Antibiotic Resistance: How to Properly Take Antibiotics and Maintain Their Effectiveness

Antibiotics are powerful medications that have saved millions of lives by fighting bacterial infections. However, their effectiveness is under threat due to the growing problem of antibiotic resistance. This is a phenomenon where bacteria develop the ability to withstand the action of antibiotics, making the treatment of infections increasingly difficult and even impossible. Understanding how to properly use antibiotics is key to slowing down this process and preserving their effectiveness for future generations.

What is antibiotic resistance and why does it matter?

Antibiotic resistance occurs when bacteria mutate or acquire genes that allow them to survive in the presence of antibiotics. This is a natural evolutionary process, but it is significantly accelerated by the improper and excessive use of antibiotics. When antibiotics are used inappropriately, they destroy sensitive bacteria, leaving resistant strains to multiply. As a result, infections that were once easily treatable become difficult to cure, leading to increased mortality and morbidity [2, 3].

The problem is particularly acute in hospital settings, where multi-drug resistant organisms (MDROs) are prevalent [1, 8]. For example, the mortality rate from Staphylococcus aureus bacteremia (SAB) remains unacceptably high, especially involving methicillin-resistant strains [2]. In intensive care units, there is a steady increase in antibiotic-resistant infections, while the number of new antibiotics entering the market continues to decline [3].

Principles of rational antibiotic use

Rational antibiotic use (antibiotic stewardship) is a comprehensive approach aimed at optimizing antibiotic use to minimize resistance and maximize their effectiveness [1]. The core principles include:

• Avoid excessive prescription: Physicians should avoid excessive coverage and treatment of colonizing organisms, such as in respiratory secretions or urinary catheters, which do not cause an active infection [1].
• Consider local resistance data: When choosing empirical therapy (initial treatment before test results are available), it is necessary to take into account the prevalence of multi-drug resistant organisms in a specific medical institution or region [1, 4, 5].
• Choose antibiotics with a low resistance potential: Whenever possible, preference should be given to antibiotics that are less likely to promote the development of resistance [1].
• Optimal dosing and duration: The antibiotic should be prescribed at the highest possible dose that does not cause toxicity, and for the shortest duration necessary to eliminate the infection [1, 3]. This achieves an optimal drug concentration at the infection site and minimizes exposure time for non-target bacteria [3].

Initial (empirical) therapy and de-escalation

In cases of severe infections such as sepsis or septic shock, it is critical to initiate adequate antibiotic therapy as early as possible [3, 8]. Initial therapy is often empirical, meaning it is prescribed before the causative pathogen and its antibiotic susceptibility are precisely identified. In such situations, broad-spectrum antibiotics are used [3, 8].

Key aspects of empirical therapy:

• Timeliness: Antibiotics must be administered promptly [3].
• Adequate dose: At the start of treatment, a high dose tailored to the patient's pharmacokinetic characteristics is often recommended, especially in severe sepsis, where physiological changes can affect drug behavior [3, 8].
• De-escalation: Once the pathogen is identified and its antibiotic susceptibility is determined (via culture and antibiogram), therapy should be de-escalated. This means switching from a broad-spectrum to a more targeted antibiotic that effectively acts against the specific pathogen [3, 8]. This reduces selection pressure on bacteria and minimizes the development of resistance.
• History review: When choosing antibiotics, the patient's previous antibiotic therapy and history of multi-drug resistant organisms should be taken into account [8].

