Talk:Antimicrobial resistance

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Over prescription of Antibiotics[edit]

It could be beneficial to discuss the over prescribing of antibiotics to patients and how it has led to an increase in antibiotic resistant infections.

Updates needed? Yes, near end of 2014[edit]

This is a big issue and will probably continue to be in the future for some time, so the page needs to be better, some consolidation, rewriting and updating. I've taken an interest in this and want to make some changes that I'll propose here before making. A better title might be "Antimicrobial resistance." By one definition, by the WHO, "antimicrobial" is a broader term covering all microbial organisms (viruses, fungi, parasites as well as bacteria), while antibiotic resistance refers to "resistance to antibiotics that occurs in common bacteria that cause infections." (see WHO fact sheet 194) The CDC waffles, using both.

I've written a new introductory paragraph as follows:

Antimicrobial resistance occurs when pathogenic microbes continue to grow after exposure to one or more antimicrobial agents due to genetic modifications that impart resistance. Microbes that exhibit resistance can include viruses, fungi and parasites, but antimicrobial resistance (also called antibiotic or drug resistance) is mostly a problem in the treatment of infections caused by bacterial pathogens. In a recent report, the World Health Organization states that antibiotic resistance is "a growing public health threat of broad concern... [that] threatens the achievements of modern medicine."[1] Bacteria that are resistant to multiple antibiotics are considered multidrug resistant (MDR) or, more colloquially, superbugs.[2] In September 2014, US president Obama issued an executive order forming a task force to tackle the threat and calling the issue one of national security.[3]


The existing intro paragraph doesn't much stress the importance of the issue I don't think.

Other issues:

- veterinary medicine is probably not the best subheading for this section. To me that would indicate that drug resistance is a problem in the treatment of animals with infections, which is not the issue here or course. It should be something like: Inappropriate use of antibiotics in animal husbandry IMHO

- maybe create a new subheading under Prevention, called Action. Include more about the executive order, the CDC threat report of 2013, this ( and then keep this updated (action plan to be submitted by 15 February 2015).

I'm making my way through, wordsmithing and looking for other possible changes/additions — Preceding unsigned comment added by Jtamad (talkcontribs) 04:13, 8 December 2014‎ UTC}

  1. ^ WHO. "Antimicrobial resistance: global report on surveillance 2014". World Heath Organization. Retrieved 8 December 2014. 
  2. ^ "Antibiotic Resistance Questions & Answers". Get Smart: Know When Antibiotics Work. Centers for Disease Control and Prevention, USA. 30 June 2009. Retrieved 20 March 2013. 
  3. ^ "Executive Order -- Combating Antibiotic-Resistant Bacteria". The White House. Retrieved 8 December 2014. 
please focus on improving the body of the article. per WP:LEAD, the lead paragraph should summarize what is in the body of the article. when you do that well, you don't need any sources in the lead, as everything in the lead is already in the body, and of course well sourced there per WP:VERIFY. Jytdog (talk) 05:17, 8 December 2014 (UTC)

Article title change?[edit]

There's an article title antimicrobial resistance that is pretty minimal. How about changing the title of this article to "antimicrobial resistance" (better I think) and combine the articles? juanTamad 10:58, 17 January 2015 (UTC) — Preceding unsigned comment added by Jtamad (talkcontribs)

