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IFH Newsheet Sept 2018 Do antibacterials contribute to antibiotic resistance

 

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The IFH survey of media coverage on this issue is now online here

New IFH review: Do antibacterial products contribute to antibiotic resistance? – a survey of UK and US media coverage 1997 to 2017

This review covers 3 decades of media coverage about a possible relationship between exposure of domestic microbes to disinfectants/antibacterials used for hygiene, and development of antibiotic resistance. In all, 23 media articles published between 1997 and 2017 were analyzed together with consumer feedback.  The review illustrates the considerable amount of inaccurate or misleading reporting of this issue and suggests it is a cause of public misunderstanding and mistrust about hygiene. It also shows how inconsistent understanding of the term “antibacterial” has contributed to the confusion.  

Many early articles were prompted by the “explosion” in marketing of antibacterial products during the 1990s, including soaps, cleaners, dishwash liquids, and products impregnated with antibacterial agents such as chopping boards, cloths, etc.  This coincided with publications showing that exposing bacterial populations to residue-forming phenolic disinfectant triclosan produced reduced susceptibility to antibiotics.  In 14/23 of the articles, journalists were careful to use conditional terms such as “helps, may contribute, could lead to, but 4 articles implied that a link to antibiotic resistance in clinical practice was proven.    Quotes, reviewed in this report reflect the extent to which the experts and the public oppose use of these products because of concerns about resistance.

Opposition to microbiocidal products reflects lack of understanding of what is meant by resistance. In reality “antibiotic resistance” demonstrated in the lab studies is “reduced susceptibility” not “clinical resistance”. Although links have been shown iny lab studies, after nearly 20 years of investigation, there is still no valid evidence that home use is contributes to emergence of antibiotic resistant strains.    

Confusion is also due to lack of clarity about the term antibacterial.  Some experts, expressing concern about “links between antibacterial use and antibiotic resistance” are talking only about residue-forming microbiocides such as triclosan, whilst others assume that the term applies to any disinfectant.  Since 15/23 articles were based on research using triclosan, this further tends to imply that all household disinfectants have the potential to induce antibiotic resistance.

This however creates problems, because opposition to “antibacterials” is preventing objective assessment of evidence showing that, in risk situations, wiping or detergent-based cleaning is not enough, and that a disinfectant or hand santizer is required to break the chain of infection. For alcohol handrubs, data confirms that they are as effective as handwashing. Since alcohol and oxidizing biocides used in many surface disinfectants have a non-specific microbiocidal action and leave no active residue, they are unlikely to encourage resistance development.  There is little to suggest that risks outweigh health benefits – when disinfectants are used as part of targeted hygiene as necessary to break the chain of infection. A number of expert reports have been commissioned on this issue in the last 10 years. These stress the hygiene importance of microbiocides, but also the need to use them prudently, only in situations where there is identifiable risk of spread of harmful microbes. This view was also supported by experts in 9 of the 23 of the media articles

Opposition to microbiocides reflects a lack of understanding of how they work.  Antibiotics must be administered at low concentrations to avoid side effects, but declining drug levels between doses creates conditions favourable for emergence of resistance. By contrast disinfectants can be safely used at much higher concentrations, which rapidly kill microbes before they can enter the body thus obviating the need for antibiotic prescribing.  It is rarely considered that disinfectants or hand sanitizers, used as part of a targeted hygiene approach (right place, right time, right product) could combat antibiotic resistance by reducing the need for antibiotic prescribing. This is illustrated by the results of a new study, detailed below, which showed that using disinfectants on high frequency touch surfaces could reduce spread of infections and drug resistant bacteria in hospital settings

Taken together, these examples demonstrate the importance of evaluating hygiene practices  involving disinfectants/antibacterials on a case by case basis according to the type of microbiocidal agent involved, where it is to be used and what alternative approaches tere are which will reduces contamination to a safe level in that situation.  This issue is discussed in a review by Bloomfield, Carling and Exner at http://www.egms.de/en/journals/dgkh/2017-12/dgkh000293.shtml.

The media review can be found at https://www.ifh-homehygiene.org/review/could-use-antibacterial-products-...

 

Published: 03/09/2018

Publication Type: Newsletter