Preventive antibiotic prescribing can be lifesaving in certain clinical situations, but its growing overuse may quietly worsen the global crisis of antibiotic resistance. This is the conclusion of a study published in the journal Clinical Microbiology and Infection.
Researchers from the Second Faculty of Medicine, Charles University note that the practice of prescribing antibiotics “just in case” is increasingly extending beyond evidence-based use. While antibiotics remain one of the most important tools in modern medicine, their widespread preventive use creates continuous selective pressure on the human microbiome and accelerates the emergence of antibiotic-resistant bacterial strains.
According to Dr. Marek Štefan, the situation creates a paradox: in an effort to prevent a small number of infections, hundreds of healthy individuals receive antibiotics, ultimately reducing the effectiveness of these drugs over the long term.
The authors identify several clinical scenarios in which the problem is particularly evident. These include empirical antibiotic treatment for viral pneumonia, post-exposure doxycycline prophylaxis to prevent bacterial infections, the use of vancomycin to reduce the risk of Clostridioides difficile infection, and preventive treatment of close contacts of patients with invasive streptococcal disease.
Special attention is given to cases involving invasive Group A streptococcal infections. According to epidemiological data from the Netherlands, approximately 580 healthy individuals would need to receive preventive treatment to avert a single secondary case. In many instances, the antibiotics used belong to the World Health Organization’s “Watch” category—medications that require careful monitoring because of their higher potential to drive resistance.
The researchers emphasize that the traditional clinical approach of “better safe than sorry” can no longer be considered a risk-free strategy in an era of rising bacterial resistance. In their view, modern medical caution should be reflected not in excessive prescribing but in stricter limitations on antibiotic use.
They recommend applying more rigorous prescribing criteria: antibiotics should be used only when there is strong evidence of benefit, preference should be given to narrow-spectrum drugs from the WHO’s Access category, and treatment duration should be kept as short as possible.
The authors stress that increasing mortality from treatment-resistant infections makes a reassessment of preventive antibiotic practices particularly urgent. Preserving the effectiveness of antibiotics, they argue, will require abandoning routine prophylactic prescribing and adopting a more targeted, evidence-based approach.
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