Amadei, Steffanie S., and Vicente Notario. “A Significant Question in Cancer Risk and Therapy: Are Antibiotics Positive or Negative Effectors? Current Answers and Possible Alternatives.” Antibiotics, vol. 9, no. 9, 2020, p. 580.
The authors of the study debate the usefulness of antibiotics for cancer patients, outlining the problems that their consumption causes. Namely, the aggravation of the condition of patients with cancer is mentioned, which directs the conversation toward the discussion of substitutes such as bacteriophages and the related treatment opportunities that cause lesser harm. Moreover, the problem of antibiotic resistance in patients is outlined as one of the key reasons for including bacteriophages in treatment options. The article can be considered an important addition to the arguments against antibiotics.
Amarasiri, Mohan, Daisuke Sano, and Satoru Suzuki. “Understanding Human Health Risks Caused by Antibiotic Resistant Bacteria (ARB) and Antibiotic Resistance Genes (ARG) in Water Environments: Current Knowledge and Questions to be Answered.” Critical Reviews in Environmental Science and Technology, vol. 50, no. 19, 2020, pp. 2016-2059.
The authors of the article raise a very important point concerning the use of antibiotics as the standards method of reducing the threat of bacteria affecting an individual. Namely, the presence of antibiotic-resistant bacteria and the implications of ignoring them is explored in this research. The authors conclude that antibiotics may need to be substituted with the medications that would allow preventing the threats caused by antibiotic-resistant bacteria as well. The specified article can be used to promote change in the current healthcare context not by removing antibiotics but by offering substitute options.
Fiore, Marco, et al. “Nosocomial Spontaneous Bacterial Peritonitis Antibiotic Treatment in the Era of Multi-Drug Resistance Pathogens: A Systematic Review.” World Journal of Gastroenterology, vol. 23, no. 25, 2017, p. 4654.
In another research that addresses some of the positive effects of antibiotics, this paper explores the idea of using the specified medication for treating the infections developed during the hospital stay. According to the research outcomes, using antibiotics in case of a nosocomial issue allows for curbing the development of a health complication at the earliest stage possible. As a result, massive health issues can be addressed by introducing post-surgery patients to antibiotic treatments. The article can be utilized to support the pre-antibiotic argument and specify the cases in which the use of antibiotics is inevitable. Notably, its focus on the existence of drug resistance pathogens allows exploring the issue in greater depth.
Heta, Saimir, and Ilma Robo. “The Side Effects of the Most Commonly Used Group of Antibiotics in Periodontal Treatments.” Medical Sciences, vol. 6, no. 1, 2018, p. 6.
This research is very direct in its intent, specifying the key adverse effects that antibiotics cause in patients. According to the authors, apart from the increasing resistance to their effects, regular consumption of antibiotics may result in nausea, gastrointestinal problems, diarrhea, stomatitis, and related health issues that are typical in patients that use antibiotics as a treatment option research explains. Therefore, the application of antibiotics needs to be reconsidered, with a careful evaluation of the patient’s health specifics. The article can be used as the basis for the promotion of change in the use and prescription of antibiotics.
Hopkins, Heidi, et al. “Impact of Introduction of Rapid Diagnostic Tests for Malaria on Antibiotic Prescribing: Analysis of Observational and Randomised Studies in Public and Private Healthcare Settings.” BMJ, vol. 29, no. 356, 2017, pp. 1-8.
Examining the problem of antibiotic susceptibility and considering the issues associated with the use of antibiotics in the context of managing malaria, the study provides a decent overview of the positive and negative effects of the specified treatment. As a result, opportunities for the further choice in using antibiotics when addressing similar concerns and fighting the threat of infections in vulnerable patients are introduced. The research provides a basis for making a decision concerning the application of antibiotics in the management of a specific health issue and serves as an important argument in considering the subject matter on a case-by-case basis.
Hussein, Elsayed Os, et al. “Ameliorative Effects of Antibiotic-, Probiotic-and Phytobiotic-Supplemented Diets on the Performance, Intestinal Health, Carcass Traits, and Meat Quality of Clostridium Perfringens-Infected Broilers.” Animals, vol. 10, no. 4, 2020, p. 669.
Offering a different perspective, this paper argues that antibiotics should be considered as a legitimate treatment option. According to the results of the study, antibiotics still provide an unparalleled extent of infection prevention and management. In addition, the study shows that antibiotics lead to the desired outcomes faster than any other available treatments. Therefore, the study serves as a solid argument in favor of antibiotics, which means that it can be used as a counterargument against the established thesis statement.
Works Cited
Amadei, Steffanie S., and Vicente Notario. “A Significant Question in Cancer Risk and Therapy: Are Antibiotics Positive or Negative Effectors? Current Answers and Possible Alternatives.” Antibiotics, vol. 9, no. 9, 2020, p. 580.
Amarasiri, Mohan, Daisuke Sano, and Satoru Suzuki. “Understanding Human Health Risks Caused by Antibiotic Resistant Bacteria (ARB) and Antibiotic Resistance Genes (ARG) in Water Environments: Current Knowledge and Questions to be Answered.” Critical Reviews in Environmental Science and Technology, vol. 50, no. 19, 2020, pp. 2016-2059.
Fiore, Marco, et al. “Nosocomial Spontaneous Bacterial Peritonitis Antibiotic Treatment in the Era of Multi-Drug Resistance Pathogens: A Systematic Review.” World Journal of Gastroenterology, vol. 23, no. 25, 2017, p. 4654.
Heta, Saimir, and Ilma Robo. “The Side Effects of the Most Commonly Used Group of Antibiotics in Periodontal Treatments.” Medical Sciences, vol. 6, no. 1, 2018, p. 6.
Hopkins, Heidi, et al. “Impact of Introduction of Rapid Diagnostic Tests for Malaria on Antibiotic Prescribing: Analysis of Observational and Randomised Studies in Public and Private Healthcare Settings.” BMJ, vol. 29, no. 356, 2017, pp. 1-8.
Hussein, Elsayed Os, et al. “Ameliorative Effects of Antibiotic-, Probiotic-and Phytobiotic-Supplemented Diets on the Performance, Intestinal Health, Carcass Traits, and Meat Quality of Clostridium Perfringens-Infected Broilers.” Animals, vol. 10, no. 4, 2020, p. 669.
The clinical practice guideline coauthored by the American Academies of Pediatrics and Family Physicians is a filtered resource document. This is because the paper relays the findings of a specialized study on the topic in question. McGraw Hill’s article on access to medicine is a general information source. It relays information regarding general ailments that relate to the otitis ailment (McGraw-Hill, N.d). McCracken’s journal on the treatment of acute otitis media (AOM) in an era of increased microbial resistance is another filtered source of information (McCracken, 1998). This is because the paper exists to address issues, which pertain to the treatment of acute cases affected by increased microbial resistance. The minutes arising from interviews pass for unfiltered resources. This is because the reactions of the respondents are not predetermined. Lastly, Stan Block’s journal on causative pathogens, the resistance of antibiotics, and therapeutic considerations is a filtered information resource. This is because the contents of this center on data collected within the four-year period within which the study occurred (Block, 1997).
