This paper will discuss antimicrobial resistance, the global impact of it, and how nurses can impact this phenomenon. Antibiotic resistance is a term that means the loss of the ability of an antibiotic to destroy bacteria. It develops under the influence of constant changes and mutations that microorganisms are exposed to. This phenomenon poses a serious threat to the reduction of the effectiveness of medicines.
Global Health Problem: Antimicrobial Resistance
In the early 80s of the last century, the resistance of microorganisms to antibiotics began, which is now a global problem. It was caused by the uncontrolled and unjustified use of antibacterial agents for therapeutic and preventive purposes in medicine, veterinary medicine, agriculture and in the food industry. According to WHO experts, by the middle of the XXI century, as a result of complex and multifactorial reasons, bacterial resistance to antibiotics will reach a new level (“Antibiotic resistance,” 2020). It will pose a global threat to public health, and humanity will enter the post-antibiotic era. Until a few years ago, some bacteria, such as Escherichia coli and Klebsiella pneumoniae, were susceptible to traditional antibiotics. In recent years, it has been found that they have begun to acquire resistance to third-generation cephalosporins (“Antibiotic / antimicrobial resistance,” n. d.). Current trends are such that the development of new antimicrobial drugs in the last 30 years has not been very promising. During the same period, the bacteria developed several different mechanisms of resistance to antibiotics.
Under these conditions, the need to develop potentially new means of combating drug-resistant microbial strains is of paramount importance. The deepening of modern knowledge about these innovative therapeutic strategies is of paramount importance. It is possible that in the near future they will turn out to be irreplaceable antibacterial agents of last resort and will save millions of lives. The search for new promising antimicrobial strategies is more urgent than ever, and the post-antibiotic era has become even closer.
Therefore, this issue is important for nursing, and nurses can actively influence the reduction of cases of irrational antibiotic therapy. Rational use of any medical products is a fundamental principle of clinical practice. It is its violation that leads to a decrease in the quality of medical care, an increase in treatment costs, and an increase in the risk of side effects. In addition to all of the above, the improper use of antibiotics leads to the aggravation of a very serious global problem — the growth of antibiotic resistance of pathogenic microorganisms.
Global Impact of Antimicrobial Resistance
The problem of antibiotic resistance in America is also quite acute. The Committee on Health and Public Policy of the American College of Physicians claims that up to 64% of antibiotics prescribed in hospitals are unnecessary or are prescribed in inappropriate dosages (Manning, 2016). Data from studies conducted in the United States show that the most frequent situations in outpatient pediatrics when antibiotics are prescribed unreasonably are fever, prolonged cough and inflammation of the palatine tonsils. In patients of infectious departments, a fourth situation is added to these three main ones — diarrhea.
Determination of sensitivity to antibacterial drugs on various media in the United States is often carried out without taking into account the age characteristics of patients. Quite often, doctors with intestinal pathogenic dysbiosis offer antibiotics as sensitive drugs only in injectable forms. An adequate prescription of an antimicrobial agent for bacterial infection does not give a positive effect. This problem is faced by American doctors of all specialties, especially by primary care doctors. At the same time, the resistance to the same pathogen in the same antibiotic is different in different regions of the United States. In every state there is a situation of independent purchase of antibacterial drugs by patients in the pharmacy network.
The problem of antibiotic resistance in Mexico is even more critical. 70% of Mexicans, having caught the FLU, SARS and other viral infections, start a course of antibiotics without consulting a doctor (Garza-González et al., 2019). At the same time, half, in the absence of an effect, stops taking one antibiotic and starts drinking another, a third prefers to start intramuscular injections and self-medication. The main problems in Mexico, as in the United States, are the unjustified appointment of antibacterial agents and errors in the choice of an antibacterial drug. In Mexico, there are also significant territorial variations in the spread of antimicrobial resistance. In this regard, the importance of territorial monitoring of resistance and bringing its results to doctors of various specialties is indisputable. The departments with the highest frequency of antibiotic use in Mexico are intensive care, urological, and pulmonological units. The problem of the country’s health care is the low clinical effectiveness of the treatment and the high costs of purchasing ineffective antibiotics.
How Nurses Can Impact Antimicrobial Resistance
The main way that nurses can have an impact on the global topic on antibiotic resistance is patient education. Saves the doctor’s time and allows to limit the prescribing of antibiotics without reducing patient satisfaction by providing them with written information by the nurse. It can consist of leaflets with information about the disease and the drug. Nurses can give general instructions to patients (drink more, ventilate the room) and explain the appointment of medications prescribed by a doctor for a child (“for cough”, “for a runny nose”). In addition, in order to justify the uselessness of antibiotics, the nurse should repeatedly emphasize the viral nature of the disease in conversation with patients. Thus, there is a restriction or delay in taking antibiotics for the main group of their consumption. As a rule, these are the children of anxious, overprotective mothers who are inclined to immediately ask the doctor to prescribe antibiotics to the patient (Andrea et al., 2019). By raising awareness of clients, educating them about the consequences of antibiotic resistance, nurses help to fight this global problem.
In addition, nurses can participate in information campaigns (for example, “An antibiotic is a reliable weapon if the target is a bacterial infection”). It is necessary to notify not only patients, but also pharmacists of pharmacy institutions. Sometimes they can sell an antibiotic to a patient without a doctor’s appointment. Thus, the possibility of free access encourages the widespread use of antibiotics by the population for self-treatment. The participation of nurses in information campaigns can prevent a high probability of excessive use, errors in choosing the dose, duration of treatment, and the drug.
The modern concept of human health programming is aimed at preventing antibiotic resistance. Measures for its prevention include timely vaccination, as well as taking medicines exclusively on a doctor’s prescription. The role of a nurse in the fight against antibiotic resistance is to control patients, fulfill their doctor’s prescriptions and not resort to self-medication. To solve this acute problem, it is necessary to raise the level of awareness of medical workers, patients, scientific society, and especially the mass media.
Andrea, R. B., Domínguez-Martís, E. M., Mosteiro-Miguéns, D. G., Freire-Garaba, M., & Novío, S. (2019). Nursing students’ knowledge and awareness of antibiotic use, resistance and stewardship: A descriptive cross-sectional study. Antibiotics, 8(203), 1-18.
Antibiotic resistance. (2020).
Garza-González, E., Morfín-Otero, R., Mendoza-Olazarán, S., Bocanegra-Ibarias, P., Flores-Treviño, S., Rodríguez-Noriega, E., … Camacho-Ortizscott, A. (2019). A snapshot of antimicrobial resistance in Mexico. Results from 47 centers from 20 states during a six-month period. PLOS ONE, 39(6), 849-857.
Manning, M. L. (2016). Antibiotic stewardship for staff nurses: Five key ways you can influence antibiotic use. American Nurse Today, 11(5), 12+.