Perspectives on Managing Antibiotic Resistance

Tackling antibiotic resistance likely requires a multifaceted approach. Better and faster point-of-care testing, new treatments, and antimicrobial stewardship could hold promise for future control.

Starting At the Bedside and Doctor’s Office

Precise antibiotic selection — a core principle of antimicrobial stewardship — plays a critical role in combating resistance. In this effort, some children’s hospitals are leading the way.

At the Ann & Robert H. Lurie Children’s Hospital of Chicago, effective antibiotic stewardship means treating antibiotics as a precious resource, said Sameer Patel, MD, MPH, medical director of the hospital’s Antimicrobial Stewardship Program.

“Healthcare providers should start antibiotics only when truly needed, choose the narrowest-spectrum effective medication, and stop treatment as soon as the infection is resolved,” he added.

According to Patel, system-level strategies to strengthen antibiotic stewardship programs include:

• Monitoring antibiotic use and resistance patterns
• Educating frontline providers
• Regularly updating and disseminating clinical guidelines
• Integrating decision support tools to inform real-time prescribing

“At children’s hospitals, we have seen a rise in antibiotic-resistant infections,” he said. “This means that first-line antibiotics are sometimes ineffective for common infections, such as urinary tract infections and pneumonia, especially in medically complex children.”

Patel has also noted an increase in treatment-resistant Enterobacterales in otherwise healthy children who likely acquire these organisms in the community. Certain resistant strains have originated from antibiotic use in livestock and have been transmitted to humans via contaminated food, water, or environmental exposure, he said.

“As a result, we are often forced to use antibiotics [in humans] that are less effective, carry higher risks of side effects, or are more broad spectrum — further driving resistance over time.”

Another issue: overprescribing of antibiotics. Pediatricians can face pressure from concerned parents to prescribe an antibiotic when it is not indicated. Pediatricians can reassure families by recommending supportive care measures, such as fluids, rest, and fever or pain relievers, and by emphasizing their availability for follow-up if symptoms worsen or do not improve, Patel said.

As pediatricians educate parents on proper antibiotic use, Patel calls for broader, systemic support for infectious disease specialists.

“Investing in systems to track antibiotic use, set clear reduction targets, and fund efforts to meet those goals is critical,” he said. “Strengthening antimicrobial stewardship across both healthcare and agriculture is urgently needed.”

New Treatments May Be Developed

A new class of drugs to target drug-resistant Acinetobacter baumannii is moving to late-stage clinical trials, potentially offering infectious disease specialists another tool in the inpatient setting.

An investigational drug, zosurabalpin, made by Roche in collaboration with Harvard University, is hoped to address antimicrobial resistance while also advancing our understanding of bacterial membranes.

If successful in phase 3 studies, the drug has potential to be modified to target other gram-negative organisms, said Christopher A. Ohl, MD, professor, internal medicine, infectious diseases, at Wake Forest University School of Medicine in Winston‑Salem, North Carolina.

As development continues for the investigational drug, the CDC classifies A baumannii as one of the seven antimicrobial-resistant pathogens whose incidence rose by a combined 20% during the COVID-19 pandemic compared to 2019 levels (CDC). (Other culprits: carbapenem-resistant Enterobacterales, Candida auris, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, extended-spectrum beta-lactamase-producing Enterobacterales, and multidrug-resistant Pseudomonas aeruginosa).

Developing a new class of drugs — even if it takes years for prime time — is a significant piece of a complex puzzle for solving for antibiotic resistance. But the urgency is immediate, so what can be done now?

Call For More Rapid Diagnostic Tests

Interventions such as point-of-care testing can be equally vital in the fight against resistance. There is a need for rapid diagnostic tests to identify pathogens faster, say closer to 24 hours rather than the typical 72, Ohl said.

“If we have better and faster testing, it allows for earlier, more targeted antibiotic use, which can improve outcomes, shorten the duration of antibiotic therapy, and reduce hospital length of stay,” he added. “Still, there’s much work to be done to determine how best to use the diagnostic tools and antibiotics currently available.”

The next step is to equip frontline providers to manage antibiotic use directly, Ohl said. Advances in artificial intelligence offer new opportunities to support real-time decisions at the point of care — when and whether to prescribe antibiotics, and which one to choose, he said.

Ohl and Patel reported having no relevant financial relationships.