The irrational and harmful over-prescription of antibiotics in the U.S., Canada and most other counties around the world is setting the stage for a global medical catastrophe. Superbugs are quickly evolving into supervillains and could be unstoppable in the future if stringent limits and precautions are not immediately employed. Following is a concise overview of the issues involved.
Staggering
number of needless prescriptions:
“At least 30 percent of antibiotics prescribed in the United States are
unnecessary, according to new data published today in the Journal of the
American Medical Association (JAMA) by the Centers for Disease Control and
Prevention (CDC), in collaboration with Pew Charitable Trusts and other public
health and medical experts.
“The study analyzed antibiotic use in doctors’ offices and emergency
departments throughout the United States. CDC researchers found that most of
these unnecessary antibiotics are prescribed for respiratory conditions caused
by viruses – including common colds, viral sore throats, bronchitis, and sinus
and ear infections – which do not respond to antibiotics. These 47 million
excess prescriptions each year put patients at needless risk for allergic
reactions or the sometimes deadly diarrhea, Clostridium difficile.”
Antibiotic overprescribing in hospitals:
“The CDC estimates that more than 70% of the bacteria responsible for the
2 million infections acquired in US hospitals each year are resistant to at
least one commonly used antibiotic, and 20% to 50% of antibiotics prescribed in
US acute-care hospitals are unnecessary or inappropriate.
“Examples of interventions to prevent overuse or overprescribing of
antibiotics in hospitals, including intensive care units, include use of rapid
diagnostics and community or hospital-based resistance data to determine
appropriate empiric treatment, avoidance of administering unnecessary
broad-spectrum antibiotics, shortening the duration of therapy whenever
possible, and basing treatment on pharmacokinetic and pharmacodynamic
characteristics of the patient and his or her infection.”
Threat of a post-antibiotic world:
“In the
context of few innovative or new antibiotics in the drug development pipeline,
the World Health Organization (WHO) describes a future of a post-antibiotic
world and warns that not only will this eliminate the advances in healthcare
made over the past 100 years, which have ensured longer life in most parts of
the developed and developing worlds, but it may also result in simple
infections becoming unmanageable and potentially fatal. The United Kingdom
Chief Medical Officer has highlighted the need for clinicians to preserve the
effectiveness of antibiotics by giving clear evidence-based guidance on their
appropriate use and has stated that we are losing the battle against infectious
diseases, and antibiotics may no longer be effective in the long term.”
Risks that have been shown to be
associated with overuse of antibiotics:
Increase of
antimicrobial resistance
Increase of
more severe diseases
Increase of
the length of disease
Increase of
the risk of complications
Increase of
the mortality rate
Increase of
healthcare costs
Increase of
the risk of adverse effects, some being life-threatening
Increase of
re-attendance due to infectious diseases
Increased
medicalization of self-limiting infectious conditions
The cause of antibiotic resistance:
“A bacterium
resists a medication when the bacterium has changed in some way. The change
either protects the bacterium from the action of the medication or neutralizes
the medication. Any bacterium that survives an antibiotic treatment can
multiply and pass on its resistant properties. Also, some bacteria can transfer
their medication-resistant properties to other bacteria — as if passing along a
cheat sheet to help each other survive. The fact that bacteria develop
resistance to a medication is normal and expected. But the way that medications
are used affects how quickly and to what extent resistance occurs.”
Why antibiotics are overprescribed:
“Human
behavior is always complex and it is difficult to tease out various factors.
The question of why doctors are prescribing antibiotics when they shouldn’t is
no exception. When doctors are asked their most common response is that they
are pressured by patients and parents of sick children to prescribe them. Other
factors have also been suggested, however.
“Patient
education can be time consuming, and writing a prescription may be the pathway
of least resistance for a busy practitioner. We also live in a time of waning
trust in professionals. The old paternalistic model is dead. Now everyone feels
it is appropriate to question experts, especially when it comes to their own
health. This is reasonable to an extent, but it makes it more difficult for a
physician to refuse a request by a patient who feels that they ‘know their own
body’ and what they need.
“Even
experienced doctors may also doubt themselves. We also live in an era of
defensive medicine, in which a doctor may not wish to risk a complication,
especially if they are going against the strong desires of their patient. This
situation feels like a lawsuit waiting to happen. By contrast, the risk of antibiotic
resistance is diffuse and distant. Human psychology favors avoiding the
immediate direct risk for the delayed indirect risk with diffuse
responsibility.”
What
antibiotics should not be used for:
“Antibiotics treat bacterial infections but not viral infections. For
example, an antibiotic is an appropriate treatment for strep throat, which is
caused by the bacterium Streptococcus pyogenes. But it's not the right
treatment for most sore throats, which are caused by viruses. Other common
viral infections that don't benefit from antibiotic treatment include:
Cold
Flu (influenza)
Bronchitis
Most coughs
Some ear infections
Some sinus infections
Stomach flu
Taking an antibiotic for a viral infection:
Won't cure the infection
Won't keep other people from getting sick
Won't help you or your child feel better
May cause unnecessary and harmful side effects
Promotes antibiotic resistance”
One example - fluid in the middle ear:
“Fluid in the middle ear, also called
otitis media with effusion, is a common condition in children. Fluid often
accumulates in the ear, just like in the nose, when a child has a cold. In the
absence of other symptoms, fluid in the middle ear usually doesn't bother
children, and it almost always goes away on its own without treatment, says
Janice Soreth, M.D., director of the FDA's Division of Anti-Infective Drug
Products. ‘It usually does not need to be treated with antibiotics unless it is
accompanied by additional signs or symptoms or it lasts a couple of months.’
“If your
doctor does not prescribe an antibiotic for your child, do not insist on one.
Taking an antibiotic when it is not necessary can be harmful. It increases the
risk of getting an infection later that antibiotics cannot kill.
“Instead,
‘observe your child,’ says Soreth. ‘If symptoms change, call your doctor to
seek further help.’ Symptoms to watch for include fever, irritability,
decreased appetite, trouble sleeping, tugging on the ear, or complaints of
pain. ‘If symptoms occur, it doesn't mean the doctor misdiagnosed the
condition,’ says Soreth. ‘What started out as a viral condition may have
morphed into a bacterial infection several days later. If this happens, an
antibiotic may be appropriate.’"
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Photo: http://www.three21wellness.org/antibiotic-over-prescription-in-children-with-down-syndrome/
Jerry De Luca is a Christian freelance writer who loves perusing dozens of interesting and informative publications. When he finds any useful info he summarizes it, taking the main points, and creates a (hopefully) helpful blog post.
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