Pathfinder for the Quest Towards Combating Antibiotic Resistance
It has come. It has come to haunt. It has come to kill. It has come to stay. What is it? Where is it? It has spread through Africa taking the lives of the young and the old. It is the deadly and destructive Mycobacterium Tuberculosis, more commonly referred to as Tuberculosis (TB).
As a result of the antibiotic resistance that TB has developed, we are now stuck with several incredibly powerful strands of TB that are killing thousands. Hospitals are filled with divided families, anxious discouraged children, and dying parents, relatives, and friends. Across the globe special organizations like the Red Cross, the Center for Disease Control, and the World Health Organization, are working furiously to develop new antibiotics to attack this resistant bacterial strain. Can we make up for our mistakes? Can we wait any longer? Who’s next? The world awaits these answers, as thousands lie dead.
It is now clear that antibiotics have been consistently misused and overused; this has caused various forms of bacteria to develop resistance to our strongest antibiotics and antimicrobials affecting our agriculture, environment, and personal health. We constantly question ourselves and desire to find why this problem, when we know it exists, continues to get worse. This primarily stems from the ignorance of concerned parents as well as the faulty and improper practices of various medical professionals. Consequently, the best way to counter this significant problem is to implement proper and effective outreach programs aimed to educate the community (primarily parents and physicians) concerning topics such as paternal expectations, medical satisfaction, and abuse of antibiotics. It is of the utmost importance to combat this problem in this fashion in order to preserve our most precious medical treatments.
The following pathfinder has been designed to address the issue of antibiotic resistance. It primarily aims to focus on two study areas; these being: (1) why antibiotics are being abused and misused in our society (particularly in the United States) and (2) if outreach programs that target this problem through the education of physicians and parents of young children (which are thought to be the primary contributors to this problem) are effective in improving the impact of and reducing the abuse of antibiotics.
Overall, there are a number of excellent starting places when the researcher begins to study these two topics. EBSCOHost is an important online database. This is a good area to begin one’s intended research in order to find studies and papers that are related to both of these topics. It should be noted that one should use this source with caution because hundreds of articles may be displayed; therefore, specific searches must be used. Also, www.scirus.com is a wonderful search engine to find articles through narrow searches. Although, both of these Internet-based searches provide lists and lists of articles, I believe that the best way to research such a topic is to find a Medical Library that has many of the prominent journals that are published. Here, with the help of an experienced librarian one can find the best articles from excellent journals such as Pediatrics, Emerging Infections Diseases, and JAMA. For a topic where valid medical studies and papers must be used, avoidance of search engines such as Google and Ask Jeeves is necessary.
Journals/Articles from Pediatrics
Articles dealing with educational outreach:
Bauchner, Howard, Stavroula Osganian, Kevin Smith, and Randi Triant. “Improving Parent
Knowledge about Antibiotics: A Video Intervention.” Pediatrics 108 (Oct 2001):
845-851.
This particular study used a video, which was “developed [to] promot[e] the judicious use of oral antibiotics” to, “through a randomized trial,” assess the positive “effectiveness of the video to influence parents’ knowledge, beliefs, and self-reported behaviors.” Unfortunately, through descriptive results that can be found in the article, it was determined that this video did minimal effect. This may have happened because “parents [the studied population] did not view the video,” “parent knowledge was already high,” or the presentation of the content may not have been very effective. It was therefore concluded that the physicians’ and parents’ behavior can be changed through a multifaceted approach (there is a very good analysis and discussion of the importance of changing physician behavior in the last few paragraphs of the study).
Belongia, Edward A., Bradley J. Sullivan, Po-Huang Chyou, Kurt D. Reed, and Benjamin
Schwartz. “Community Intervention Trial to Promote Judicious Antibiotic Use and Reduce Penicillin- Resistant Streptococcus Pneumoniae Carriage in Children.” Pediatrics 108 (Sept. 2001): 575-581.
