Change Your World Week Fall 2021 (Archived)

Antibiotics are an integral part of modern medicine. Since their development and commercial availability in the early 20th century, antibiotics have been used to successfully treat countless patients, afflicted by bacterial infections. With their widespread availability and success came an unintended consequence; widespread and inappropriate use has led to bacterial resistance, rendering a growing number of antibiotics ineffective.

The problem is largely threefold. First, antibiotics are being overprescribed. According to data published by the Journal of the American Medical Association (JAMA), at least 30% of antibiotics prescribed in the US are unnecessary and most of these occur in the outpatient setting (e.g. clinics, emergency department). Antibiotics are being prescribed for illnesses that don’t respond to antibiotic treatment (e.g. common colds, bronchitis, sinus infections). Two factors contribute to this specific issue: healthcare providers are prescribing antibiotics prior to identifying a bacterial infection; patients are requesting antibiotics because they believe they will cure them. This can be attributed to wanting to avoid legal liability for failing to treat, as well as the demands on healthcare providers to meet patient satisfaction metrics (i.e. the same issues that contributed to the opioid epidemic).

Second, antibiotics prescribed correctly for bacterial infections often have an unnecessarily broad spectrum, when a more specific antibiotic would have been more appropriate. Because these antibiotics target a wide range of bacteria, instead of specifically the one causing the illness, they have a greater chance of creating resistant bacteria.

Third, misuse of antibiotics by patients. When antibiotics are prescribed, patients are specifically instructed to complete the entire antibiotic regimen, regardless of whether their symptoms subside prior to completion. It is quite common for patients to disregard this order. It is also common for patients to retain the leftover antibiotics and use them at a later date when they become ill from an unrelated ailment, or give the antibiotics to a sick friend or family member. The failure to complete a full antibiotic regimen allows the bacteria to survive and develop resistance.

The issue of antibiotic resistance isn’t new. It is an issue that organizations and individuals have been contending with for decades. The solutions have been largely focused on physicians. Protocols have been developed to limit the prescribing of antibiotics based on patient presentation (e.g. symptomatic vs asymptomatic, days since onset) and patient specific risk factors (e.g. pregnancy, immunocompromised). Some insurances have denied reimbursement for antibiotic administration to unsupported diagnoses. Protocols such as “delayed prescribing” (i.e. writing an antibiotic prescription, in the outpatient setting, with instructions to withhold administration until after a specified length of time, if symptoms persist) have been devised and shown some promise. There has also been a public service initiative to educate the public on the proper use of antibiotics; however, it isn’t very widespread or visible.

The solution to this problem is not a simple one. It will take a multifaceted approach from all parties (e.g. healthcare providers, pharmaceutical companies, and the public), because all parties contribute to the issue. On the part of the healthcare provider it will take judicious use of antibiotics and hospital administrators who support their efforts. From the pharmaceutical companies it will take continued research into new antibiotics, to make up for those that have become ineffective due to antibiotic resistance. Finally, from the public it will take personal ownership and education. There are a multitude of educational sources available to the public. Two great resources are the CDC and the WHO.

Antibiotics are an integral part of the healthcare system. When used appropriately, they have great success in reducing morbidity and mortality; however, when antibiotics are overprescribed or misused, there can be serious consequences. Antibiotic resistance is an issue that needs continued focus. Professional healthcare organizations (e.g. American Medical Association, Emergency Medicine Residents’ Association) have made significant contributions to preventing antibiotic resistance through physician education and providing decision making tools to healthcare professionals. These actions have made a concerted effort to reduce the inappropriate use of antibiotics, but it's not enough. Public education on the issue of antibiotic resistance (i.e. prevalence, cause, consequences), and what individuals can do to help mitigate the threat (i.e. following prescription directions, not pressuring physicians for unnecessary antibiotics), is a solution that hasn’t received enough attention and could prove beneficial to combating the issue.

We are asking that the public educate themselves on the dangers of inappropriate antibiotic use and to act accordingly. When antibiotics are prescribed, take them as directed. When your doctor doesn't believe antibiotics are the correct course of treatment, trust in their expertise, instead of demanding antibiotics. If you don't trust your doctor, find one that you do. Finally, adopt proper hygiene practices (e.g. hand washing) will reduce the risk of infection, thereby reducing the need for an antibiotic.

We believe a combined effort on the part of healthcare providers and the public will have a significant impact on the reduction of antibiotic resistance.

CDC: About Antibiotic Resistance. https://www.cdc.gov/drugresistance/about.html

CDC: 1 in 3 Antibiotic Prescriptions Unnecessary. https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html

CIDRAP: Overuse and Overprescribing of Antibiotics. https://www.cidrap.umn.edu/asp/overuse-overprescribing-of-antibiotics

FDA: Combating Antibiotic Resistance. https://www.fda.gov/consumers/consumer-updates/combating-antibiotic-resistance

JAMA: Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. https://jamanetwork.com/journals/jama/fullarticle/2518263

JAC: Appropriateness of antibiotic prescribing in the emergency department. https://doi.org/10.1093/jac/dky447

NY Times: ‘Delayed Prescribing’ May Help Cut Down on Antibiotic use. https://www.nytimes.com/2021/05/24/well/delayed-prescription-antibiotics.html

Science-Based Medicine: Overprescribing Antibiotics. https://sciencebasedmedicine.org/overprescribing-antibiotics/