These sources are suitable for this study since they cover different aspects of the study topic. It is notable that each article highlights a different aspect of the study, making it a unique source of data when compared to the rest. Some of them provide information that is specific to the topic of study, while others provide support information. This is crucial to the study process since it provides information explaining certain occurrences and their significance.
Data found in the minutes from interviews passes for primary research evidence. This is because it relays first-hand information straight from the respondents. Stan Block’s journal on causative pathogens is an evidence summary guideline document. The contents of this paper depend on findings reached after analyzing data within a specified period. The journal by the Pediatrics and Family Physicians is an evidence-based guideline document.
This is because the interest groups consulted during this compilation came up with definitions as regards crucial matters concerning the study topic. Another evidence summary document is McCracken’s article, highlighting the treatment of acute OM. This applies since findings rely on established facts arrived at after extensive study periods. McGraw Hill’s article on Access Medicine exists out of this group. This is because it states known facts about the ailments without citing evidence for these facts.
Watchful waiting is a suitable method of treating children with AOM because the diagnosis of the same requires an extended observation period. This allows the clinical expert to determine the history of onset symptoms and determine the presence of middle ear infection (MEE) by looking for indicators of middle ear inflammation.
It is advisable to insist on proper medication and dosage practices among patients diagnosed with these ailments or other viral infections (Block, 1997). This minimizes the rate of development of resistant strains of the virus. Quarantine for infected persons serves as another method of minimizing disease spread. Most importantly, drugs with adequate antimicrobial coverage should be administered when treating correctly identified ailments.
Given the complicated nature of this ailment, keenness during the diagnosis and treatment stages is mandatory. It is noteworthy that the incapacitation of these patients places them at high risk of unethical practices from the attendants. Confidentiality counts among ethical issues contravened on several occasions by attendants. Patient information deserves protection, by all means, irrespective of the circumstances a practitioner undergoes. In addition, the treatment of children may pose a tricky situation to practitioners. All underage patients should issue their consent before their subjection to any medical procedure, after receiving adequate advice on the rigors and implications of the activities they will go through. The clinical practitioner breaches ethical considerations by performing medical procedures on unknowing minors without the consent of their guardians or caregivers (Subcommittee on Management of Acute Otitis Media, 2004).
References
Block, L. (1997). Causative pathogens, antibiotic resistance and therapeutic considerations in acute otitis media. The Role of New Macrolides for Pediatric Infections, 16(4), 449-456. Web.
McCracken, G. (1998). Treatment of acute otitis media in an era of increasing microbial resistance. Current Assessment of Diagnosis and Management of Otitis Media, 17(6), 576-579. Web.
McGraw-Hill. (N.d). Access Medicine. Current Pediatrics, 17. Web.
Subcommittee on management of Acute Otitis Media. (2004). Diagnosis and management of Acute Otitis Media. PEDIATRICS, 113(5), 1451-1465. Web.
An antibiotic is a term that was used originally to refer to a class of drugs derived from microorganisms and used to treat infections caused by other microorganisms. However, most of the antibiotics currently in use are either semi-synthetic or synthetic. They achieve this by either killing (bactericidal) or inhibiting the growth of bacteria (bacteriostatic). Physicians prescribe antibiotics when a patient is diagnosed with a bacterial infection.
There exists a wide range of antibiotics that a physician can choose from. This is dependent on if the causative bacteria are gram negative or gram positive. Other antibiotics are broad-spectrum such as chloramphenicol. This means that they can be used to treat infections caused by a wide range of bacteria. Amongst the agents used to treat gram positive bacterial infections include penicillin and macrolides such as erythromycin. Those that are used to treat gram-negative bacterial infections include floroquinolones and aminoglycosides (Hamilton-Miller, 1984).
Antibiotics achieve their beneficial effects by acting on the bacterium cell. The bacterium comprises several targets for antibacterial agents depending on the class chosen. These targets include the bacterial cell wall, ribosomes, cell membrane or on the bacterial DNA.Those that act on the cell wall such as penicillin and vancomycin inhibit the synthesis of new cell wall. Thus, the permeability of the cell wall is altered leading to cell lysis.
Alteration of the cell membrane such as that caused by polymixin causes leakage of important cellular material leading to cell death. Those that act on ribosomes inhibit protein synthesis. This is achieved through blocking of the initiation or translocation steps which depends on the agent used.
These agents bind on specific ribosomal sub units either the 50s or 30s sub units of bacterial ribosome. Examples include tetracycline and aminoglycosides.Those that act on DNA prevent its replication. This class includes flouroquinolones.The damage to the DNA starts by initiation of strand breakage followed by temporary arrest of growth and eventually total inhibition of replication (Pakyz, MacDougall, Oinonen & Polk, 2008).
The pharmacokinetic and pharmacodynamic profiles of the drugs need to be considered when choosing the suitable agent for the condition in question. These range from the location of the infection, the route of administration, absorption of the drug from the gastro-intestinal system, the half-life of the drug and possibility of drug interactions. Care should be exercised in special groups such as pregnant or lactating women and in patients with impaired kidney or liver functions.
Proper use of antibiotics should be encouraged as abuse may lead to resistance. This can be fostered through accurate diagnosis of infection and issuing of proper instructions to the patient..Over-use of antibiotics like penicillins and cephalosporins has contributed to increased allergic cases to these drugs. This may present as skin rash, anaphylactic reaction, shock or edema. This leads to development of new medical problem, which increases the cost of healthcare. Some antibiotics such as tetracyclines upset the normal flora, which leads to gastrointestinal disturbances. New evidence, suggests that these antibiotics can lead to bowel disorders (Davies, 1996).
Over-Use of Antibiotics and Resistance
Over-use of antibiotics arises mostly from institution of empirical treatment for the various infections that affect patients. It is common for antibiotics to be prescribed for the treatment of viral infections like flu, colds or gastroenteritis. Viral infections normally weaken the immunity of the subject.
It is perceived that this may to lead to secondary bacterial infection. Since antibiotics have no activity against viral infections, they should be preserved for use when the patient is diagnosed with the bacterial infection. Other interventions should be considered first such as boosting the immune system before resorting to use of antibiotics (Pakyz, MacDougall, Oinonen &Polk, 2008).
In some cases, antibiotics are prescribed for minor infections. This is improper use as these cases are supposed to resolve by themselves. The body normally develops immunity to this infection. Use of antibiotics in these cases should only be considered when the body’s immunity fails to fight the condition.
