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A recent report analyzing the global burden of disease shows that the incidence and mortality from severe sepsis has continued to rise across the period 1990-2017. Although the burden is highest among low-income countries, there are more than 5 million deaths recorded annually in high-income countries and this burden is disproportionately high among young persons, being mostly from communicable infections. Despite residing in one of those high-income countries, I have witnessed severe morbidities such as amputations as well as unexpected mortalities among acquaintances and their relatives, along with rather frequent newspaper reports of such events occurring in young people within my community. These cases are invariably due to infections with Group A Streptococcus (Strep Pyogenes), Meningococcus or Pneumococcus, all organisms sensitive to penicillin and its derivatives to this day. However, it appears that in each case the appropriate antibiotic is not administered, or there is an inordinate delay in administration, due to a rigid anti-microbial stewardship (AMS) policy resulting from the unwarranted and generalized fear of anti-microbial resistance (AMR). In Australia, there has been an editorial drive from the leading medical journal to constrain general practitioners from prescribing antibiotics until proof of bacterial infection is demonstrated from swabs or blood cultures. Having personally witnessed post-partum deaths of women within 24-hours of delivery from Strep. Pyogenes when antibiotics were not given, I encourage that representative medical associations within high-income countries should review and explain what appears to be a lop-sided AMS policy. It appears that the idea of constraining antibiotic use was directed to protect a debilitated segment of the unwell population but the side effect is unnecessary mortality and morbidity among the young and normally healthy segment.

Delaying Antibiotics: A Cause for the Rise in Morbidity and Mortality from Sepsis?