Antibiotic evidence too strong to resist

Until today I’d not realised there were members of the scientific community not convinced that antibiotics cause antimicrobial resistance, but apparently the many studies demonstrating an association haven’t been enough to persuade some the relationship is not coincidental.
The reason, put simply, is that the evidence so far has mainly come from population, or ecological, studies – far cruder instruments than randomised controlled trials of individuals when drawing cause and effect conclusions.
Nonetheless, I would have thought the jury had been in on this one for quite a while; I’ve never met a microbiologist who appears to harbour any doubt on the relationship between antibiotic prescribing and drug resistance.
Of course, tobacco companies maintained an unshakeable public denial of the causal links between smoking and lung cancer long after Richard Doll and colleagues provided robust epidemiological evidence – but this was “ignorance” of the convenient variety that kept companies in business.
Some politicians’ long-standing reluctance to link carbon emissions with climate change is perhaps another example of a conversion it was expedient to delay.
Still, I’ve no reason except perhaps a journalist’s skeptical bent to suspect there’s an agenda behind non-believers.
In any case, doubting Thomases on the antibiotic issue will have nothing to stand on now last week’s Lancet delivered the smoking gun in the form of an elegant piece of individual research.
The randomised, double-blind, placebo controlled trial of over 200 volunteers clearly shows that the macrolide antibiotics, azithromycin and clarithromycin, caused drug resistance in streptococci for up to six months.
Worryingly, clarithromycin conferred resistance not only to macrolides but also to tetracyclines and other antibiotics.
The key message, according to an accompanying editorial, is that “antibiotic prescribing affects the patient, their environment, and all the people that come into contact with that patient or with their environment…We have to do act before ‘the antibiotic era finally grinds to its apocalyptic halt”.
Lancet 2007;369:482-490