I agree. The current title is misleading; antibiotics are not used to combat viral infections. We could rename the article as suggested and leave a redirect from Antibiotic resistance. Graham Beards (talk) 12:41, 17 January 2015 (UTC)
  • Support Doc James (talk · contribs · email) 23:58, 17 January 2015 (UTC)
  • Disagree strongly I totally disagree with the move, albeit 9 days late. the antibiotic article has had long existing problems that are not solved by a move. I worked on the antimicrobial resistance article a year ago, for reasons that can be discussed. It is a meta heading so to speak and needs to stay a separate article IMHO. Graham Beards's point has nothing to do with widening the title to antimicrobial resistance
Jtamad, Antibiotic resistance is what lay people know about, want to know about and and need to know about. Antifungal and antiviral, anti-protozoal resistance is for the expert. Doc James although head huncho at WP: Medicine, is clearly not a content expert on this as an ER doc. CAVEAT: This is no personal attack, but merely the facts, like the bold font sticking out. (BTW: if you guys want to rename something partout, why not rename antibiotic sensitivity to antibiotic susceptibility which is the proper term. Skin is sensitive, neither bacteria not antibiotics.) --Wuerzele (talk) 05:18, 27 January 2015 (UTC)
Antimicrobial resistance is a broader term. One does not need to be an expert to figure this out.
This is an editorial discussion rather than a content one. Do we want more articles that are narrower in scope or fewer articles that are broader in scope. I am in the later camp.
Doc James (talk · contribs · email) 15:33, 27 January 2015 (UTC)
  • Re: "Antimicrobial resistance is a broader term. One does not need to be an expert to figure this out" A broader term, exactly , but it appears you didnt follow that this means more content. why would you want to pack in more content into this page? Does one need to be a content expert to figure this out?
  • So, one more time, in more words: Antimicrobial resistance is a meta heading and NOT in common use by the lay audience. But antibiotic resistance is, and is WAY enough to write about in one article, as it was. You cannot cram all of antimicrobial resistance in one article on an encyclopedic level. I suggest a separate article, which was the status quo.
  • Re "This is an editorial discussion rather than a content one." First, I dont see you discuss anything and why are you differentiating editorial from content?? Merging teh 2 articles (editorial decision) enormously influences the content.
  • Re: "Do we want more articles that are narrower in scope or fewer articles that are broader in scope." ?? Counterquestion: Why distract from the issue on the table by generalizing the issue ad ultimo? Rhethoric? This is a talk page on one not very easy, but damn important topic, antibiotic resistance. why are you even posing this loaded question? for me to getsecond thoughts? I clearly answered your question for this, antibiotic resistance, and said Do NOT throw in antiviral and antifungal etc. so there was no need to ask. First, there is no wild abundance of WP articles in the area of clinical microbiology and infectious diseases anyway, -correct me if I am wrong, with stats- to justify a merger of this kind. Second by comparison, consider all the kinds of overlapping pages, eg for Meningococcus and its diseases 3 or even 4, and you make a fuss about this one mega topic of antimicrobial resistance, that permeates all fields of medicine incl. veterinary medicine, soil biology and what not.
  • You merely allow antibiotic resistance to be a redirect, but not to have its own page? You don't need to be a content expert to realize that that is undue.
  • Procedural comment: It is unheard of on WP, that only two editors establish a consensus, when numerous other editors work on a page. after waiting only like, what? one day, and on a decision of such a huge topic. Have a good one. --Wuerzele (talk) 08:04, 29 January 2015 (UTC)
Moved Jan 26th [1] after more than one week. Doc James (talk · contribs · email) 13:53, 29 January 2015 (UTC)
Doc James striking out the minor error I made, after having written IN THE BEGINNING if you look up: 9 days. It appears you use that error as a distraction and excuse to not engage in a discussion. And again, if its not too much for you , please have the courtesy to ping me if you communicate. --Wuerzele (talk) 08:13, 31 January 2015 (UTC)
It is totally obvious that you dodge discussions, but that is no remedy.--Wuerzele (talk) 05:27, 7 March 2015 (UTC)

image and caption[edit]

as of this version, image and caption were as in the top image.

Antibiotic resistance tests: The bacteria in the culture on the left are susceptible to the antibiotics contained in the white paper discs. The bacteria in the culture on the right are resistant to most of the antibiotics.

Was changed, per the bottom version.

Antibiotic resistance tests: The bacteria in the culture on the left are susceptible (dark, clear rings) to the antibiotics contained in the white paper discs. Those on the right are fully susceptible to only three of the seven antibiotics tested.

