Current efforts to tackle antibiotic resistance are "not nearly radical enough," according to a new review article in the journal Evolutionary Applications.
The article by Prof Ben Raymond, Associate Professor in Microbial Ecology and Entomology, University of Exeter, calls for a multi-pronged, integrated management approach to tackle the global antimicrobial resistance crisis.
Dr Raymond said that the “business-as-usual approach” of relying heavily on reducing antibiotic use and discovering new drugs could lead to "disaster," as exemplified by the history of resistance in gonorrhoea and the emergence of untreatable infections.
He proposes five rules for the sustainable use of antibiotics. These include acting to protect new drugs before resistance emerges, avoiding heavy use of single drugs for extended periods of time, using more multidrug combinations of antimicrobials to protect against resistance and mutation development, gathering more detailed data to enable the targeting of specific resistant microbes, and the use of short, intensive courses of antibiotics as opposed to low-dosing.
Dr Raymond said, "People think the best way to tackle antibiotic resistance is to give out fewer antibiotics and find new drugs. Those are important steps, but this approach alone is not nearly radical enough.”
He pointed out that, “No drug yet discovered is evolution proof, and the typical practice of using single drugs at once, in unprotected 'monotherapies' is unsustainable,” adding that, “Resistance to new antibiotics can become widespread in two or three years, so new drugs must be partnered with more sustainable patterns of use."
Dr Raymond warned that broader lessons of resistance management from other disciplines are "not widely appreciated" among microbiologists, while evolutionary biologists and clinicians need to talk to each other much more often.