207
it is crucial to start an empiric therapy because any delay at the beginning of the
treatment increases the mortality rate. Nonetheless, empiric therapy should be
adjusted after the confirmation of the diagnosis. Especially, this is recommended
because during the treatment with empiric therapies broad spectrum agents are used
(Barlam et al. 2016).
If it is indicated after the confirmation of diagnosis, the broad spectrum agent
should be altered with a narrower spectrum agent. This is a method called de-escalation and it aims the reduction of selective pressure on the bacterial pathogen to
develop antimicrobial resistance. Indeed, the antimicrobial resistance development
is closely related to selective pressure thus, if we manage to reduce selection pressure this will also have positive effects on the reduction of the emergence of antimicrobial resistance. In cases where the presence of a bacterial pathogen(s) is not
proved, the therapy should be discontinued. The inability to follow the existing
guidelines properly for the prescription of antimicrobials complicates the situation
(Bennadi 2013). Physician’s fear of litigation creates conflicts, especially in patients
in whom it is not clear if the prescription of an antimicrobial agent is needed or will
improve its condition at all.
This is a big dilemma and seems to contribute to the overuse of antibiotics for
prophylaxis. Except for this, sometimes physicians may face pressure from patients
to prescribe antibiotics that the patients have already bought and used. They may
also have the demand to be treated with specific antibiotics. This usually results due
to extensive advertising of pharmaceutical companies. Thus, the prescribing behavior of the physician plays a role in antimicrobial resistance development. The physicians should estimate the cost benefit ratio taking into consideration not only the
individual but also the community as a whole, which is vital for the prevention of
antimicrobial resistance development (Dellit et al. 2007). They should also educate
their patients about the proper use of antibiotics and the devastating effects, which
are caused by the overuse, and misuse of antibiotics in daily life. The main aim is to
understand that antibiotics are not the treatment for any health care problem and
they should be prescribed from doctors only in cases where they are the only option
of treatment. Unfortunately, the lack of a patient’s education leads to the belief that
a good doctor is a doctor who prescribes medications. All those mentioned above
seem to contribute to the emergence of antimicrobial resistance and should not be
neglected because they are significant causes for the increased rates of antibiotic
prescription (Selgelid 2007; Penchovsky and Traykovska 2015; Garau et al. 2014;
Septimus 2018).
The under consumption of antibiotics is another important reason, which is correlated with antimicrobial resistance development. In detail, in cases where a course
of therapy is not completed properly, the bacteria that would have been normally
killed, survive instead and become resistant. Therefore, due to the development of
antimicrobial resistance, the treatment with the drugs used the first time against the
bacteria is not effective anymore. It should be highlighted that the compliance of
patients is related not only to its educational interventions but also to its financial
status. Indeed, some patients especially in developing countries cannot afford to
complete their treatment and sometimes even pay for their transportation to health
9 Drug Discovery for Targeting Drug Resistant Bacteria
it is crucial to start an empiric therapy because any delay at the beginning of the
treatment increases the mortality rate. Nonetheless, empiric therapy should be
adjusted after the confirmation of the diagnosis. Especially, this is recommended
because during the treatment with empiric therapies broad spectrum agents are used
(Barlam et al. 2016).
If it is indicated after the confirmation of diagnosis, the broad spectrum agent
should be altered with a narrower spectrum agent. This is a method called de-escalation and it aims the reduction of selective pressure on the bacterial pathogen to
develop antimicrobial resistance. Indeed, the antimicrobial resistance development
is closely related to selective pressure thus, if we manage to reduce selection pressure this will also have positive effects on the reduction of the emergence of antimicrobial resistance. In cases where the presence of a bacterial pathogen(s) is not
proved, the therapy should be discontinued. The inability to follow the existing
guidelines properly for the prescription of antimicrobials complicates the situation
(Bennadi 2013). Physician’s fear of litigation creates conflicts, especially in patients
in whom it is not clear if the prescription of an antimicrobial agent is needed or will
improve its condition at all.
This is a big dilemma and seems to contribute to the overuse of antibiotics for
prophylaxis. Except for this, sometimes physicians may face pressure from patients
to prescribe antibiotics that the patients have already bought and used. They may
also have the demand to be treated with specific antibiotics. This usually results due
to extensive advertising of pharmaceutical companies. Thus, the prescribing behavior of the physician plays a role in antimicrobial resistance development. The physicians should estimate the cost benefit ratio taking into consideration not only the
individual but also the community as a whole, which is vital for the prevention of
antimicrobial resistance development (Dellit et al. 2007). They should also educate
their patients about the proper use of antibiotics and the devastating effects, which
are caused by the overuse, and misuse of antibiotics in daily life. The main aim is to
understand that antibiotics are not the treatment for any health care problem and
they should be prescribed from doctors only in cases where they are the only option
of treatment. Unfortunately, the lack of a patient’s education leads to the belief that
a good doctor is a doctor who prescribes medications. All those mentioned above
seem to contribute to the emergence of antimicrobial resistance and should not be
neglected because they are significant causes for the increased rates of antibiotic
prescription (Selgelid 2007; Penchovsky and Traykovska 2015; Garau et al. 2014;
Septimus 2018).
The under consumption of antibiotics is another important reason, which is correlated with antimicrobial resistance development. In detail, in cases where a course
of therapy is not completed properly, the bacteria that would have been normally
killed, survive instead and become resistant. Therefore, due to the development of
antimicrobial resistance, the treatment with the drugs used the first time against the
bacteria is not effective anymore. It should be highlighted that the compliance of
patients is related not only to its educational interventions but also to its financial
status. Indeed, some patients especially in developing countries cannot afford to
complete their treatment and sometimes even pay for their transportation to health
9 Drug Discovery for Targeting Drug Resistant Bacteria