There is no source for this caption. Both versions of the captions are wrong. The dark rings are growth which means resistance. No ring = no growth = susceptible. Both of those are relative, not absolute. See the caption here. I would be happy to see the image restored with a correct and sourced caption. To explain, the dish is covered with the antibiotic. The white disks have different strains of bacteria on them. If the bacteria are resistant to the drug, they live and divide and expand, creating the dark circle. The amount of expansion is important - if the drug slows down growth, that is useful to know. If the bacteria are either killed or are prevented from dividing (in other words, the drug is a bacteriostatic agent), nothing happens, there is no growth, and no dark ring appears, and this shows that the bacteria are susceptible to the drug. OK with everybody? Jytdog (talk) 13:54, 26 January 2015 (UTC)

This is my image from cultures I made. The dark rings are not growth; they are areas where no colonies of bacteria can be seen, that is no growth. The dishes are not covered in antibiotic. The antibiotics are in the white discs. There is a different antibiotic in each one. The discs do not have strains of bacteria on them. The whole of the plates where covered with one strain of bacteria; a resistant strain and a sensitive strain. This is an example of a standard antibiotic sensitivity screen. I don't know where you have got the idea that the dark rings are growth and that each disc contains bacteria. Graham Beards (talk) 15:59, 26 January 2015 (UTC)
I restored the image with its caption and added a reference. Here is a relevant quote from the reference "The pathogenic organism is grown on Mueller-Hinton agar in the presence of various antimicrobial impregnated filter paper disks.  The presence or absence of growth around the disks is an indirect measure of the ability of that compound to inhibit that organism."--agr (talk) 16:13, 26 January 2015 (UTC)
Thanks, i was wrong! We had an edit conflict where we were each adding a source. I added content to the caption to better clarify the experiment. Sorry for my mistake. Duh and a big self-trout for me. Jytdog (talk) 16:15, 26 January 2015 (UTC)
just want to apologize again for this. amazing example for me of how one can find a source and cite it and fail to read it clearly. oy. sorry again. Jytdog (talk) 17:09, 26 January 2015 (UTC)
Thanks for the apology. But I don't think your caption edit is quite right. As i understand the procedure (Graham can correct me), the agar in the dish is streaked with a solution that contains the bacteria to be tested. At that point they are invisible. The antibiotic disks are then placed on the agar and the dish is incubated for a day or two. The bacteria grow out producing the "lawn" of bacteria you see in the image, except where antibiotic has defused from the disks in high enough concentration. It is not that the disk are added to grown bacteria and then kill them. The clear areas are where bacteria never grew.--agr (talk) 17:16, 26 January 2015 (UTC)
That's correct. This technique does not differentiate bactericidal and bacteriostatic antibiotics, i.e. those that kill and those that just inhibit reproduction. The potency of antibiotics is expressed as the minimum inhibitory concentration – it's all about the lack of bacterial growth, not killing them. "The clear rings where bacteria have died" is not correct, the bacteria have not grown in these zones. Graham Beards (talk) 18:43, 26 January 2015 (UTC)
thanks for the correction. fixed it.

missing talk page after page move[edit]

Doc James please move talk from antibiotic resistance here. I did not agree with the page move and am awaiting your reply.--Wuerzele (talk) 07:15, 28 January 2015 (UTC)

Wuerzele Agree - please, let's have missing Talk page restored. I will go to WP:chat for advice on how to do this. Regards, IiKkEe (talk) 12:29, 28 January 2015 (UTC)
Moving and merging. Please note I was not the one who did the original move. Doc James (talk · contribs · email) 18:25, 28 January 2015 (UTC)

false information in lede[edit]

"In medical therapy AMR is most problematic, but viruses, fungi and parasites can also occasionally become resistant."

This is an embarrassingly false sentence on 2 levels.

  • First, AMR ≠ antibiotic resistance

AMR =antibiotic resistance + antiviral drug resistance + antifungal drug resistance + antiprotozoal drug resistance

So, the sentence should be "In medical therapy antibiotic resistance is most problematic, but viruses, fungi and parasites can also occasionally become resistant."