This is a document of a community intervention program conducted in Wisconsin aimed at educating clinicians concerning antibiotic resistance. It discusses how in fact it appears that the outreach program was effective and led to significant reductions in the unnecessary prescriptions of antibiotics. Methods and statistics and thoroughly provided in the article.
Wheeler, J. Gary, Melinda Fair, Pippa M. Simpson, Leigh Ann Rowlands, Mary E. Aitken, and
Richard R. Jacobs. “Impact of a Waiting Room Videotape Message on Parent Attitudes
Toward Pediatric Antibiotic Use.” Pediatrics 108 (Sept. 2001): 591-597.
This specific article describes a study that was completed to see if educational strategies focused on parents of pediatric patients in the form of a video could effectively reduce the rates of antibiotic prescribing and misuse. It was concluded that combinations of education tools are effective and can change parent attitudes about antibiotics. Although it was found that “changes in parent attitudes may be necessary” it was concluded that these efforts need to be combined with physician outreach to bring about “changes in prescribing rates” (591).
Articles dealing with reasons for abuse/misuse of antibiotics:
Barden, Louise S., Scott F. Dowell, Benjamin Schwartz, and Cheryl Lackey. “Current Attitudes
Regarding Use of Antimicrobial Agents: Results from Physicians’ and Parents’ Focus Group Discussions.” Clinical Pediatrics. November 1998. EBSCOhost. Jan. 2003. <http://web23.epnet.com/citation.asp?tb=1&_ug=ds+0%2C4%2C >.
This study was intended to find what possible reasons exist for the increased and unnecessary use of antibiotics. Through focus group discussion in Atlanta, Georgia, the authors assessed attitudes of both physicians and parents regarding this issue. Conclusions that were drawn (from elaborate results that are provided in the article) include that: (1) “the physicians attributed their inappropriate prescription practices to unrealistic parental expectations”; (2) parents indicated that they “seek guidance, evaluation, and reassurance when they take their child with upper respiratory tract symptoms to the physician;” (3) “An educational program directed at primary care physicians on the use of antibiotics for respiratory tract infections resulted in a 44% reduction of antibiotic prescriptions that remained constant for 5 years after the initial intervention. Educational programs for physicians combined with community education have also been successful in reducing inappropriate antibiotic prescriptions” (4) opposing view points of both the parent and the physician need to be considered.
McGlynn, Elizabeth A., Rita Mangione- Smith, Marc N. Elliot, Paul Krogstad, and Robert H.,
Brook. “The Relationship between Perceived Parental Expectations and Pediatrician Antimicrobial Prescribing Behavior.” Pediatrics 103 (April 1990): 711-719.
This study intended to determine whether parental expectations and pressure were the cause of overprescriptions. Also, to determine if, consequently, the parents were satisfied with the visit if an antibiotic was prescribed. By controlling a number of factors that previous studies had failed to account for, this study concluded that physicians were more likely to inappropriately prescribe antibiotics if they believed a parent desired antibiotics. Also, physicians underestimated patient expectations and therefore prescribed a number of antibiotics for viral infections and purposely inaccurately diagnosed bacterial infections (this in turn caused an increase in prescriptions).
Finkelstein, Jonathan A., Robert L. Davis, Scott F. Dowell, Joshua P. Metlay, Stephen B.
Soumerai, Sheryl L. Rifas-Shiman, Margaret Higham, Zachary Miller, Irina Miroshnik,
Alex Pedan, and Richard Platt. “Reducing Antibiotic Use in Children: A Randomized
Trial in 12 Practices.” Pediatrics 108 (July 2001): 1-8.
This paper analyzed the study, which was intended to determine the effect of outreach with mailings, waiting room materials, and educational group sessions on antibiotic use. This outreach, intended to change the practices of physicians and parents, studied the effects of this program in 12 different practices; this was done through analysis of rates of antibiotic courses dispersed per person per year in experimental and control practices. There was success in the promotion of the initiatives and consequently, patient and physician behavior education are the best ways to attack this problem of overuse.