Specifics of treating complex infections

Certain infections present particular challenges due to high pathogen resistance:

• Staphylococcus aureus bacteremia (SAB): Treatment of SAB remains a major clinical challenge, particularly with methicillin-resistant strains. Mortality remains high. New agents with antistaphylococcal activity are available, and their role as alternatives to standard treatments is actively being investigated. Managing such patients requires a multidisciplinary approach [2].
• Helicobacter pylori infection: Growing antibiotic resistance reduces the effectiveness of empirical H. pylori eradication regimens, especially those containing clarithromycin [4, 5, 6]. Studies show significant rates of resistance to clarithromycin, metronidazole, and levofloxacin, whereas resistance to amoxicillin and tetracycline is less common [6]. Local epidemiological surveillance of resistance and identification of clinical predictors of resistance are critical for selecting the optimal treatment strategy [4, 5].
• Sepsis in neonates and children: WHO guidelines for the treatment of sepsis in low- and middle-income countries require ongoing review. Amid growing antimicrobial resistance, recommendations for empirical therapy must be updated, taking into account local susceptibility data, cost, and the risk of side effects [7].
• Bloodstream infections in ICUs: Bloodstream infections (BSIs) are common in intensive care units and are a prognostic factor for severe sepsis. It is important to distinguish between community-acquired BSIs (usually caused by sensitive bacteria) and healthcare-associated BSIs (often caused by resistant hospital strains). When MDROs are suspected, combination antibiotic therapy may be mandatory to broaden the spectrum of action, but it should be continued for no more than 2-5 days before switching to monotherapy [8].

The patient's role in combating resistance

Every patient plays a vital role in preserving the effectiveness of antibiotics:

• Take antibiotics only as prescribed by a doctor: Never start taking antibiotics on your own and do not use leftover medications from previous courses or antibiotics meant for other people.
• Strictly follow doctor's instructions: Take the medication at the prescribed dose, frequency, and for the entire prescribed course, even if you feel better. Premature discontinuation of treatment can lead to the survival of the most resistant bacteria and a relapse of the infection.
• Do not demand antibiotics for viral infections: Antibiotics do not work against viruses (e.g., colds, flu). Taking them in such cases is not only useless, but also contributes to the development of resistance.
• Do not share antibiotics: Each treatment course is individual.
• Prevent infections: Practice hand hygiene, get vaccinated, and avoid contact with sick people. The fewer infections there are, the lower the need for antibiotics.

Combating antibiotic resistance is a shared responsibility. The proper use of antibiotics today determines their effectiveness tomorrow.

Sources

• [1] Antibiotic Stewardship: Strategies to Minimize Antibiotic Resistance While Maximizing Antibiotic Effectiveness. (Medical Clinics of North America, 2018) https://pubmed.ncbi.nlm.nih.gov/30126574/
• [2] Pharmacotherapeutic options for treating Staphylococcus aureus bacteremia. (Expert Opinion on Pharmacotherapy, 2017) https://pubmed.ncbi.nlm.nih.gov/29115883/
• [3] Bench-to-bedside review: Appropriate antibiotic therapy in severe sepsis and septic shock--does the dose matter? (Critical Care (London, England), 2009) https://pubmed.ncbi.nlm.nih.gov/19519961/
• [4] Antimicrobial Resistance Patterns and Predictors in Helicobacter pylori Infection: A Real-World Cohort Study. (Microorganisms, 2026) https://pubmed.ncbi.nlm.nih.gov/42197514/
• [5] Antimicrobial Resistance Patterns and Determinants of Helicobacter pylori Culture Success: A Prospective Study. (Antibiotics (Basel, Switzerland), 2025) https://pubmed.ncbi.nlm.nih.gov/41463759/
• [6] Antibiotic Resistance of Helicobacter pylori in Patients with Peptic Ulcer. (Medicina (Kaunas, Lithuania), 2022) https://pubmed.ncbi.nlm.nih.gov/36676631/
• [7] Reviewing the WHO guidelines for antibiotic use for sepsis in neonates and children. (Journal of Tropical Pediatrics, 2018) https://pubmed.ncbi.nlm.nih.gov/29790842/
• [8] Treatment of bloodstream infections in ICUs. (BMC Infectious Diseases, 2014) https://pubmed.ncbi.nlm.nih.gov/25431091/

The information provided in the article is for reference purposes only and does not replace the consultation of a qualified medical specialist. Always consult a doctor for the diagnosis and treatment of diseases.