  • Second, "In medical therapy antibiotic resistance is most problematic"? according to whom? An HIV doc doesnt say that The person with MDR Malaria or a MDRfungal infection doesnt. Imagine a soil biologist reading this, must think these medical folks cant look beyond their plate. So: "Most problematic" is in the eye of the beholder, unless qualified "for the healthcare system, for public health etc. I think what you want to say is "most common", not most problematic.
  • Third, whats occasionally? defined by whom and how ? For me influenza doesnt occasionally become drug resistant, it is regularly amantadine resistant, and Tamiflu resistance is common depending on the strain. The sentence may be correct for Herpes simplex virus, but in an immunosuppressed patient not so. therefore, this is weasely, vague and not very thoughtful( it honestly sounds like a student wrote this) and not encyclopedic. This is way too sloppy for a lede sentence.

I also think, that AMR shouldnt be equated with drug resistance, as in the first sentence, since there is a separate WP page on. Cancer cells certainly become drug resistant to cancer drugs, but that's not AMR.--Wuerzele (talk) 09:29, 29 January 2015 (UTC)

Causes section a mess[edit]

Just starting to read article - Causes section is a mess. Here's how I might organize it:

Causes: Widespread use. Causes of Widespread use:

 low cost of generics, 
 uncontrolled access  
 (does globally widely available have to be mentioned as well? is it separate from the previous two?),  
 perception that antibiotics are a harmless panacea
 ubiquitous use in the meat industry to increase yields
 ? convenience of dosing (development of potent, qd po drugs)

Broadspectrum antibiotics

Lower and less frequent dosing - this area requires some research as to the dosing patterns that are more likely to create antibiotic resistance. See doi: 10.1097/CCM.0b013e318180fe62, doi: 10.1128/AAC.01053-05, doi: 10.1093/jac/dkm511, doi: 10.1128/AAC.01486-06, DOI: 10.1007/978-1-4614-1400-1_14

dissemination of resistance - ? in-patient-community links, agriculture-community links, high-risk patients. again, this area requires some research (see DOI: 10.1111/j.1469-0691.2008.02081.x) — Preceding unsigned comment added by Levydav (talkcontribs) 13:24, 8 February 2015 (UTC)


User replaced "Antibacterials in soaps and other products may contribute to antibiotic resistance" will "Antibacterials in soaps and other products do not contribute to antibiotic resistance, but are discouraged for other reasons" [2]

Ref says "A link between antibacterial chemicals used in personal cleaning products and bacterial resistance has been shown in vitro studies (in a controlled environment)." Thoughts? Doc James (talk · contribs · email) 05:36, 7 March 2015 (UTC)

I replaced the incorrect (above) sentence with the status quo which is correct. YOu, inserted a maybe which is uncited or original research. Read the reference again. --Wuerzele (talk) 05:50, 7 March 2015 (UTC)


In this edit [3] this material was restored to the lead

"Resistance may take the form of a spontaneous or induced genetic mutation, or the acquisition of resistance genes from other bacterial species by horizontal gene transfer via conjugation, transduction, or transformation. Many antibiotic resistance genes reside on transmissible plasmids, facilitating their transfer. Antibiotic-resistance plasmids frequently contain genes conferring resistance to several different antibiotics."

For one it was covered in the second sentence. Two it is overly complicated for the lead. Doc James (talk · contribs · email) 05:39, 7 March 2015 (UTC)

(edit conflict)why picking and choosing? you made much more massive changes than just that, which I reverted per WP:BRD, you ll have to discuss way more than the above- or make each edit separately.--Wuerzele (talk) 05:57, 7 March 2015 (UTC)

new topic: lede in general[edit]