Patients nowadays are pressurizing doctors to prescribe antibiotics in cases that do not deserve. It is so sad that while doctors know the implications of this, they still yield to the patient demands. This malpractice should be stopped in order to avert the danger of resistance.
Resistance develops due to alteration of the target site of agent or through mutation. Mutation occurs even in the absence of antibiotic. Hence, reduction in drug over-use is the goal in order to reduce mutation due to alteration of the target site. This has become a major problem especially with the discovery of the superbug gene-NMD-1.This mediates resistance across the various classes, even carbapenems which are the hardest to develop resistance (Hamilton-Miller, 1984).
Danger of antibiotic resistant bacteria infections
There is general concern among health care professionals due to the spread of the superbug gene-NMD-1.The gene develop when antibiotics are misused. Consequently, this causes the normal flora to evolve into unhealthy bacteria. This poses danger to the individual and others especially the immunocompromised. Development of newer antibiotics is also taking place at a slower rate. Since resistance leads to a narrowed spectrum of treatment options, future infections by resistant bacteria are likely to be fatal (Hamilton-Miller, 1984).
Resistance is also likely to increase the cost of healthcare provision. Lack of treatment options leads to prolonged hospitalization. In addition, fewer available alternatives may be expensive hence increasing the cost. The superbug gene is also likely to cause fast spread of infections across the globe. (Davies, 1996).
Conclusion
Antibiotic development is a slow and expensive process. From the above discussion, it is explicit that over-use of antibiotics is posing a major threat to provision of healthcare. Thus, several measures need to be developed in order to curb this malpractice thereby arresting the problem of antibiotic resistance. Firstly, preventive measures such as proper nutrition and hygiene should be observed to reduce the risk of infection. The use of antibiotics in minor conditions should also be avoided (Davies, 1996).
The physician should prescribe antibiotics after accurate diagnosis of the infection. Shorter courses of treatment may be encouraged to reduce prolonged exposure to the drug.
References
Davies, J. (1996). Microbes: What does not kill them makes them stronger. Web.
Hamilton-Miller, J. M. (1984). Use and abuse of antibiotics. Journal of Clinical Pharmacology, 18(4), 469-474.
Pakyz, A.L., MacDougall, C., Oinonen, M. & Polk, R. (2008). Trends in antibacterial use in US Academic Health Centers: 2002 to 2006. Archives of Internal Medicine, 168(20), 2254-2260.
The overuse of antibiotics by the general population today has raised many questions about the potential effects of this practice. Polls have shown that 70 to 80 percent of the reported cases of sinus infection nationally have resulted in the prescription of an antibiotic dose [Tyler, 2007]. Additionally, despite the fact that there is no data supporting their efficacy, antibiotics are prescribed in 70% of the reported cases of bronchitis [Dent, 2000].
Why are these unnecessary prescriptions being made? What are the effects of exposure to excess antibiotics on the human population? What other sources can humans get exposed to antibiotic residues from? The following discussion will try to shed some light on this.
Exposure to antibiotics
Therapeutic exposure
Since they started being used in the 1940s, antibiotics have saved many lives; previous to this, simple infections like wound sepsis could easily be fatal to the patient. The antibiotics are prescribed in a wide range of bacterial infections; they however have no effect on viral organisms.
Misinformed and self-prescription
A common practice among mothers is to ask for a dose of antibiotics for their children once they see green or yellow mucous following sinusitis [Dent, 2000]. Another practice is to dose a child or oneself with antibiotics that were leftover from a previous treatment once similar signs appear; this is very dangerous as the drugs are not prescribed by a qualified physician; the danger of under-dosing is very realistic. In addition to this, some infectious conditions do not even need a dose of antibiotics and can be remedied by conservative procedures and hygienic practices [Gross et al, 2007].
Animal and Farm inputs residues
This is a very subtle way of exposure since even the consumer is usually not aware of the exposure. The antibiotics that are commonly used in animals are virginiamycin, lincomycin, erythromycin, tetracyclines, and tylosin. These are used as animal feed additives to prevent mostly gastrointestinal infections. The residues of these chemicals are found in products such as meat, eggs, and milk. Some antibiotics are also used in agriculture particularly as sprays to control bacterial infections of fruits.
The use of antibiotic additives in animal feed has been banned in Europe.
Effects of overuse of antibiotics
The aim of administering an antibiotic is to kill bacteria. Several effects can arise from overzealous or reckless use of the drugs.
Disruption of Normal Flora
Various body systems are inhabited by bacterial that are practically harmless to the person. Some of them are even beneficial; this is especially so as they compete for the limited resources in their habitat with the pathogenic bacteria. Large doses of antibiotics or long-term treatments can lead to the death of these commensals giving leeway to the pathogenic bacteria to thrive; ironically, treatment thus leads to disease.
Creation of drug-resistant strains
This is among the biggest problems associated with the excess use of antibiotics. The prolonged exposure of both harmless and pathogenic bacteria to antibiotics leads to the selection of drug-resistant strains. Additionally, the bacteria can share their new capabilities through the exchange of small sections of mobile genes known as plasmids. Some of the drugs now that previously guaranteed cures for sudden diseases are no longer effective. People are starting to die from bacterial infections again since the available drugs are no longer effective. Among the bacteria species that have shown this resistance are Staphylococcus, Pseudomonas, Salmonella, E-coli, and Campylobacter; the latter three have been associated with the use of antibiotics as feed additives in food animals.
Multiple Drug Resistance and World health
The rise of multiple drug-resistant bacteria is mainly attributed to the sharing of plasmids by bacteria. The world is now steadily running out of antibiotics to fight this new menace. Of particular importance is the emergence of the multiple drugs resistant tuberculosis bacteria.
Step to mitigate overuse of antibiotics
Training of health practitioners
The rise of the resistant strain is a relatively new phenomenon; the medical practitioners can be trained on new methods of evaluating the warrant of a case for a prescription of antibiotics. Additionally, they can be trained to react better to clients demanding to be prescribed antibiotics; and how to inform them of the dangers of unwarranted antibiotic therapy [Dent, 2000].
Restrictions of use of antibiotics
The presence of a pathogenic bacterium in a clinical test is not tantamount to an intion and does not automatically deserve antibiotics; some of the conditions can be treated conservatively without any harm to the patient [Mossey, 1994].
Methods of evaluating the amount and quality of antibiotic therapy in a healthcare institution can be employed; the desired effects of reducing the volume of unnecessary antibiotic therapy can be achieved standardization of healthcare [Williams, 2005]. There have been success stories in the recent past; for example, the use of antibiotics to treat upper respiratory diseases has been in the past reduced in the outpatients [Wilson, 2002].