Pichichero, Michael E., John L. Green, Anne B. Francis, Steven M. Marsocci, and Marie L.
Murphy. “Outcomes after Judicious
Antibiotic use for Respiratory Tract Infections seen in a Private Pediatric
Practice.” Pediatrics 105 (April 2000): 753-760.
This study was intended to determine if antibiotics are needed for a viral cause and if, contrary to popular belief, provide any sort of benefit. The study was conducted over the course of twelve months through the assessment of children who came in for medical visits. The children were monitored for thirty days without antibiotics to see if viral infections were affected by an antibiotic (it should be noted that children with obvious bacterial infections were excluded from the study). It was concluded that antibiotics do not decrease the likelihood of a return visit. Also, patients have improper knowledge of antibiotics, physicians fear dissatisfaction of the patient, and daycare policies are all primary causes of improper antibiotic expectations.
Takata, Glenn S., Linda S. Chan, Paul Shekelle, Sally C. Morton, Wilbert Mason, and S. Michael
Marcy. “Evidence Assessment of Management of Acute Otitis Media: The Role of Antibiotics in Treatment of Uncomplicated Acute Otitis Media.” Pediatrics 108 (August 2001): 239-248.
This study addressed the effectiveness of antibiotic treatments on uncomplicated forms of Otitis Media. Antibiotics were shown to have limited benefit in these situations (because it is viral) and only seem to contribute to the development of resistance and contrarily had increased side effects. Therefore, it was found that antibiotics are not needed or necessary in situations when bacterial infections are not clearly prevalent.
Watson, Rebecca and Scott F. Dowell. “Antimicrobial use for Pediatric Upper Respiratory
Infections: Reported Practice, Actual Practice, and Parent Beliefs.” Pediatrics 104 (Dec. 1999): 1251-1261.
This article studied “physician beliefs, their prescribing practices, and the attitudes of patients.” After a strong statistical analysis, it was concluded that “physicians recognize the problem of antibiotic resistance but their reported practices are not in line with recently published recommendations.” Also, there is a lack of consistency between practicing pediatricians and interestingly enough “patient beliefs are correlated with their own physician’s practices.”
Palmer, Diana A. and Howard Bauchner. “Parents’ and Physicians’ Views on Antibiotics.”
Pediatrics. June 1997. EBSCOhost. 11 Dec. 2002. <http://www.pediatrics.org/cgi/content/full/99/6/e6>.
The study attempted to find the difference in opinions between parents and physicians. Ironically it was found that “both the parent and the physician surveys suggest that parents are concerned about the overuse of antibiotics, but often request them when their physicians believe they are unnecessary.” By analyzing the parents’ “range of knowledge, experiences, concerns, and reasons for use” the authors were able to find that parents were misinformed on what antibiotics could effectively treat. Also, parents have even requested to have specific antibiotics to treat their children on the basis (from most important to least important factors) side effects, strength, taste, dosage schedule, and cost. On the other hand, physicians have noticed that parents have misconceptions but for time issues as well as satisfaction issues, antibiotics are often overprescribed. Realizing what was determined in the article will certainly aid in intervention strategies and help reduce antibiotic misuse.
Bauchner, Howard, Stephen I. Pelton, and Jerome O. Klein. “Parents, Physicians, and Antibiotic
Use.” Pediatrics 103 (Feb 1999): 395-402.
This was a particular study, which analyzed, through a survey, how parent’s influence prescribing patterns and what pediatricians and physicians nationwide believe will help with this problem. It was concluded that physicians conform to parents’ pressures although they perceive the inappropriate expectation. Also, overprescriptions result because of not only patient pressures, but because of the desire for the physician to satisfy the patient, improper beliefs in the abilities of antimicrobials, legal liability, the need to be efficient in practice, and misunderstanding diagnostic criteria as well. It was found that with educational outreach to “reduce the use of inappropriate antimicrobial agents in the ambulatory setting we need to alter patient-physician communication” (397). Furthermore, with outreach, hopefully the patient may begin to question the physicians’ practices leading to a decrease in overprescriptions and the spread of resistance.
