Jessie Kopp's article review

Leibovici, L., Soares-Weiser, K., Paul, M., Goldberg, E., Herxheimer, A., Garner, P. (2003). Considering resistance in systematic reviews of antibiotic treatment. Journal of Antimicrobial Chemotherapy, 52, 564-571.

Leibovici, Soares-Weiser, Paul, Goldberg, Herxheimer, and Garner conducted a study to analyze systemic reviews of antibiotic treatment with regards to antibiotic resistance. Particularly, the authors were interested in determining if current research on antibiotics examined the effects of antibiotic resistance in their articles. Additionally, if antibiotic resistance was not discuss, Leibovici et al. looked to see if the original data had measures on resistance that could have been used. In order to conduct their analysis, a massive search for antibiotic publications was performed. The authors had specific inclusion criteria for publications to determine if it would be included in the review. These criteria included studies published between 1996 and 2000 which examined “systemic administration of antimicrobial drugs, comparing drug to placebo or non-antibiotic drugs or other procedures, drug to drug, or different duration of treatment.”(p. 565) After their literature search was concluded, the authors had a number of questions that were answered about each article. Specifically, they looked at whether the review considered the issue of antibiotic resistance when determining what antibiotics should be used in treatment. Moreover, they examined the types of data that were collected including subgroup analyses between resistant and susceptible microbes, superimposed infection, and colonization of resistant microorganisms. Lastly, they looked at how collected data were explained. Of 111 articles reviewed, 44 articles included resistance in their discussion. This is just less than 40% of all the publications reviewed. It is important to note that the authors did rank the articles in accordance to their relevance to antibiotic resistance. The articles that had higher relevance to antibiotic resistance did discuss the topic at a greater rate around 46%. A second consideration of this study was to determine how many articles had collected data on antibiotic resistance. A second review was conducted that produced 279 usable articles. Of these articles, only 35% contained data on resistant microorganisms to the drug that was being studied. Leibovici et al. concluded that these data have implication both at the community level and the clinical level. At the community level, they suggested that these reviews will be utilized by doctors when they are determining the best course of therapy for their patients.

The current study was conducted to point out the lack of consideration given to antibiotic resistance in systematic antibiotic studies. The authors conducted an extensive review and determined that as great as 60% of studies failed to discuss antibiotic resistance. This number seems alarming considering the rate of occurrence of antibiotic resistance today. I find this relevant to our website because it provides an idea about the current state of antibiotic research with a specific emphasis on how today’s research is dealing with antibiotic resistance.

This study serves as a review of a vast field of research on antibiotics. It takes into account the use of antibiotics to fight numerous illnesses including but not limited to urinary tract infections, respiratory tract infections, Helicobacter pylori-related conditions, peri-surgical and post-trauma infections, infections related to cystic fibrosis, etc. In considering an array of bacterial infections, this review has the scope of including many different types of bacteria that are able to acquire resistance. While this field of research seems to encompass a huge field of knowledge, majority of the time it fails to answer the question about which therapy is best to fight these infections when it fails to review antibiotic resistance. The authors of this paper point out that overall; this research is presenting “skewed” perspectives on antibiotics. Most of this research only considers short effects of the antibiotics instead of long lasting effects not only on the individuals in the study, but on the community as a whole. This is extremely troublesome. In the past we have placed our blind faith in antibiotics to ‘cure all.’ Unfortunately, this led to the overuse and misuse of antibiotics; which in turn led into increased antibiotic resistance. I think the authors published this study to address a serious problem in antibiotic research. They are calling for a reform to this field of research to include the examination of long term effects of all aspects with antibiotic therapy for all drugs, specifically antibiotic resistance.

Lastly, the authors make a case for what systematic reviews can do for antibiotic treatment. Systematic reviews can be used to determine if a treatment has advantages over other treatments when considering antibiotic resistance. Moreover, by conducting these types of reviews, we can determine if treatments have an effect on the occurrence of antibiotic resistance. As the authors pointed out, many of these studies are used by health practitioners when considering treatment options. By including the effects drugs can have on antibiotic resistant microbes or vice versa, physicians can make more informed decisions when treating patients. This may be of utmost importance in situations such as in the ICU where the correct treatment may mean the difference between life and death. To address the second outcome, it is critical to always be evaluating whether bacteria are acquiring antibiotics due to the chosen course of treatment. By examining the effect treatment has on the induction of resistant bacteria, we may be able to determine the correct course/amount of therapy to use in order to minimize the rate of antibiotic resistance.

In conclusion, I chose this article to include in my project because I feel that it is pertinent to our website. My project will review antibiotic resistance including suggested changes to practices in today’s research. I feel this article exemplifies the need for a change in antibiotic research by outlining the lack of inclusion of antibiotic research. Considering that antibiotic resistant bacteria are causing so much chaos in today’s world, it is a wonder how the research has ignored it. I understand that it is difficult to research since it may take a fair amount of time for resistance to appear. However, like Leibovici et al., I strongly believe that it must be considered in all antibiotic research no matter how difficult it is to study.