Patient-Physician interaction
This is a very important part of the whole process of health care. The physicians should take upon themselves the responsibility of educating their patients on pruthe dent use of antibiotics [Dent, 2000]. The intimate relationship between the doctor and the patient can serve as the ultimate conduit for the transfer of this essential information.
Restrict use of antibiotics in animals and on plants
A complete ban should be placed on the use of any antibiotic product on food animals and plants. This would limit the exposure of the hapless population through their food. Better methods of gaining profits from the industry should be formulated.
Prudent use of antibiotics
Among the major steps to prevent over exposure to antibiotics is to avoid their use during mild viral infections such as colds and flu. The body’s immune system usually can fight these infections on its own. Symptomatic treatment of the condition that is making the individual can however be done.
All the antibiotic drugs that are leftover from a previous treatment should be destroyed to prevent any temptation to use them in the future.
AStrictadherence to the instruction of use of the antibiotic is paramount; the drugs should be taken at the right amount, at the right time and for the right duration. Once the period of treatment has elapsed, the patient should stop taking the drug immediately.
Conclusion
There is no doubt that the use of excess antibiotics is a very grave issue; it is in my opinion that the studies the have been done on the subject are only the tip of the iceberg; serious violations are rampant everywhere. It is possible to eliminate this phenomenon to forestall a future breakdown of the world’s defenses against diseases; through commitment and integrity, the various control measures can work.
References
Dent Sharon. “Deadly risks of antibiotic overuse warrant widespread education”. FP- Report. Volume 6, Number 3. (2000). AAFP: News Department. American Academy of Family Physicians. Web.
Gross Peter A. and Brijesh Patel, “Reducing Antibiotic Overuse: A Call for a National Performance Measure for Not Treating Asymptomatic Bacteriuria”. Clinical Infectious Diseases: 45: (2007):1335–1337.
Mossey J, Abrutyn E, Berlin JA, et al. “Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women?” Ann Intern Med 120: (1994); 827–33.
Tyler Allison Greg. “A Word on Antibiotic overuse”. Healthline. 2007. Web.
Wilson SD, Dahl BB, Wells RD.”An evidence-based clinical pathway for bronchiolitis safely reduces antibiotic overuse”. American Journal of Medicine, Quarterly: 17: (2002):195–9.
Williams SC, Schmaltz SP, Morton DJ, Koss RG, Loeb JM. “Quality of care in U.S. hospitals as reflected by standardized measures, 2002–2004”. New England Journal of Medicine: 353: (2005)255–64.
The ability of a bacteria or virus to resist the effects of another microorganism is widely referred to as antibiotic resistance. A providential experiment in 1928 by Alexander Fleming led to the discovery of antibiotics. Antibiotics can be defined as naturally occurring substances produced by bacteria and work to kill other competing bacteria. Fleming’s finding was a landmark and led to large scale production of penicillin from the mold Penicillium notatum in the early ’40s. Most surprisingly, the resistance of antibiotic was experienced in the same year. This has so far contributed to 75% of acquired infections that are linked to antibiotic resistance worldwide (Anderson, p. 318). Generally, antibiotic resistance is genetically evolved via mutation in the pathogen genome (a phenomenon referred to as horizontal gene transfer) but it can also occur as a result of the application of an evolutionary strain on a population. This is seen in the microorganisms that mutate to allow their survival and later they pass the genes to their offspring. Consequently, this results in the likelihood of a fully resistant bacteria colony. The bacterium carries or transfers important information in persons by the plasmid method. The bacterium may carry one or several resistance genes, where the latter is known as the multi-resistant process. Another microorganism may also transport genes and this class encompasses antimicrobial resistance. In addition, the introduction of antibiotics, which is specifically a drug, can occur through transformation protocols. This is however useful in instilling effective genes into the microorganism. Recent studies have demonstrated that antibiotic resistance is contributed by how much antibiotic is consumed. For instance, the advancement of methicillin resistance is suggested to occur as a result of the overuse of second and third generation of cephalosporins (the broad-spectrum antibiotics). Other factors that cause this resistance includes; incorrect prescriptions and diagnosis, oral application of antibiotic in livestock among others (Mathew and Liamthong, p. 116). The bacteria cell is simply destroyed by an antibiotic and leads to the non-functionality of a critical process. An antibiotic can render the protein nonfunctional when it binds to its wall. This protein is then used in copying the DNA and making the walls of the cells more effective in the reproduction and growth of bacteria. The DNA of a bacterium may undergo a mutation that codes one or several proteins. The resulting protein is altered as the antibiotic is unable to bind to it and this leads to the survival of the bacteria by mutation. When antibiotic is present in individuals, the reproduction and survival of bacteria are highly enhanced (Purdom, p. 34). In most cases, antibiotics do not cause resistance but it creates an environment that is antibiotic-resistant friendly. Several microorganisms have shown resistance to a number of drugs. A drug-resistant infection occurs as a result of a patient contracting a resistant organism or once the antibiotic drug is introduced into the body. The patient becomes more serious with numerous complications which can lead to death. Antibiotics are key weaponry in the fighting of diseases caused by microorganisms. The penicillin drug first attaches to the walls of the bacteria and destroys it completely. This follows the destruction of the bacteria walls and eventual death. Resistant microbes thwart the binding of penicillin by producing enzymes that disintegrate the antibiotic. Further research demonstrates that ribosomes may also be attacked by erythromycin harboring them from manufacturing protein. The ribosomes of the resistant bacteria are distorted making the drug-wall binding process impossible. In addition, bacteria become resistant to various antibiotics through the ribosomal route. These antibiotics in the market today include tetracycline and streptomycin (Anderson, p. 321). There are three methods of how the gene can confer resistance as discussed in the following paragraphs. The first method is referred to as spontaneous DNA mutation. Here, the DNA in the bacteria undergoes mutation which has been linked to the resistance of most antibiotic drugs (Cesar and Murray, p. 443).
Figure 1: Spontaneous DNA mutation
The second method is the microbial sex called transformation where a bacterium takes the DNA of another bacterium as shown in figure 2. An example of a disease linked to this transformation is penicillin resistant gonorrhea.
Figure 2: Transformation
The third way is the most shocking resistance acquired to date. It involves a plasmid (a small circle of DNA) that darts from a different bacterium (shown in figure 3). One plasmid molecule slews number of resistant. In 1968, Shigella diarrhea claimed the lives of over 12,000 people in Guatemala. The disease was caused by the microbe that harbored the plasmid resistances.
Figure 3: Plasmid resistance
Many scientists have established that antibiotic resistance is inevitable but considerable measures can be undertaken to slow the rate of infection. These have been suggested to improve infection control, to develop novel antibiotics and appropriate medication. In addition, patients often contribute to resistance when they take drugs for a very short time and stop once symptoms improve. This however helps the proliferation of the resistant microorganisms. The patient should be fully assisted when undergoing treatment. Finally, more research should focus on the ways of ‘narrowing the spectrum’ to target only a few bacteria types so that resistance can be restricted.