Journals/Articles from Emerging Infectious Diseases
Weinstein, Robert A. “Controlling Antimicrobial Resistance in Hospitals: Infection Control and
Use of Antibiotics.” Emerging Infectious Diseases 7(April 2001): 188-191.
This article discusses what forces have lead to resistance, which primarily are failures of hospital hygiene, selective pressures created by overuse, and mobile genetic elements encoding for bacterial resistant organisms. The author finds that “at the root of the problem are health care workers, who, although generally willing to do the right thing to control antimicrobial drug resistance undervalue the problem and do not know what the ‘rich’ thing is or need an easier way to do it” (188). Therefore, it was concluded that to control resistance, surveillance, hygiene monitoring of health care workers, and math modeling was needed.
Journals/Articles from JAMA
Articles dealing with educational outreach:
Perz, Joseph F. and Allen S. Craig, Christopher S. Coffey, Daniel M/. Jorgensen, Edward
Mitchel, Stephanie Hall, William Schaffner, and Marie R. Griffin. “Changes in Antibiotic Prescribing for Children after a Community-Wide Campaign.” The Journal of the American Medical Association 287(June 2002): 3103-3107.
This article provides the study that was completed in Knox County Tennessee, which dealt with the community-wide media-based campaign to educate doctors, parents, and the general public on the topic of antibiotic resistance. The intervention efforts included lectures, presentations, seminars and the distribution of new prescribing guidelines, pamphlets and newspapers, which were used to promote the proper uses of and the importance of antibiotics and antibiotic resistance. It was studied and determined that through the intervention efforts there was an 11% reduction in prescription for antibiotics, which is a significant decrease and important in considering the effects of effective educational outreach.
McCraig, Linda F. Richard E. Besser, and James M. Hughes. “Trends in Antimicrobial
Prescribing Rates for Children and Adolescents.” JAMA 287 (June 2002): 3096-3102.
This study intended to find trends in overprescriptions after “organizations undertook efforts to promote appropriate antimicrobial prescribing” (3096). The NAMCS, which is an annual sample survey by the National Center for Health Statistics, surveyed office physicians from 1973-2000 and found that in recent years there has been an overall decline in the number of prescriptions. Two separate trends were noticed: (1) in population based studies the declining rates indicate that there have been “changes in visit or prescribing thresholds” resulting from successful education of physicians and parents (3101); (2) in visit based studies the declining rates of prescribing indicate that patients seem to bee realizing when it is necessary to approach a doctor when ill, which also results from educational outreach. Furthermore, reductions in overprescriptions “coincide with increased attention by the media to the problem of antimicrobial resistance with efforts by many organizations to promote appropriate use of antimicrobials. Overall, interventions have proved to be effective in reducing unnecessary antimicrobial treatment.
Stephenson, Joan. “Icelandic Researchers are Showing the Way to Bring Down Rates of
Antibiotic-Resistant Bacteria.” JAMA 275 (1996): 175.
In this study based in Iceland there has been a significant decrease in penicillin resistant bacteria. Therefore, it has been concluded that outreach appears to be working though the distribution of newspapers, utilization of the radio as well as the television. Therefore, the advice given concerning when antibiotics are necessary appears to be followed and should be continued.
Soumerai, SB and Avorn J. “Principles of Educational Outreach Academic Detailing to Improve
Clinical Decision Making.” JAMA 263 (1990): 4.
This article provides the principles of outreach that have been proven to be effective and must be followed in order for intervention efforts targeted towards physicians and parents to be effective: conduct interviews that investigate prescribing patterns; develop programs focused on categories of physicians; define behaviors and objectives; present both sides of the issue to establish credibility; promote active participation; provide concise materials; repeat messages; and provide positive reinforcements.
