Antibiotic Resistance Explained: The Impact of Medication Nonadherence

Antibiotic resistance is one of the most pressing global health challenges today, leading to over a million deaths per year since 1990¹. As bacteria evolve to resist the effects of antibiotics, common infections that were once easily treatable are becoming harder and more expensive to manage². One often overlooked factor that is significantly contributing to the rise of antibiotic resistance is medication nonadherence, a phenomenon where patients do not follow prescribed treatment regimens³. Whether it’s skipping doses, stopping treatment early, or not taking antibiotics as prescribed, medication nonadherence has a profound impact on the effectiveness of antibiotics and the development of resistant bacteria⁴

How Does Antibiotic Resistance Occur?

Antibiotic resistance occurs when bacteria mutate or acquire mechanisms that allow them to survive exposure to drugs designed to kill or inhibit their growth². This process can happen naturally over time, but it is often accelerated by human actions, especially antibiotic misuse⁵. When bacteria are exposed to suboptimal doses or incomplete courses of antibiotics, they are more likely to develop resistance. The more people fail to follow their prescribed antibiotic regimen, the greater the opportunity for these bacteria to adapt and become resistant⁵.

Stopping Antibiotics Early​

One of the most common forms of medication nonadherence occurs when patients stop taking antibiotics before the prescribed course is completed. For example, a patient might feel better after a few days of treatment and decide they no longer need to continue the medication. 

What Happens if You Stop Taking Antibiotics Early

While this might seem harmless, stopping antibiotics early means that some bacteria, though weakened, may still survive. These surviving bacteria can potentially mutate, leading to antibiotic resistance⁶. If the infection recurs, it may be harder to treat, requiring stronger antibiotics or longer courses of treatment. Merely skipping doses or taking antibiotics at irregular intervals can also contribute to resistance, as antibiotics need to maintain a certain level of concentration in the body to be effective. Missing doses or taking the drug inconsistently reduces its effectiveness, allowing bacteria to recover and potentially become resistant⁷.

Consequences of Stopping Antibiotics Early​

When common antibiotics are no longer effective, treatment options become limited. Conditions that were once easily treatable, such as urinary tract infections, pneumonia, and skin infections, can become life-threatening⁷. The global health community is already seeing the effects of this phenomenon, with an increasing number of “superbugs” that are resistant to multiple drugs⁸. The rise of resistant bacteria also leads to longer hospital stays, more intensive care treatments, and increased healthcare costs. In worst case scenarios, antibiotic resistance can pose significant risks for individuals receiving surgical and cancer treatments, where antibiotics are critical in preventing infections⁹.Medication nonadherence is a significant, yet often underestimated, contributor to the growing problem of antibiotic resistance¹⁰. By failing to complete a prescribed antibiotic regimen, patients unwittingly give bacteria the opportunity to develop resistance, making infections harder to treat in the future. Addressing medication nonadherence through better patient education, improved healthcare access, and emerging technologies is essential in promoting adherence and mitigating the spread of antibiotic resistance. By encouraging adherence to prescribed regimens, we can help preserve the effectiveness of antibiotics.

References

1. University of Oxford. “Antibiotic Resistance Has Claimed at Least One Million Lives Each Year since 1990 | University of Oxford.” Ox.ac.uk, 16 Sept. 2024, www.ox.ac.uk/news/2024-09-17-antibiotic-resistance-has-claimed-least-one-million-lives-each-year-1990.
2. Missouri Department of Health and Senior Services. “What Is Antibiotic Resistance.” Mo.gov, 2019, health.mo.gov/safety/antibioticresistance/generalinfo.php.
3. Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine, 353(5), 487–497. https://doi.org/10.1056/nejmra050100 
4. Endashaw Hareru, Habtamu, et al. “Antibiotics Non-Adherence and Its Associated Factors among Households in Southern Ethiopia.” SAGE Open Medicine, vol. 10, Jan. 2022, p. 205031212210904, https://doi.org/10.1177/20503121221090472.
5. Mayo Clinic Staff. “Antibiotics: Are You Misusing Them?” Mayo Clinic, 9 Apr. 2022, www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/antibiotics/art-20045720
6. Habboush, Yacob, and Nilmarie Guzman. “Antibiotic Resistance.” National Library of Medicine, StatPearls Publishing, 20 June 2023, www.ncbi.nlm.nih.gov/books/NBK513277/.
7. World Health Organization. “Antimicrobial Resistance.” World Health Organization, World Health Organization, 21 Nov. 2023, www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.
8. Tosh, Pritish K. “Protect Yourself from Superbugs.” Mayo Clinic, 2018, www.mayoclinic.org/diseases-conditions/infectious-diseases/expert-answers/superbugs/faq-20129283.
9. NHS . “Antibiotic Resistance – Antibiotics.” NHS, 11 Nov. 2022, www.nhs.uk/conditions/antibiotics/antibiotic-antimicrobial-resistance/.
10. Masud, Abdullah Al, et al. “Assessing Community Antibiotic Usage and Adherence as per Standard Treatment Guidelines: A Potential Area to Enhance Awareness at Community-Pharmacy Settings.” Exploratory Research in Clinical and Social Pharmacy, 1 Dec. 2024, pp. 100552–100552, https://doi.org/10.1016/j.rcsop.2024.100552. Accessed 18 Dec. 2024.