References
Anderson, Kevin. “Bacterial resistance to antibiotics.” Creation Research Society Quarterly 41.4 (2005): 318–326.
Cesar, A. and Murray, E. “Antibiotic-Resistant Bugs in the 21st Century – A Clinical Super-Challenge”. New England Journal of Medicine 360.5 (2009): 439-443.
Mathew, C. and Liamthong, S. “Antibiotic resistance in bacteria associated wit food animals: a United States perspective of livestock production”. Foodborne Pathogical Disaster. 4.2 (2007): 115–33.
Purdom, G. Is natural selection the same thing as evolution? In the New Answers Book. Arkansas: Master Books, Green Forest, 2006.
This article addresses antibiotic resistance in livestock in America (Harris, 1). The article appears in the New York Times and highlights the new regulations that farmers must adhere to before getting a prescription on antibiotics for animals. According to the article, on average, 2 million individuals become ill and an estimated 100,000 die from nosocomial infections resulting from microbial resistance to antibiotics. According to the article close to 80 percent of human antibiotics sold in the US are also used to treat animals (Harris, 1).
The FDA has proposed new rules that bar farmers from administering antibiotics to farm animals such as pigs and cattle. The other regulation the FDA is putting in place requires drug manufacturers to modify drug labels to include a prescription. These new restrictions are in line with the Obama administration directive to restrict the use of antibiotics in agriculture. The new law has been both welcomed and criticized. Critics of this FDA regulation ascertain that, because the regulations are to be enforced voluntarily, most farmers, especially small scale will have a hard time implementing the changes. On the other hand, supporters of the rule argue that the restriction will reduce drug resistance in America (Harris, 1).
Questions
How Does Antibiotic Endurance Happen?
Antibiotic resistance is a regular occurrence that has been happening from the time past of microorganisms such as bacteria. Research shows that some bacteria sequestered from glaciers, and that had not been in contact with humans or animals were found to be resilient to several existing antibiotics. In addition, research shows that a significant level of natural bacterial endurance to antibiotics must consequently be estimated but living microbial cells will be those that are of least sensitivity or are resilient. It is hard to calculate the rapidity of resistance in microorganisms as it is determined by among other things, the category of the drugs (antibiotic), the class of microorganisms, and the degree of contact the microorganisms have to drugs or antibiotics besides the capability of the resilient bacteria to endure and reproduce (Mayers, 25).
Following the development of microbial resistance, the particular microorganisms could become extinct, or the resilient strains may be substituted by vulnerable microorganisms. Although current research has made tremendous gains in the area of microbial resistance to antibiotics, there is still considerable information that is unfamiliar about what ensues to drug resistance when it advances.
Literature on ways to combat drug resistance indicates that it is essential to use drugs especially antibiotics at the precise prescription amount, as it ensures that the correct amount of the antibiotics reach the location of contamination within an adequate duration of time to guarantee retrieval from illness. If the accurate dosage is not administered, or if the antibiotic course is not finalized, several bacteria may persist and may be less vulnerable to treatment using the same antibiotics a second time. The less susceptible microorganisms replicate and their numbers proliferate within the microbial populace in total.
What Are the Consequences of Antibiotic Endurance?
When resilient microorganisms cause contagions, the range of drugs or antibiotics that can be employed to manage the infections or illnesses is narrowed. If instantaneously known, the clinician or veterinarian can apply other drugs or antibiotics with slight or no jeopardy to the patient or animal. If the resistance is not known until the course of the first drug fails to control the illness or infection, the interval between first diagnosis and the initiation of effective treatment can end up in needless suffering and a worsening of the patient’s state (Criswell).
How Comparable Are The Antibiotics Spent In Domesticated Animals To Those Spent In Humans?
Numerous infections in domesticated animals mimic those that originate from man, so it is no wonder that certain drugs used to combat infectious microorganisms in man are similarly useful in healing animal diseases and infections. Nevertheless, many chemical compounds employed in treating farm animals are dissimilar from those employed in humans. However, where there is a biochemical comparison in the drugs there is no proof that human beings’ use of drugs is in any manner influenced by their use in farm animals (Mayers, 25).
What Consequence Would Outlawing the Use of Particular Antibiotics In Farm Animals Have on Antibiotic Resilient In Humans?
There is no clear answer to this question. Nonetheless, broad exploration continues to be done in America and through the globe with the sole purpose of offering humanity an answer to the query. Despite the mystery, surrounding antibiotic and drug resistance, all the existing substantiation proposes that the usage of antibiotics and other drugs in farm animals has had a slight or no effect on the occurrence of antibiotic resilient in human contagions with microorganisms in the genus Enterococcus being transmitted by animals.
Undeniably, current research indicates that microbial resistance in human Enterococcus microorganisms to drugs in the antibiotic class, used in the last twenty-five years in fowls and other farm animals all over the globe is static. This is not astonishing because the enterococci strains from farm animals do not last in the human intestine. In the existence of man, it has protractedly been recognized that some genera and classes of microorganisms such as bacteria, for instance, Campylobacter and Salmonella can be transmitted from farm animals to humans (National Office of Animal Health).
Antibiotics are a powerful weapon in the fight against pathogens, and therefore many parents, as soon as the child’s temperature rises, immediately turn to treatment with antibiotics. However, such self-medication is unacceptable, especially in the case of children. Moreover, microorganisms quickly adapt to the antibiotic, and some can contribute to their destruction. The more often an antibiotic is used, the more successfully and faster the microorganisms adapt to it. Therefore, it is necessary to look for drugs that break the very mechanism of resistance since there are already bacteria that cannot be stopped by almost any antibiotic.
The studied article raises the topic of the impact of antibiotic consumption on the transfer of antibiotic-resistant bacteria by schoolchildren. This research under study aimed to examine the systemic consumption of antibiotics by schoolchildren and assess their consumption, the rate of transfer, and resistance of respiratory pathogens living in the mucosa of the upper respiratory tract (Farkaš et al., 2020). The study analyzed the incidence and the nature of resistance of the most common respiratory pathogens.
The research methods included population research, collection of samples, isolation and identification of bacteria, antimicrobial sensitivity testing, and static analysis. Farkaš et al. (2020, p. 267) note that “7% of the healthy children had consumed antibiotics in the previous six months, and this percentage was higher for children presenting with upper respiratory tract infection”. In conclusion, the article concludes that schoolchildren have significant resistance to antibiotics and that this age group should become an object for intensive training in the correct administration of such drugs both at the level of patients and at the level of medical professionals.
