Withdrawing Antibiotics Temporarily Could Restore Their Effectiveness Against Resistant Bacteria

Antibiotic resistance has been an issue in the field of disease control for over two decades. Microorganisms find their way around antibiotics as quickly as new drugs are made. So far, the likes of methicillin-resistant Staphylococcus aureus (MRSA) and multiresistant pseudomonas aeruginosa are of serious concern.

Multi-Drug Resistant Bacteria

Multi-Drug Resistant Bacteria. Image Courtesy of Dr Graham Beards

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Currently, antibiotic resistance is a major global issue that poses a threat to human lives. In 2019, approximately 5 million people died from antibiotic-resistant infections. It is so serious that the resistance of a microbe to just one antibiotic poses a tremendous danger let alone to several. Sometimes this happens in cases where there is no other treatment option.

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A lot of research has been done to find a possible solution to this. Medical experts have carried out various experiments to find out how long we should give antibiotics before the microorganism becomes resistant or whether we should even give certain types of antibiotics at all.

One possible way to restore efficacy would be to totally withdraw the drug from being prescribed and used. There is a theory that infers that a temporary withdrawal of an antibiotic, which lets several generations of bacteria evolve without being exposed to it, could restore the effectiveness of the drug.

Reviving old antibiotics: the colistin example

The concept of withdrawing an antibiotic for a period of time has shown effectiveness. Over time, some really old antibiotics were brought back, and they worked. Examples are colistin, fosfomycin, pristinamycin, etc.

Colistin is in the polymyxin group of antibiotics. The resistance that microorganisms produced against the drug was an issue of concern all over the world. However after it was also noticed that the drug was also toxic to both the brain and kidneys, it was withdrawn from the market for some years.

Read Also: A New Hope in an Old Cure: Nourseothricin’s Potential Against Resistant Bacteria

Recently, it was reintroduced as a last-resort drug and is being used for the treatment of infections caused by multidrug-resistant microorganisms.

The current issue: azithromycin overuse

During the COVID-19 pandemic, people used a lot of antibiotics, including azithromycin. Its versatility and lesser side effects made it a drug of choice at the time.

Scientists have expressed their concerns about microorganisms becoming resistant to the drug. Currently, it is actively contributing to antimicrobial resistance.

A study published by Dr. Dragana Sokolovic in Frontiers highlighted how the pandemic, increased the use of antibiotics, especially azithromycin.

They analyzed antibiotics prescribed in hospitals between 2019 and 2021 and discovered high consumption of azithromycin, vancomycin, cefuroxime, ciprofloxacin, meropenem, and others. When compared to the period before the pandemic, the values were higher.

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The concept of bacterial memory during antibiotic exposure

Scientists have agreed on the theory that microbes respond to antibiotics differently after a series of repeated exposures. This makes them adapt to the prevailing environmental conditions.

In this manner, they build resistance against the antibiotic, making it ineffective. Putting a temporary ban on antibiotics breaks this cycle, making the bacteria more vulnerable.


The revival of drugs like colomycin and fosfomycin has proven to be more beneficial. The current body of scientific research supports this claim. The concerns that have come up with azithromycin should be addressed in this manner, and who knows, years from now, azithromycin might reemerge looking and acting new.


Cassir, N., Rolain, J. M., & Brouqui, P. (2014, October 2). A new strategy to fight antimicrobial resistance: the revival of old antibiotics. Frontiers. https://doi.org/10.3389/fmicb.2014.00551

Bergen, P. J., Landersdorfer, C. B., Lee, H. J., Li, J., & Nation, R. L. (2012). ‘Old’ antibiotics for emerging multidrug-resistant bacteria. Current opinion in infectious diseases, 25(6), 626–633. https://doi.org/10.1097/QCO.0b013e328358afe5

Sokolović, D., Drakul, D., Vujić‐Aleksić, V., Joksimović, B., Marić, S., & Nežić, L. (2023, February 27). Antibiotic consumption and antimicrobial resistance in the SARS-CoV-2 pandemic: A single-center experience. Frontiers. https://doi.org/10.3389/fphar.2023.1067973



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