Pichichero, Michael E. “Dynamics of Antibiotic Prescribing for Children.” JAMA 287 (June
2002): 3133-3135.
This article looks at how physicians have been consistently receiving word to watch antibiotic use and overuse. Physicians are faced with anxious parents with busy schedules, insurance company audit, and litigation (malpractice). This has consequently led to diagnostic uncertainty, sociocultural and economic pressures, and the pressure to meet expectations. To change the course of this problem new diagnostic techniques must be developed along with physician education that presents that antibiotics are not for viruses, antibiotics do not affect retention or return visit rates, and overuse of antibiotics brings about unnecessary costs.
Gonzales, Ralph, John F. Steiner, Andrew Lum, and Paul H. Barrett, Jr. “Decrease Antibiotic Use in Ambulatory Practice: Impact of a Multidimensional Intervention on Treatment of Uncomplicated Acute Bronchitis in Adults.” JAMA 281(April 1999): 1512-1518.
This study analyzes the effects of a distinct intervention trial aimed at parents regarding acute bronchitis (a viral form of bronchitis that cannot be effectively treated with antibiotics). It was concluded that “antibiotic treatment of adults diagnosed as having uncomplicated acute bronchitis can be safely reduced using a combination of patient and clinician interventions” (1512).
Articles dealing with reasons for abuse/misuse of
antibiotics:
Schwartz, Benjamin, Arch G. Mainous III, and S. Michael Marcy. “Why do Physicians Prescribe
Antibiotics for Children with Upper Respiratory Tract Infections?” JAMA 279 (March
1999): 881-882.
The key question of investigation is: “Do physicians treat purulent rhinitis because they are unaware that therapy is of no benefit, because they are responding to patient expectations created through previous experience, or because of pressure to see more patients and maintain satisfaction” (882). This article discusses a few proposed reasons for the overprescribing of antibiotics: education (a difference between practices of pediatricians and family physicians exist), experience (family physicians may prescribe more because they are less familiar with cases that exist), and expectation (there is a tendency for parents to “become” or act as the physician. This results from changes in practices and physicians and changes in medical cases) and economics (there is tendency for practices to overprescribe due to the need to retain clients; furthermore, time and money are two significant factors). Also, for physicians sometimes it is a “goal” to see as many patients as possible as well as limit costs with other necessary diagnostic tests.
Mainous, Arch G., and William J. Hueston, and Jonathan R. Clark. “Antibiotics and Upper
Respiratory Infection: Do some Folks Think there is a Cure for the Common Cold?” JAMA 279 (March 1999): 901-906.
This study states that it has been determined that antibiotics are given for the common cold and viral infections (for which antibiotics provide no benefit); therefore this problem must be attacked. Using physician, dentists, and optometrists in Kentucky, statistics were compiled regarding how many antibiotics were prescribed and for what reasons.
Subscription Databases
Articles/Journals from EBSCOhost:
Schwartz, Benjamin, Mary Jo Trepka, Edward A. Belongia, Po-Huang Chyou, and Jeffrey P.
Davis. “The Effect of a Community Intervention Trial on Parental Knowledge and Awareness of Antibiotic Resistance and Appropriate Antibiotic Use in Children.” Pediatrics. Jan 2001. EBSCOhost. 3 Jan. 2003. <http://www.pediatrics.org/cgi/content/full/107/e6>.
This was an excellent study conducted in the northern communities of Wisconsin, which determined that “Parental knowledge and awareness about antibiotic indications and antibiotic resistance can be changed with educational interventions directed at parents and clinicians.” This was determined through surveys that questioned the subject’s knowledge, beliefs, and practices before and after intervention efforts in the studied areas. The article further provides in-depth analysis of results and statistics.
Tan, K.M. “Educational Outreach Visits: Effects on Professional Practice and Health Care
Outcomes.” Journal of Continuing Education in the Health Professions. 4 March 2002.