The resistance of bacteria to antibiotics is a severe threat to human health. Due to the spread of resistance, it becomes more and more challenging to find an effective treatment every year. Even if people have never abused antibiotics, they may get resistant microflora from someone in their immediate environment or genetically (Yelin & Kishony, 2018). Acquired antibiotic resistance occurs when, despite the use of an antibiotic, the bacteria continue to multiply, which requires the use of a new antibiotic that is stronger than the one previously taken.
The fight against resistance can go in two ways: first, creating new drugs that can effectively suppress resistant microorganisms and inventing ways to slow the spread of resistance. In my practice, I will consider the fact that children have a relatively high resistance to antibiotics. Moreover, instead of prescribing antibiotics to treat viral infections, such as the flu, runny nose, or irritation of the pharyngeal mucosa, other, more efficient, methods of treatment may be prescribed. I will also stick to the information from the article that the rational use of antibiotics can reduce the likelihood of resistance. In addition, it is worth paying attention not only to children but also to their parents. After all, as already mentioned, resistance to antibiotics can be not only acquired but also congenital.
Today, antibiotics are widely used in the fight against various types of bacteria. However, the concept of antibiotic resistance is also widespread in modern society, especially among children. These drugs are abused not only in situations where there are no indications, for example, taking them for viral infections, but also choosing the wrong drugs. To solve this problem, it is necessary to properly prescribe antibiotics and conduct research to create new, more effective drugs.
References
Farkaš, M., Čulina, T., Sišul, J., Pelčić, G., Mavrinac, M., Mićović, V., & Tambić Andrašević, A. (2020). Impact of antibiotic consumption on the carriage of antibiotic-resistant bacteria by school children. European Journal of Public Health, 30(2), 265-269.
Yelin, I., & Kishony, R. (2018). Antibiotic resistance. Cell, 172(5), 1136-1136.
Streptomycetes are mycelial bacteria, ubiquitous in nature and integral participants in the life of the biosphere. They are aerobic, gram-positive organisms of the prokaryotic type. They form a branched mycelium with a diameter of 0.5–2.0 microns (Barbuto Ferraiuolo et al., 2021). Mycelium is usually not fragmented; it is divided into two parts: primary (substrate) and secondary (air); secondary may be absent. The filaments of the mycelium do not break up into fragments. Representatives of the family are able to form immobile bacterial spores. They are created in the form of chains on the spore-bearing hyphae of the aerial mycelium. There are more than 500 species of this bacteria and they play a crucial role for humans and the environment.
These bacteria are the basis for creating antibiotics as they produce specific substances that eliminate harmful cells. Almost 60% of antibiotics are formed by streptomycetes, making them the most popular means of fighting infection (Barbuto Ferraiuolo et al., 2021). As a result, they attack the competing microorganisms with their antibiotic power and may inhibit benevolent bacteria’s growth. Hence, streptomycetes are beneficial for a human body in a way that may prevent numerous infectious diseases.
What is more, streptomycetes are responsible for the creation of the after-rain earthy smell. These mycelial bacteria excrete drought-resistant spores to ensure their own survival in the dry soil. The shell of these spores contains geosmin, which has a familiar earthy forest aroma. The raindrops that fall on the ground throw these tiny ultralight spores into the air, making people inhale this smell. Finally, streptomycetes produce geosmin, which can be scented by camels from a very long distance. It helps these animals find the water source.
The topic of significant interest is the causes and effects of antibiotic resistance. This is one of the burning concerns in global health care as antibiotics have enabled people to treat serious infections, but their effectiveness is decreasing due to bacteria growing resistance (Chokshi et al., 2019). No effective alternatives to antibiotics have been developed so far, which makes people prone to infectious diseases and vulnerable to epidemics and pandemics.
I chose this topic as it directly has and may have an impact on my health and the health status of my close ones. I have a relatively rich medical history, as I had multiple respiratory infections in my childhood, so I had to use antibiotics. I may be quite vulnerable to new diseases (COVID-19 is a bright illustration of hazards), so I would like to know more about the causes and effects of antibiotic resistance. This topic is an important area for research in nursing as nurses are responsible for the administration of antibiotics, patients’ health condition assessment, and, in many cases, prescriptions, as well as educating patients on the associated risks.
The major causes of antibiotic resistance are the misuse of this medication and its utilization in food production (and farming). The effects of antibiotic use are associated with increased risks to public health as people are becoming vulnerable to various infectious diseases.
I will use the following keywords: antibiotic resistance, causes and effects, and nursing. I will search with the help of such databases as PubMed, Google Scholar, and Science Direct.
Numerous articles are available on the topic, and I am able to choose among studies that shed light on diverse aspects of the issue. As the focus is on causes and effects, I decided not to use nursing among the keywords to narrow my search. As a result, I located two valuable sources that can become central to my examination of the topic.
Article 1
Chokshi, A., Sifri, Z., Cennimo, D., & Horng, H. (2019). Global contributors to antibiotic resistance. Journal of Global Infectious Diseases, 11(1), 36-42. Web.
The article under analysis is written by Chokshi et al. (2019) and is concerned with the causes of antibiotic resistance on a global scale. The researchers concentrate on the contributors to the problem in developing and developed countries. Chokshi et al. (2019) implemented a qualitative literature review of the articles published between 1963 and 2017. The studies that did not mention the causes of antibiotic resistance concentrated on the molecular basis of antibiotic resistance, or were published in a language other than English were excluded. As a result, 2281 studies on developing nations and 1227 publications on developed countries were screened, and the overall number of articles included in the literature review was 31 (Chokshi et al., 2019). Out of these 31 articles, 18 pieces were on developing states and 13 publications on developed nations. The authors also referred to several reports published by the Centers of Disease Control (CDC), the World Health Organization (WHO), and the Food and Drug Administration (FDA).
The researchers note that fundamental causes of antibiotic resistance in developing nations include the lack of resistant development surveillance, clinical misuse, poor quality of antibiotics, and the high availability of this kind of medication. For developed countries, the major contributors to increasing antibiotic resistance are the excessive use of antibiotics in farming and a low level of control over antibiotic use in healthcare facilities (Chokshi et al., 2019). The researchers also emphasize that the current research on new antibiotics or alternatives is relatively slow and insufficient, which is a global contributor to enhancing antibiotic resistance. Policymakers should develop regulations promoting the research on new antibiotics other ways to treat specific diseases (Chokshi et al., 2019). It is concluded that more sustainable regulatory measures are necessary for both developed and developing nations to slow down antibiotic resistance. The implications of this article may have far-reaching effects as the research can become the ground for the development of strict regulations of antibiotic use and can facilitate research of new antibiotics or their alternatives.
