The microbiome plays a key role in health, and its disruption, particularly by antibiotics, can lead to many adverse effects, including antimicrobial resistance (RAM). This study conducted at the Yale School of Public Health (New Haven, Connecticut) confirms a close link between the duration of antibiotic treatment and the emergence of antibiotic resistance genes. The message passed, in the review mBio, on a reduction, also thanks to better calibrated antibiotic treatments, of this risk of antibiotic resistance.
Antibiotic resistance is now recognized as one of the main public health burdens, which threatens the effectiveness of available treatments and can lead to prolonged hospital stays and increased mortality. We know that reducing the use of antibiotics could be an interesting strategy to curb resistance. Lead author, epidemiologist Melinda Pettigrew of the Yale School of Public Health notes that, yet, data remain limited on how duration of treatment affects resistance genes.
One antibiotic, too long, can induce multiple RAMs
This analysis of data from a randomized controlled trial (the SCOUT-CAP trial) in children diagnosed with community-acquired pneumonia treated with beta-lactam antibiotics reveals that:
- a 5-day course of antibiotics is just as effective as the standard 10-day course;
- DNA sequencing of throat swabs and stool samples taken from children at 2 study points identifies even fewer resistance genes in children who received the 5-day vs. 10-day treatment;
- some of these genes are found to be associated with beta-lactam resistance, which the researchers expected.
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However, longer antibiotic treatment also leads to a significant increase in associated resistance genes to other antibiotics.
“The increase in resistance is therefore possible vis-à-vis drugs other than that of the treatment followed”, writes the main author.
- the duration of treatment changes the population of commensal bacteria in different ways and the antibiotic affects the microbiota as a whole.
The study did not measure how long these effects or “resistome” or collection of resistance genes persist in bacteria, but it is clear that the microbiome eventually returns to normal.
The researchers will now attempt to exploit the microbiome and analyze it in such a way as to be able to identify the patients most at risk of “microbiotic” resistance to antibiotics.
Source: mBio 22 March, 2022 DOI: 10.1128 / race.00195-22 Comparison of the Respiratory Resistomes and Microbiota in Children Receiving Short versus Standard Course Treatment for Community-Acquired Pneumonia
Plus on Antibiotic Resistance
Editorial Team SantélogApr 25, 2022Writing Health log
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