EBSCOhost. 14 Dec 2002. < http://search.epnet.com/>.
This paper deals with the outreach visits and their ability to help with professional practice or patient outcomes related to antibiotic resistance. There were 13 studies completed to assess the effects of outreach. It was concluded that outreach “when combined with complementary interventions” were effective.
Coleman, Cynthia-Lou. “States eyed as the key to Campaign
Success.” The C.A.USE: Careful
Antibiotic use to Prevent Resistance. 9 Oct 1997. EBSCOhost. CDC. 3 Jan. 2003. <http://www.cdc.gov/ncidod/dbmd/cause/oct97.htm>.
Various states across the United States have been working to combat this problem antibiotic resistance; successful programs such as in Colorado and Maryland are identified. The article notes that successful outreach must contain and utilize coalitions, presentations, educational problems, physician feedback, and materials.
Bishai, William. “A Report from the 38th Annual Meeting of the Infectious Diseases Society.”
Infectious Diseases Society of America. Sept 2000. EBSCOhost. 14 Dec. 2002. <http://hopkins-id.edu/education/id_events/IDSA00/9idsa00_01.html>.
There were three intervention efforts that were discussed in this article, which analyzed whether three different interventions were effective in decreasing the prevalence of antibiotic resistance. First, the Kaiser Program in Denver caused a 50% decrease in unnecessary prescriptions (a decrease in prescriptions correlates decrease in both antibiotic misuse and consequently resistance). Next in a study in Alaska, there was a decrease in clinical visits (a decrease in visits shows that parents began to notice that only for bacterial infections should one go to the doctor in hopes of gaining an antibiotic) and decrease in prescriptions. Finally, in Baltimore, following a demonstration project at Johns Hopkins University there was both a decrease in actions that promote resistance with and without intervention.
“Changes in Clinical Practice can Reduce Antibiotic Resistance.” Bureau of Epidemiology and
Utah Department of Health. March 2000. EBSCOhost. 3 Jan. 2003.
< http://hlunix.hl.state.ut.us/els/epidemiology/newsletter/00mar/mar00.html>.
Through testing in Alaska, it was concluded that outreach programs affect both the patient and the providers. The program caused the decline in prescriptions per visit and usage and affected the providers practices as well. The second section of the article describes the activities, types of research, and prevention needed to address antibiotic resistance.
Solomon, DH. “Cultural and Economic Factors that (Mis)shape Antibiotic use: the
Nonpharmocologic Basis of Therapeutics.” Annals of Internal Medicine. July 1998.
EBSCOhost. 8 Jan 2003. <http://search.epnet.com/>.
This article sites that patients desire “for a tangible product of the clinical encounter” as well as “incorrect perceptions of the effectiveness of antibiotics, particularly viral infections” have led to the misuse of antibiotics. On the contrary, this article states that physician overprescription results from “lack of information,” the “desire to satisfy the patient,” and “pressure [felt] from managed care organizations.”
“Parental Knowledge about Common Respiratory Infections and Antibiotic Therapy in
Children.” Southern Medical Journal. Oct 1999. EBSCOhost. 8 Jan. 2003.
Due to the fact that parent’s have misconceptions on antibiotic use, this study attempted to find out if parent’s have sufficient knowledge concerning proper antibiotic use and if not, if a “common denominator” exists that can be used to determine if there is a cause of this. Using a questionnaire and interviews, it was concluded that parents know that a problem with antibiotic resistance exists but do not think that it applies to them. Also, the parents’ desire for a quick recovery for their children leads to an increased desire in an antibiotic. Furthermore, the parents past experiences’ lead them to become the “doctor” in many situations. Therefore, parents need to be given information in order to understand the magnitude of this problem and the importance of misuse and overuse.