The article in question is a reliable and valuable source of information for the proposed study on the causes and effects of antibiotic resistance. The authors’ credentials suggest they are knowledgeable and unbiased, so the findings and conclusions are relevant and reliable. The employed methodology is also sound, so the results of the study are valid. Notably, the findings reported in the publication under consideration are consistent with the conclusions made in other studies. For instance, Li and Webster (2017) also state that the misuse of antibiotics and the low pace of research on new antibiotics and alternative treatment measures are major causes of increasing antibiotic resistance.
The article by Chokshi et al. (2019) is a valuable source for my research on the causes and effects of antibiotic resistance because it provides essential insights into the primary contributors of antibiotic resistance. This publication is helpful to nursing and can contribute to the advancement of the practice as it provides insights into the causes of the problem. Nurses aware of the misuse of antibiotics would be more willing to advocate for patient best outcomes and reasonable use of antibiotics. The article adds to the existing knowledge base on the matter and serves as additional evidence related to the factors leading to the enhancement of antibiotic resistance. Although I was aware of the primary causes of resistance to antibiotics, the article helped me gain insights into the difference related to the contributors to the problem between developed and developing countries.
Article 2
Pulia, M., Kern, M., Schwei, R., Shah, M., Sampene, E., & Crnich, C. (2018). Comparing appropriateness of antibiotics for nursing home residents by the setting of prescription initiation: a cross-sectional analysis. Antimicrobial Resistance & Infection Control, 7(1), 1-8. Web.
The article by Pulia et al. (2018) deals with the use of antibiotics in the healthcare setting. The purpose of the study under consideration is to examine the characteristics of antibiotic therapy among nursing home (NH) residents and compare its appropriateness in terms of prescription initiation. The retrospective cross-sectional multi-center study was implemented to address the research objectives. The researchers analyzed the data obtained from several NH locations in Wisconsin between 2013 and 2014 (Pulia et al., 2018). The patients with lower respiratory tract infections, urinary tract infections, and skin and soft tissue infections were included in the study. The appropriateness of antibiotic prescription was measured with the help of the Loeb criteria grounded on the data from the NH. Such statistical data as the Chi-square test and logistic regression were utilized to compare the appropriateness of antibiotic use by infection types and setting.
According to the results of the study, approximately 87% of antibiotic prescriptions were initiated in NH, 8.3% were started in an outpatient setting, and 4.6% were created in the emergency department (Pulia et al., 2018). At that, inappropriate antibiotic use was identified in almost 81% of outpatient clinic prescriptions, 73.3% of emergency department initiations, and nearly 56% of NH prescriptions. Pulia et al. (2018) conclude that antibiotic prescriptions in outpatient clinics are associated with the highest level of misuse of this medication. The researchers also stress that further investigation of the use of antibiotics in outpatient settings is necessary to decrease the instance of antibiotic misuse.
The article in question is a useful source for the proposed research as it provides detailed insights into a particular case of antibiotic misuse. The authors are experts in the field of medication use as they have degrees in emergency medicine and public health. The study is a relevant source of reliable and valid data because the researchers utilized proper research design and methods. Sound statistical tests were used, so the data could be generalized and can serve as evidence needed for further exploration of the topic (Pulia et al., 2018). The data were collected over a year, and several healthcare facilities participated in the study, which also suggests that the generalizability of findings is high. The conclusions made by Pulia et al. (2018) are consistent with other studies on the matter, as the misuse of antibiotics in the healthcare setting is seen as one of the leading causes of antibiotic misuse (Li & Webster, 2017; Chokshi et al., 2019). Importantly, the study by Pulia et al. (2018) provides data regarding a specific case that illustrates the exact mechanisms affecting the severity of the problem on a global scale.
This article is valuable for my research as it provides specific data regarding a particular case in the healthcare setting. The report makes a considerable contribution to the nursing practice because it unveils specific instances of antibiotic misuse. Nurses, especially those working in outpatient environments, should be more cautious and become active advocates for patient needs. The article did not provide any surprising information, but it was instrumental in developing the understanding of exact gaps in the healthcare setting.
Article 3
Durdu, B., Meric Koc, M., Hakyemez, I. N., Akkoyunlu, Y., Daskaya, H., Sumbul Gultepe, B., & Aslan, T. (2019). Risk factors affecting patterns of antibiotic resistance and treatment efficacy in extreme drug resistance in intensive care unit-acquired Klebsiella Pneumoniae infections: A 5-year analysis. Medical Science Monitor, 25, 174-183. Web.
The article under analysis is concerned with the causes and effects of drug resistance with the focus on Klebsiella Pneumoniae infections. The purpose of this study was to identify the factors that influence antibiotic resistance in an intensive care unit related to Klebsiella Pneumoniae hospital-acquired infections. Additionally, the authors aimed to determine the effects of the use of medication in patients with high-level antibiotic resistance on patient survival. The present retrospective study was implemented at an adult intensive care unit of an urban hospital. Data collection took place between 1 January 2021 and 31 May 2017. The participants’ lifespans measured the effectiveness of the antibiotics used.
The study included 208 patients (63% males and 27% females) with a median age of 67.5 years and a median stay in a hospital of 16.5 days. The crude mortality rate of the participants during their follow-up was 70% (Durdu et al., 2019). Descriptive statistics to describe the participants’ characteristics were utilized, and Kruskal-Wallis analysis was employed to compare the averages of quantitative attributes, and post hoc Dunn tests were used for multiple comparisons (Durdu et al., 2019). The effects of treatments were measured with the help of the multivariate statistical method.
It was found that although combining medication in the presence of antibiotic resistance is an efficient practice, some drugs are not suitable for this therapy. In many cases, there were delays in prescribing an adequate remedy, which led to a shorter lifespan. Durdu et al. (2019) found that the patients prescribed a combination of tigecycline and trimethoprim-sulfamethoxazole had longer survival times considerably. It is suggested that trimethoprim-sulfamethoxazole can be an effective alternative as the basis of the antibiotic combinations utilized to address hospital-acquired infections.
The article in question is a valuable source for the present research as it provides an in-depth analysis of a particular case that illustrates the effects of antibiotic misuse. The article’s findings show that the current pharmacological practices have limited effectiveness and contribute to increased levels of antibiotic resistance (Durdu et al., 2019). Due to the sound methodology employed in this study, the findings are valid and expand the knowledge base on the issue under analysis. At that, the small sample poses certain limitations to the generalizability of data as the patients of one hospital took part in the research. It is also noteworthy that this article’s findings are consistent with other studies that display the correlation between antibiotic misuse in hospitals and antibiotic resistance. For instance, similar to Durdu et al. (2019), Pulia et al. (2018) also examine a specific case and find a direct link between the existing practices and antibiotic resistance. Li and Webster (2017) provide more general information on the matter, which shows that the case under analysis can be seen as an illustration of the apparent trend.
