An Antibiotic Prescription Induces Resistance at the Individual Level More Than the Group Level

Abstract

To the Editor: An unnecessary antibiotic prescription may be viewed as a time bomb that may detonate in the recipient as a Clostridium difficile or antibiotic-resistant infection in subsequent months. Antibiotic utilization selects multidrug-resistant bacteria in both the individual and the facility.1,2 Many practitioners view an antibiotic prescription as a benefit to the individual at the expense of the group. However, an unnecessary antibiotic prescription hurts the INDIVIDUAL. The intensity of the damage and disruption of bacterial flora may be greater in the individual who received the antibiotic than at the group level, according to data from a hospital ward and Scottish general practice.3,4 This is an important risk-benefit consideration when contemplating antibiotic therapy for an individual. For example, Rotjanapan et al5 found that 11 (12%) of 96 residents who received an antibiotic for suspected urinary tract infection (UTI) developed C difficile colitis within 3 weeks of treatment. Inpatient quinolone therapy in the preceding 30 days increased the odds that a symptomatic UTI was caused by a quinolone-resistant organism 16 times.6 Quinolone therapy during the prior 6 months increased the odds that a febrile UTI was caused by a quinolone-resistant organism 17.5 times in outpatients.7 Trimethoprim/sulfamethoxazole prophylaxis for 1 month in postmenopausal women increased resistant Escherichia coli in the stool from approximately 20% to 85%.8 Of interest, a recent study found that antibiotic treatment of asymptomatic bacteriuria in young women increased the risk of subsequent symptomatic UTI 3 times. Antibiotic treatment in this situation apparently replaced relatively benign colonizers with more virulent bacteria.9