Without getting too involved in the specifics of the reverts I need to mention I did some work on this article in November, and one of the major things I worked on was simplifying the lede. This is very important because this article is an excellent candidate for translation of the lede through the Medical Translation Project.
This means we need something that can be read by as many as possible, as it will be translated into 108+ different languages, many spoken where schooling is very limited. Discussing the ways in which resistance can occur is overly complicated for the lede and even so that paragraph is complicated even for a native English reader. That isn't as much of a problem down in the article, but remember the lede is supposed to be written for high-school reading level or below WP:LEDE. We have to remember the goal of the article – to inform people (not only college educated people) about antibiotic resistance. -- CFCF 🍌 (email) 10:55, 7 March 2015 (UTC)
  • I came here because of a notice at WikiProject Medicine. The information seems a bit technical for the lead as compared to the kind of language which I think is common. Almost every term here is a jargon term. This may be warranted or may not be. If the article focuses on health, then typically less jargon is used, but if it is science focused, then more is acceptable. If this content is to be included then the proposer should talk through why it is important to include. It might be, but an argument should be made. Blue Rasberry (talk) 15:39, 10 March 2015 (UTC)
  • the lede is absolutely horrible. it's the only thing we IiKkEe and I havent touched in our day long work over. I will take a stab at it doing it gradually and not 40 changes in one. I want to remind everybody that this article is a mongrel of a recent move that docJames refuses to discuss ( see above). I think it should be moved back to antibiotic resistance for reasons outlined above. please supply link of notice in wikiproject medicine on this talkpage for transparency.--06:23, 11 March 2015 (UTC)

Length of therapy[edit]

I modified the paragraph about length of therapy under human medicine because to me it seemed to conflate discussion of best length of therapy based on studies of effectiveness vs a patient deciding to shorten a prescribed length of therapy on the belief that it might increase probability of resistance developing. I see the editorial in BMJ that recommends ignoring advice about taking complete course of recommended therapy, stopping 72 hours after symptoms subside, but is this generally accepted? If not, seems there should be a statement that generally accepted recommendation is to continue the prescribed course of therapy (based on guidelines from Stuart Levy and others. juanTamad 05:51, 7 March 2015 (UTC) — Preceding unsigned comment added by Jtamad (talkcontribs)

Yes there are two different sources of evidence. 1) what guidelines / policy statements recommend 2) what review articles conclude. We should contain both ideally. Doc James (talk · contribs · email) 06:14, 7 March 2015 (UTC)
Current status on the topic seems to be: Need more RCTs before conservative official recommendations can change. juanTamad 06:53, 7 March 2015 (UTC)
A powerpoint presentation is not a very good source though. But yes they can. Doc James (talk · contribs · email) 06:55, 7 March 2015 (UTC)
Right, will look for better. Someone else added that not me. The current version is good IMHO. juanTamad 07:01, 7 March 2015 (UTC)

Off topic[edit]

This content is sort of off topic and thus I propose deleting it " - the term now preferred to hospital-acquired infections or nosocomial infections {from New Latin nosocomium ("hospital"), from Ancient Greek νοσοκομείον (nosokomeíon, "hospital"), from νόσος (nósos, "disease, illness") + κομέω (koméō, "to take care of")}." Doc James (talk · contribs · email) 06:18, 7 March 2015 (UTC)

if it's just the part you indicate above, I agree.--Wuerzele (talk) 06:22, 7 March 2015 (UTC)

Trouble archiving links on the article[edit]

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Following a "doctor's advice" though recommended by WHO may not decrease resistance to antibiotics as we already state doctors often make bad recommendations when it comes to antibiotics. If we look at the Antimicrobial_resistance#Human_medicine a number of sources state that we should be using shorter courses of antibiotics for bacterial infections much of the time. We need to balance this. Doc James (talk · contribs · email) 22:11, 22 July 2015 (UTC)

what do you want? this looks like self talk.
and who is we? you and other docs ( me not included )?
you want to balance what with what? using shorter courses in general ?
that is an ignorant and unsourced statement.--Wuerzele (talk) 03:00, 24 July 2015 (UTC)
We as in Wikipedia needs to balance the evidence and positions of both parties in the debate. The position is neither ignorant or unsourced, but I agree it is a difficult question and my suggestion is to increasingly mention the benefit of using evidence based course lengths. -- CFCF 🍌 (email) 18:00, 24 July 2015 (UTC)

Poor compliance IS an important problem, the article sounds misleading in this aspect[edit]

"Increasing bacterial resistance is linked with the volume of antibiotic prescribed, not the lack of compliance with taking antibiotics." suggests very directly that poor compliance is a minor concern.

