Antibiotic Much?
Alternative therapies to antibiotic overuse.
Growing resistance to antibiotics has otolaryngologists searching for alternatives. Now more than ever, otolaryngologists must consider the use of evidence-based perioperative antibiotics into individual practice—using the correct antibiotic at the correct time, evaluating the benefits, risks, and failures of antibiotics in chronic infections, and analyzing current research in alternative antimicrobial therapies.
All three of these factors will serve as discussion points during Wednesday’s session, “New Frontiers: Optimizing Antimicrobial Use in Otolaryngology.” The societal and personal impact of over prescribing antibiotics is significant, according to session moderator Sarah A. Gitomer, MD, assistant professor of otolaryngology at the University of Colorado School of Medicine in Aurora.
“For patients, I have seen multiple children get C. difficile colitis from routine courses of Augmentin, one of the most used antibiotics in pediatrics. Furthermore, I often see that patients are sometimes treated with antibiotics when it won't help them get better—this introduces risks to a patient without any tangible benefit,” Dr. Gitomer said. “From a societal perspective, we have been seeing increased antimicrobial resistance for decades due to overuse and inappropriate use of antibiotics. If each physician can help limit the use of antibiotics to times when it is beneficial, hopefully we can slow this process!”
Session panelist Peter Santa Maria, MBBS, PhD, said that antibiotic resistance, which can develop from over prescription of antibiotics, is now predicted to be the leading cause of death by 2050, according to the World Health Organization (WHO). Dr. Santa Maria, who is an associate professor of otolaryngology at Stanford School of Medicine in Stanford, California, described the “domino” effect of the situation.
“Failure to eradicate bacteria in chronic ENT infections (or any infections) leads to those bacteria eventually mutating into resistant bacteria. They develop multidrug resistance, meaning they even become resistant to antibiotics they’ve never been exposed to. Antibiotics also directly promote the development of bacterial persistence, meaning they are less likely to be eradicated by antibiotics in the future after exposure,” he said.
Systemic antibiotics are a powerful tool for treating common head and neck complaints, however, the downsides of these drugs are as Dr. Santa Maria described. Both the WHO and Centers for Disease Control and Prevention (CDC) have developed global action plans to fight inappropriate antibiotic use. Speakers will address key areas of maximizing antimicrobial therapies in practice, review evidence-based guidelines on surgical prophylaxis, and look at alternative therapies and the development of resistance to topical antimicrobials in chronic bacterial diseases using chronic draining ears as a model. Additionally, discussion will include cutting-edge research into developing microbiome-based treatment options for common head and neck infections.
There are some instances when it is appropriate to maximize antimicrobial therapies. Those include acute infections, especially with sepsis or bacteremia, Dr. Santa Maria said. Occasionally a colleague in another specialty can guide an otolaryngologist’s decision-making, Dr. Gitomer said.
“Sometimes our infectious diseases colleagues can help us make this call. In outpatient care, we all see patients and families who think of antibiotics as a quick fix for the common cold, and it is sometimes more time consuming to explain why they do not need antibiotics than to give out prescriptions,” she said. “Our goal with this talk is to give alternative options for this clinical scenario.”
Alternative therapies using microbiome-based treatment options for common head and neck infections are showing promise, Dr. Gitomer said.
“There are several animal studies looking at microbiome-derived treatments for chronic diseases such as sinusitis. There are also a handful of human studies with topical and systemic therapies that showed mixed results,” she said. “I think we are really in the infancy of this research. First, we really need to understand how the microbiome is preventing disease, and then we can use more refined therapies. There are some cool big studies in neonates about gut microbiome treatments to help prevent URIs in early infancy. There is so much more to learn, but it is an exciting new avenue for prevention and treatment of common head and neck infections.”
Still, challenges remain, Dr. Santa Maria said.
“Currently, physicians do not have clinical tests to help them understand antimicrobial susceptibility in chronic bacterial infections and rely on clinical tests appropriate for acute infections,” he said. “Doing this leads to inappropriate prescribing.”
The session also features panelists Nathan J. Gonik, MD, and Poogendren Lenny L. Pillay, MB-ChB MMed, MD, MHSA.
