction

Anti-infectives play a crucial role in modern medicine, providing effective treatment for many bacterial, viral, fungal, and parasitic infections. Antibiotics are particularly important. However, the excessive and inappropriate use of these drugs has led to the emergence of antimicrobial resistance, a global public health problem. This article aims to inform you about the essential anti-infectives according to the World Health Organization (WHO), the issues surrounding resistance, and good antibiotic therapy management practices.

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Essential anti-infectives according to the WHO

The WHO regularly updates a list of essential medicines, including anti-infectives considered indispensable for meeting basic health needs. Antibiotics include:

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• Penicillins (such as amoxicillin)

• First- and third-generation cephalosporins (such as ceftriaxone)

• Macrolides (such as azithromycin)

• Fluoroquinolones (such as ciprofloxacin)

• Aminoglycosides (such as gentamicin)

• Tetracyclines (such as doxycycline)

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These medicines are selected for their efficacy, safety, and affordability. They are essential for treating a variety of common infections.

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Resistance to anti-infectives

Resistance to antiinfectives, and antibiotics in particular, is a growing threat. It results from the evolution of bacteria that develop mechanisms to evade the action of drugs. The main factors contributing to this resistance include:

• Inappropriate use of antibiotics: excessive or unjustified prescribing.

• Self-medication: use of antibiotics without a doctor's prescription.

• Use of antibiotics in agriculture: to promote growth and prevent disease in farm animals.

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Consequences of antimicrobial resistance

Antimicrobial resistance leads to:

• Prolonged infections that are more difficult to treat.

• Increased morbidity and mortality due to resistant infections.

• Higher healthcare costs due to longer and more expensive treatments.

• Increased risk of resistant bacteria spreading through communities and healthcare systems.

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Antibiotic therapy:

a controlled necessity

To combat antimicrobial resistance, the judicious use of antibiotics is crucial. Here are some detailed recommendations for GPs:

Prescribe antibiotics only when necessary:

• Rigorous clinical assessment: Ensure the infection is bacterial and not viral, as antibiotics are ineffective against viruses. Use diagnostic tools such as rapid antigen detection tests or bacterial cultures to confirm bacterial infection.

• Guidelines and protocols: Follow national or international guidelines and protocols for the indications for prescribing antibiotics. For example, the use of antibiotics for upper respiratory tract infections should be strictly limited to cases where a bacterial infection is confirmed.

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Choosing the right antibiotic:

• Spectrum of activity: Opt for a narrow-spectrum antibiotic that specifically targets the pathogen identified, to minimize the impact on the normal microbial flora and reduce the risk of selecting resistant bacteria.

• Antibiotic susceptibility test results: Use susceptibility tests to guide the selection of the most effective antibiotic against the specific bacteria identified in severe or recurrent infections.

• Patient factors: Take into account the patient's allergies, potential drug interactions, and underlying conditions.

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Respect the doses and duration of treatment:

• Adherence to recommendations: Follow the specific dosage recommendations for each antibiotic and type of infection, avoiding under- or overdosing.

• Appropriate duration: Prescribe the minimum effective duration of treatment to eradicate the infection, usually 5-7 days for most community-acquired infections, unless otherwise indicated based on clinical guidelines.

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Educating patients:

• Adherence to treatment: Explain the importance of taking antibiotics exactly as prescribed, even if they feel better before the end of the treatment.

• Risks of self-medication: Inform patients of the dangers of using antibiotics without a prescription or using leftover antibiotics.

• No sharing: Insist that the antibiotics prescribed are for the patient's exclusive use and must not be shared with others.

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Promoting vaccines:

• Infection prevention: Encourage vaccination against pathogens such as pneumococcus, Haemophilus influenzae type b, and influenza to reduce the incidence of secondary bacterial infections.

• Vaccination schedule: Ensure that patients, particularly children and the elderly, follow the recommended vaccination schedules to prevent avoidable infections.

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Monitoring and surveillance:

• Review patients: Schedule follow-up consultations to assess response to treatment and adjust if necessary.

• Resistance surveillance: Contribute to antibiotic resistance surveillance systems by reporting cases of resistant infections and taking part in local and national surveys.

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Continuing education:

• Continuing education: Get involved in continuing education programs to keep up to date with the latest recommendations on antibiotic therapy and resistance management.

• Sharing knowledge: Take part in professional forums to exchange experiences and antibiotic stewardship strategies with your colleagues.

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Conclusion

Appropriate management of anti-infectives is essential to preserve their efficacy and combat antimicrobial resistance. General practitioners play a key role by prescribing rationally and educating their patients. By following WHO recommendations and adopting controlled antibiotic therapy, it is possible to protect public health and ensure that these vital medicines remain available for future generations.