"Antibiotic resistance increases with duration of treatment; therefore, as long as an effective minimum is kept, shorter courses of antibiotics are likely to decrease rates of resistance, reduce cost, and have better outcomes due to fewer complications." It continues to correctly state the 72 hour idea, but the initial line suggests it to be of minor importance.

"In some situations a short course is inferior to a long course." This is extremely misleading. The cited paper refers to the effectiveness of treatment, but does not claim that antibiotic resistance growth is more limited (than long courses).

There are a few antibiotics with special properties (e.g. unusual half-time), which require different treatment, though these are rare.

I will edit the article accordingly. If you disagree, please let me know. --mafutrct (talk) 10:38, 14 August 2015 (UTC)

In this edit] you took paraphrased content and replaced it with copied and pasted content.
You added "In selected cases, it may be appropriate to stop antibiotic therapy early. However, if a person takes an inadequate course of antibiotics, they may relapse and require further treatment. This increases the risk of developing resistance, as it would expose the person to antibiotics for longer."
The source says "Therefore, in selected cases, it may be appropriate to stop antibiotic therapy early. However, if a person takes an inadequate course of antibiotics, they may relapse and require further treatment.12 This increases the risk of developing resistance, as it would expose the person to antibiotics for longer."
This is not allowed. We must paraphrase none open source content. Doc James (talk · contribs · email) 12:58, 14 August 2015 (UTC)
Agree with the issue wrt poor complience. It appears that only one type of poor compliance (using less meds than recommended rather than stopping early) generally causes problems. Exception of course exist such as TB. And have adjusted the text further.Doc James (talk · contribs · email) 13:00, 14 August 2015 (UTC)

Opening sentence seems awkward[edit]

Currently the opening sentence of the article reads, "Antimicrobial resistance (AMR) is when microbes are less treatable with one or more drugs used to treat infection." This strikes me as an bizarre and awkward first sentence, possibly stemming from being taught throughout my life to avoid ever writing, "<noun> is when...". It also misses the fact that the use of antimicrobials can be preventive rather than curative. I would propose changing the first sentence to, "Antimicrobial resistance is the resistance of a microbe to one or more drugs used to treat or prevent infection." Or something more along those lines. Someguy1221 (talk) 00:01, 24 August 2015 (UTC)

One however does not want to use a word in the definition that is part of the term you are trying to describe. Have adjusted per your other suggestions. Doc James (talk · contribs · email) 01:35, 24 August 2015 (UTC)

External links modified[edit]

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Animal use: Claims regarding FDA announcements need editing[edit]

The article states “On April 11, 2012 the FDA announced a voluntary program to phase out unsupervised use of drugs as feed additives and convert approved over-the-counter uses for antibiotics to prescription use only, requiring veterinarian supervision of their use and a prescription. In December 2013, the FDA announced the commencement of these steps to phase out the use of antibiotics for the purposes of promoting livestock growth. “ These claims need editing to avoid misleading readers.

The FDA announcement of April 11, 2012, a news release, refers to Guidance for Industry #209 (which was published on April 13, 2012), indicating conversion from OTC to VFD status for drugs administered through feed, and from OTC to prescription status for drugs administered through water. In fact, the scope of Guidance for Industry #209 is more narrow, explicitly focused on medically important antimicrobials. The draft Veterinary Feed Directive document published on April 13, 2012 identifies requirements for VFD status. The third FDA document in the Federal Register of April 13, 2012 uses the term “prescription” only in reference to “prescription or veterinary feed directive products”, and does so only in the context of medically important antimicrobials.

The FDA list of medically important antimicrobials does not include such ionophores as lasalocid and monensin, which are both coccidiostatic and antibiotic. These are active ingredients in some products labeled for use in growth promotion. Also, there is no suggestion in Guidance for Industry #209 that conversion from OTC to prescription use only would apply to all uses of medically important antimicrobials, and the document recognizes that the nature of veterinary involvement in some uses must depend on circumstances. In this connection, see Part VII of the document.Schafhirt (talk) 20:20, 2 September 2015 (UTC)