Common painkillers linked to antibiotic resistance

Painkillers such as paracetamol and ibuprofen have been identified as key players in antibiotic resistance, in new research from the University of South Australia.
 
Published this week, the study has sounded the alarm for the use of the common over-the-counter medications, particularly for aged-care residents, who often receive multiple medications.
 
Researchers found ibuprofen and paracetamol not only drive antibiotic resistance when used individually, but amplify the resistance when used together, said the study’s lead researcher Associate Professor Rietie Venter.
 
‘Antibiotic resistance isn’t just about antibiotics anymore,’ she said.

RACGP Expert Committee Quality Care Chair Professor Mark Morgan echoes those views, saying the study has ‘thrown up a novel way common medicines might be contributing to harm’.
 
‘It used to be a simple equation of more antibiotics leads to more resistance,’ he told newsGP.
 
‘Now we are seeing evidence that antiseptics and, in this research, common analgesics can all contribute to driving antibiotic resistance.’
 
The World Health Organization has declared antimicrobial resistance ‘one of the top global public health and development threats’.
 
It estimates that in 2019, antibiotic resistance was directly to blame for 1.27 million deaths globally, and associated with 4.95 million deaths.
 
Associate Professor Venter said the study’s findings are of particular concern for aged-care residents, who are more likely to be prescribed not just antibiotics, but also pain, sleep, or blood pressure medication, ‘making it an ideal breeding ground for gut bacteria to become resistant to antibiotics’.
 
The South Australian study investigated the use of nine non-antibiotic medications commonly used in aged care, as well as ciprofloxacin.
 
Assessing the interaction of the non-antibiotic medications and ciprofloxacin on the common gut bacteria E. coli, researchers found ibuprofen and paracetamol ‘significantly increased mutation frequency’, making E. coli highly resistant to the antibiotic.
 
‘Worryingly, the bacteria were not only resistant to the antibiotic ciprofloxacin, but increased resistance was also observed to multiple other antibiotics from different classes,’ Associate Professor Venter said.
 
‘We also uncovered the genetic mechanisms behind this resistance, with ibuprofen and paracetamol both activating the bacteria’s defences to expel antibiotics and render them less effective.’
 
Associate Professor Venter said the study is ‘a clear reminder that we need to carefully consider the risks of using multiple medications’ particularly in aged care.
 
‘This doesn’t mean we should stop using these medications, but we do need to be more mindful about how they interact with antibiotics – and that includes looking beyond just two-drug combinations,’ she said.
 
Professor Morgan encourages GPs to ‘constantly consider deprescribing’ when treating patients with multiple medications in light of the growing evidence around antibiotic resistance.
 
‘We should use every opportunity to ask ourselves whether medicines are causing more harm than benefit,’ he said. ‘Are they still needed? Are they still safe for our patient?’
 
‘Our understanding of the mechanisms of antibiotic resistance continues to evolve.’
 
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