Antibiotic consumption and antibiotic-resistant association
The association between antibiotic consumption and antibiotic-resistant organisms has been widely observed, mainly for other respiratory tract pathogens. For instance, Granizo et al. observed a clear association between previous use of macrolides and β-lactam with erythromycin-resistant pneumococci in Spain [26]. Also, Malotra et al. note that azithromycin and erythromycin use increases resistance of streptococci in healthy carriers [27]. We already knew of the relationship between antibiotic prescribing and bacterial resistance in primary care when antibiotics were prescribed for respiratory or urinary infection [2]. Other studies have also shown an association between previous consumption of antibiotics and S. aureus resistance. For example, in a recent randomised controlled trial, Australian children diagnosed with bronchiectasis assigned to intermittent azithromycin consumption showed higher macrolide-resistant S. aureus carriage than those assigned to placebo [28].
The commensal flora of community-dwelling persons is, therefore, becoming an important reservoir of resistant bacteria. Fighting antibiotic resistance starts with the restricted use of antibiotics, leading to less selection pressure on the bacterial flora circulating in the population, but also on the commensal flora in an individual. Knowledge of the local resistance rates of the most common organisms to antibiotics is crucial for better prescribing of antibiotics. In a recent paper from the APRES project, van Bijnen et al. observed that many guidelines for skin infections do not contain data on local resistance [29]. GPs should be informed of the resistance profiles of the most frequent organisms causing infectious disease for more prudent use of antibiotics.