Edward, Daniel J., Peter B. Richman, Keith Bradley, Barnet Eskin, and Mark Mandell. “Parental
Use and Misuse of Antibiotics: Are there Differences in Urban vs. Suburban Settings?”
Department of Emergency Medicine. July 2001. EBSCOhost. 3 Dec. 2002.
This was a particular study that analyzed the differences between parental misuse of antibiotics in urban and rural settings (when parents improperly give antibiotics to children upon their own discretion). It was found that it was more likely for people living in suburban areas to misuse antibiotics and for people living in urban areas to go elsewhere for antibiotics. It was also concluded that parents, due to access to leftover antibiotics, cultural differences, levels of education, and medical knowledge often gave children antibiotics when they (being the parents) sought necessary.
Hamm RM, Hicks RJ, and Bembem DA. “Antibiotics and Respiratory Infections: Are patients
more satisfied when expectations are met?” J Fam Prac. March 1996. EBSCOhost. 5
Jan 2003. <http://www.infopoems.com/POEMs/JC119601.htm>.
This study determined that in fact it appears that patient’s expectations for an antibiotic, the physicians’ perception of those expectations, and the impact of antibiotic prescriptions on patient satisfaction all influence the misuse of antibiotics. The study used questionnaires on what patients knew about antibiotics and sought to find why they desired them. It was concluded that often patients would like to know why particular treatment is needed. Unfortunately, there is a tendency for physicians to prescribe antibiotics for upper respiratory infections, when they sense the expectation of the parent to receive one. Therefore, why this occurs must be investigated.
The free web is not a very useful or credible way to search for or find information. Therefore, I researched using subscription databases and through the Chestnut Hill Hospital Medical Library to find valid studies and articles written by professors and doctors who are experts in this field of study.
“Background on Antibiotic Resistance.” CDC. Jan. 2003. Center for Disease Control and
Prevention. 4 Sept. 2002. <http://www.cdc.gov/drugresistance/community/>.
The following is an excellent site and starting point to gain background information on the topic. This website is a part of the Centers for Disease Control and Prevention (CDC) website and antibiotic resistance program and therefore one can see the work of the most prestigious doctors, scientists, and researchers. The website can aid in research as it guides the reader to other sites as well.
“APUA: Alliance for the Prudent Use of Antibiotics.”
Alliance for the Prudent Use of
Antibiotics. Feb 2003. Tufts University. 4 Sept. 2002. < http://www.tufts.edu/med/apua/ \
>.
The following is a great site that outlines some of the most important research and new information regarding antibiotics available on the Internet. People associated with the site are willing to send very useful information to you as well. It is very important to visit this website since this program advocates the proper use of antibiotics.
General Information:
Organizations, Associations, and Experts
The following are a number of excellent contacts and the premier organizations involved with the fight against antibiotics resistance:
Center for Disease Control and Prevention (CDC)
1600 Clifton Rd.
Atlanta, GA 30333
U.S.A
(404) 639-3311
U.S. Food and Drug Administration (FDA)
5600 Fishers Lane
Rockville MD 20857-0001
1-888-INFO-FDA (1-888-463-6332)
Alliance for the Prudent Use of Antibiotics (APUA)
75 Kneeland Street
Boston, MA 02111-1901
617-636-0966 (telephone)
617-636-3999 (fax)
Antibiotic resistance; drug resistance, antimicrobial; bacterial resistance; educational outreach and antibiotic resistance; patient education; patient beliefs; physician practice patterns; practice guidelines; culture/economics/antibiotics
Conclusion:
Overall, as the topic of antibiotic resistance becomes more important to the future of some of our most precious medications, more information will be available on how to combat this problem. Now, there are a number of great studies and sources, which I believe I have successfully been able to locate using both the Internet and Chestnut Hill Hospital Medical Library. To find valid sources one must use databases such as EBSCOhost because information presented on the free web is not always credible. Best of luck with you searches; hopefully this pathfinder will aid you in your research endeavors.
Behnam Nabet February 2003