“Now remember to complete the entire course of your antibiotic until it’s finished, even if you feel better.”

How often has a patient heard this from either their doctor or pharmacist? Hopefully every time. As vital drugs, antibiotics have saved countless lives. Akin to other drugs, they can also be misused or overused. However, what sets them apart as a class of drugs is the unique threat that comes with their use: antibiotic resistance. Why is that a threat?

Understanding Antibiotic Resistance

Antibiotic resistance refers to the ability of microorganisms such as bacteria to continue to grow and ultimately defeat the very drug (antibiotic) intended to limit their growth or kill them altogether.¹ In other words, the microorganism becomes resistant to the antibiotic treatment. Eventually, resistance of the microorganism to even one drug poses a risk to other drugs in the same class. When this occurs, infections become harder and harder to treat.

Now why this occurs is because bacteria can adapt and develop resistance through natural selection by the mere presence of antibiotics. The purpose of antibiotics is to kill bacteria, regardless of if they’re the bad bacteria that cause infection or the good bacteria that protect us from infection. Killing the good bacteria would cause loss of the protection that they normally provide allowing the bad bacteria to grow. What could make this worse?

Factors Contributing to Antibiotic Resistance

1. Incomplete courses of antibiotic treatment → by not finishing the entire course, bacteria that survived become resistant and multiply or pass on their resistant genes to other surviving bacteria
2. Inappropriate prescribing of an antibiotic → using an inappropriate antibiotic drug that wouldn’t effectively treat the infection or using antibiotics when not needed allows bacteria to spread and either worsen or cause an infection
3. Overprescribing of antibiotics → increased use of antibiotics gives bacteria more chances to grow, survive, and become resistant through multiple mechanisms of current and future antibiotics

The Consequences

If antibiotic resistance develops to the point of utilizing first-line treatment options, then use of second or third-line options may become necessary. However, they are not always ideal or as effective, and prolonged drug treatment use may cause serious side effects and may lead to a delay in recovery. In addition, some patients with chronic conditions may not have a strong immune system to fight off simple infections, much less infections from resistant bacteria. In addition, it is possible that in some cases there are not any more treatment options to continue. All these aspects contribute to increased healthcare costs, decreased effectiveness of interventions, and poor health outcomes for patients.

Why Antibiotic Resistance Is No Longer a Future Threat

Why Antibiotic Resistance Is No Longer a Future Threat

For many healthcare professionals, antibiotic resistance was once viewed as a growing concern for the future. Today, it is a reality encountered in hospitals, long-term care facilities, and outpatient settings every day.

Recent CDC surveillance data show that antimicrobial resistance remains a significant and growing healthcare challenge. In 2024, the CDC reported that six major antimicrobial-resistant hospital-onset infections increased by approximately 20% during the COVID-19 pandemic and remained above pre-pandemic levels through 2022. These findings demonstrate that resistant infections continue to place substantial pressure on healthcare systems across the United States.

Healthcare-associated pathogens such as carbapenem-resistant Enterobacterales (CRE), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Pseudomonas aeruginosa, vancomycin-resistant Enterococcus(VRE), and Candida auris continue to present serious treatment challenges in hospitals and healthcare facilities worldwide.

One of the most alarming recent developments involves NDM-producing carbapenem-resistant Enterobacterales (NDM-CRE), a highly resistant group of bacteria often referred to as “nightmare bacteria.” Public health officials reported a more than 460% increase in NDM-CRE infections between 2019 and 2023. These infections can cause pneumonia, bloodstream infections, urinary tract infections, and wound infections while leaving clinicians with very limited treatment options.

At the same time, Candida auris, an emerging multidrug-resistant fungus, continues to spread rapidly across healthcare facilities and remains one of the CDC’s most urgent antimicrobial resistance threats. Unlike many common fungal infections, C. auris can survive on surfaces for extended periods, spread easily within healthcare environments, and demonstrate resistance to multiple antifungal medications.

The global outlook is equally concerning. The World Health Organization (WHO) continues to identify antimicrobial resistance as one of the top threats to global public health, warning that the loss of effective antibiotics could jeopardize routine surgeries, cancer treatments, organ transplants, and other modern medical advances that depend on infection prevention and treatment.

For pharmacists and other healthcare professionals, these statistics are more than numbers. Many clinicians working in hospitals have witnessed patients with bloodstream infections, pneumonia, urinary tract infections, or sepsis caused by multidrug-resistant organisms who fail multiple antibiotic regimens before effective therapy can be identified. In some cases, treatment options become severely limited or unavailable altogether despite aggressive treatment efforts.

These realities reinforce the importance of antimicrobial stewardship. Every appropriate antibiotic selection, dose optimization, de-escalation recommendation, and patient counseling intervention helps preserve the effectiveness of these life-saving medications for future patients.

Pharmacists and Antibiotic Stewardship

Pharmacists play a vital role in promoting responsible, appropriate, and effective antibiotic use. Some interventions performed by pharmacists involve dose adjustments, dose optimization (increasing or decreasing the dose depending on patient’s health status), drug-interactions, stop orders that are time sensitive, changing IV antibiotics to oral formulation, and removing or discontinuing duplicate antibiotic therapy.³

Antibiotic resistance is a multifaceted challenge. Pharmacists have a vital role in educating patients, promoting responsible antibiotic use, and advocating for evidence-based prescribing practices. Their knowledge and skills allow them to provide education to both patients and other healthcare providers regarding adherence, drug dosing, and proper antibiotic use. Through collaboration with providers, proper and effective antibiotic use can improve and continue for all current and future generations. The next time a pharmacist reminds a patient to complete their antibiotic therapy, that counseling point is about more than treating a single infection it is about helping protect one of medicine’s most valuable resources for everyone.

Original Author: Midrara Kashmari

Editorial Update (June 2026): Elizabeth Rodriguez

RxPharmacist Team

References:

1. Centers for Disease Control and Prevention. About Antimicrobial Resistance. CDC. Available at: https://www.cdc.gov/antimicrobial-resistance/
2. Centers for Disease Control and Prevention. Antimicrobial Resistance Threats in the United States. CDC. Available at: https://www.cdc.gov/antimicrobial-resistance/
3. Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs. CDC. Available at: https://www.cdc.gov/antibiotic-use/core-elements/hospital.html
4. World Health Organization. Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report. WHO. 2025.
5. Chan AHY, Beyene K, Tuck C, Rutter V, Ashiru-Oredope D. Pharmacist beliefs about antimicrobial resistance and impacts on antibiotic supply: a multinational survey. JAC-Antimicrobial Resistance. 2022;4(4).
6. CDC. Antimicrobial Resistance Data and Surveillance Updates. 2024–2025.