The article by Durdu et al. (2019) can be helpful for researchers and practitioners as it sheds light on the use of certain antibiotics. Researchers can use it as a starting point for further research or can utilize similar methods that were validated in the present study. Practitioners can also use it to develop and implement effective care plans and provide high-quality care. The use of a combination of antibiotics can be a way to decrease the antibiotic resistance rate in the population, but more research is needed in this area.
References
Chokshi, A., Sifri, Z., Cennimo, D., & Horng, H. (2019). Global contributors to antibiotic resistance. Journal of Global Infectious Diseases, 11(1), 36-42. Web.
Durdu, B., Meric Koc, M., Hakyemez, I. N., Akkoyunlu, Y., Daskaya, H., Sumbul Gultepe, B., & Aslan, T. (2019). Risk factors affecting patterns of antibiotic resistance and treatment efficacy in extreme drug resistance in intensive care unit-acquired Klebsiella Pneumoniae infections: A 5-year analysis. Medical Science Monitor, 25, 174-183. Web.
Li, B., & Webster, T. J. (2017). Bacteria antibiotic resistance: New challenges and opportunities for implant-associated orthopedic infections. Journal of Orthopaedic Research, 36(1), 22-32. Web.
Pulia, M., Kern, M., Schwei, R. J., Shah, M. N., Sampene, E., & Crnich, C. J. (2018). Comparing appropriateness of antibiotics for nursing home residents by the setting of prescription initiation: A cross-sectional analysis. Antimicrobial Resistance & Infection Control, 7(1), 1-8. Web.
The given research study critique will focus on the article by Smith et al. (2017), which investigates the impact of antibiotics on people with acute bronchitis. The study identified thoroughly what is known and unknown in the background section. For example, the authors state that “acute bronchitis is the ninth most common outpatient illness recorded by physicians in ambulatory practice in the USA” (Smith et al., 2017, p. 3). In addition, the researchers showcased the mismatch between antibiotic prescription and bacterial influence on the condition. It is stated that “pathogens implicated in acute bronchitis are Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis, each of which has been identified in up to 25% of cases in various populations” (Smith et al., 2017, p. 3). However, when it comes to antibiotics, it is reported that “antibiotics are prescribed for 60% to 83% of people who present to physicians with the condition” (Smith et al., 2017, p. 3). Therefore, in the case of what is not known, the authors state that “there are no clinically useful criteria that accurately help distinguish bacterial from viral bronchial infections therefore some authors have called for physicians to stop prescribing antibiotics for people with acute bronchitis” (Smith et al., 2017, p. 3). In other words, the study consults previously acquired data on bacterial involvement in bronchitis cases and presents contrasting evidence of antibiotic prescription but indicates that evidence is limited.
Purpose and Sampling
The purpose of the study was clearly presented and identified, which makes the research precise in its direction. The authors state that the purpose is “to assess the effects of antibiotics in improving outcomes and to assess adverse effects of antibiotic therapy for people with a clinical diagnosis of acute bronchitis” (Smith et al., 2017, p. 1). It is evident that the researchers want to know the effects of antibiotics on the condition, whether they are positive, negative, or neutral. It is important to note that this prospective cohort study included 18 trials and 5099 participants, where a simple random sampling method was utilized in order to include both antibiotic and placebo groups, and the latter acted as a control group. It is stated that “randomized controlled trials comparing any antibiotic therapy with placebo or no treatment in acute bronchitis or acute productive cough, in people without underlying pulmonary disease” (Smith et al., 2017, p. 1). In other words, the sampling plan was reliable in expecting to yield a representative sample due to a larger pool size as well as randomization. It should be noted that the sample size was sufficient to provide solid evidence for the study rationale and design since the core objective is to observe the effect of antibiotics on a particular condition. The control group did not differ demographically, and the key difference was the presence of the placebo effect, but bronchitis was present in both control and experimental groups.
Data Collection and Instruments
The data collection method was based on trial data obtained with a subsequent examination of the process. It is stated that “we examined funnel plots for each of the analyses conducted and none indicated a significant level of reporting bias,” and “we included a range of outcomes under the broad definition of ’clinically improved.’ These were clinically heterogeneous, so we used a random-effects” (Smith et al., 2017, p. 7). Thus, there was a step by step process in which the relevance and validity of data were verified for further inclusion. Therefore, considering the purpose of the study, such an approach is appropriate since longitudinal data is needed with large sample sizes in order to observe a statistically significant effect of antibiotics on acute bronchitis. The instruments included the Cochrane Central Register of Controlled Trials or CENTRAL, MEDLINE, and LILACS databases. In addition, it is stated that the authors “searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov” (Smith et al., 2017, p. 4). In other words, reputable instruments and databases were used to obtain the data for the cohort study. However, the instrument validity was not thoroughly and directly discussed since the databases are inherently valid on their own.
Results, Variables, and Conclusions
The study results were presented clearly and succinctly, where the findings indicate that there is no statistically significant difference between the use of antibiotics for acute bronchitis and avoidance of its usage when it comes to clinical outcomes. However, antibiotics had a positive effect in the case of cough occurrence, night cough, and additional beneficial outcomes or NNTB (Smith et al., 2017). In general, antibiotics were useful for treating acute bronchitis since they led to the reduction of major symptoms, such as coughing. The limitations were identified and addressed in the potential biases section, where the authors claim that “some patient subgroups are under-represented, as they may not have been recruited into the original trials” (Smith et al., 2017, p. 14). Therefore, there is a possibility of faulty interpretation due to the database data provision patterns.
The researchers did not make major attempts to control for confounding variables since there are a number of such influences. In addition, the databases diverge in their data collection methods, which is why it is impractical to control all possible confounding variables. However, the use of a specific focus on specific outcomes provides a more precise and centered analysis of the variables, which is why some databases were excluded. The conclusions were appropriate, with an emphasis on practical and research implications. In the case of the former, it is stated that “it is especially important for clinicians to share the decision about whether to use antibiotics or not with their patients, using the expected outcomes and their magnitude from this review as a basis for their discussion” (Smith et al., 2017, p. 15). For research, the authors state that “research efforts should also be directed at the identification of subsets of patients who are most likely or least likely to benefit from antibiotic treatment” (Smith et al., 2017, p. 16). In other words, conclusions are comprehensive since they address both clinical and research implications.
Quality Rating
The research study can be considered as high quality because the literature review includes thorough reference to scientific evidence, consistent recommendations are provided based on the data, and it has definitive conclusions. In addition, there is an adequate control group, a large sample size sufficient to justify the study design, the results are generalizable, and the findings are consistent. In other words, the study itself is reliable and accurate, which means it can be used as core evidence for statements in regards to antibiotics’ utility against acute bronchitis.
Reference
Smith, S. M., Fahey, T., Smucny, J., & Becker, L. A. (2017). Antibiotics for acute bronchitis. Cochrane Database of Systematic Reviews, 6(6), 1-59. Web.