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Antibiotic resistance

Overuse of antibiotics impacting drug effectiveness


Editor's note: Unedited b-roll of Dr. Matthew Rankin (Eastover Pediatrics) speaking to this topic is available for media. Download 720p version here. Download the SD version here. Additional related b-roll is available here.

Since penicillin was first used to treat an American patient in 1942, antibiotics have been on the front lines of fighting disease and saving millions of lives. More than 70 years later with the emergence of drug-resistant bacteria, the efficacy of these drugs is diminishing.

In some cases, medical professionals are facing limited treatment options in combating bacterial infections. Drug-resistant bacteria cause 2 million illnesses and roughly 23,000 deaths in the U.S. each year, according to the Centers for Disease Control and Prevention.

The agency has identified the overuse of antibiotics as the No. 1 factor contributing to the rise in superbugs that are resistant to these medications. Antibiotics are often prescribed to treat the common cold, flu, and cough illnesses such as acute bronchitis, even though these infections are viral and not bacterial, meaning that antibiotics are not an effective treatment.

The problem is so widespread that the White House held its first antibiotic stewardship summit in June. The administration brought together key human- and animal-health stakeholders to discuss efforts supporting the responsible use of antibiotics.

The CDC is in the midst of its own big effort to raise awareness about the dangers of antibiotics overuse. Related, Novant Health is spearheading an antimicrobial stewardship initiative aimed at supporting best practices for antibiotic use and improving clinical outcomes for patients.

As part of the healthcare system’s effort, Novant Health is collecting data to better understand antimicrobial prescribing practices and help improve use. “In our practices, we take seriously our responsibility to appropriately prescribe antibiotics and are working on several initiatives to protect our patients by examining our current prescribing patterns and using antibiotics according to evidence-based guidelines,” said Dr. Herb Clegg, a pediatric infectious disease specialist at Novant Health Eastover Pediatrics who is leading the systemwide initiative.

The responsible use of antibiotics is a “responsibility to the community,” said Dr. R. Scott Spies, a pediatrician at Novant Health Matthews Children’s Clinic. Spies said the Novant Health data collection effort is not punitive, but a way of “putting the onus on the physician to do the right thing.”

But doctors need help from patients to help curtail the overuse of antibiotics.

In fact, patient expectation can often drive sub-optimal prescribing. Studies show that physicians are sometimes pressured by parents and patients to prescribe antibiotics in some cases where they may not be needed. Even if patients do not ask for a prescription, doctors may prescribe antibiotics based on the belief that patients expect it.

The CDC cautions that taking an antibiotic for a virus can do more harm than good to a patient by increasing the risk of getting an antibiotic-resistant infection at a later date. Also, antibiotics can kill helpful bacteria in the gut and allow for the growth of Clostridium difficile, a bacterium that causes diarrhea and more serious conditions such as colitis.

In addition to concerns about resistance and C. difficile diarrhea, antibiotics can also cause sometimes serious side effects. The CDC reports that antibiotics account for 1 in every 5 visits to the emergency room for drug adverse effects.

Antibiotics are a powerful and life-saving therapy for patients who need them. They are effective for treating bacterial illnesses such as strep throat, whooping cough and urinary tract infections.

“Patients are slowly realizing that antibiotics aren’t a cure-all for everything that ails them,” Spies said. He said that he makes the extra effort to educate patients about the differences between viral and bacterial infections.

“My patients are pretty well-trained,” Spies said. “They know a cold virus without a lasting fever will run its course in 7 to 10 days and doesn’t need antibiotics – just Motrin, rinsing out mucus from the nasal passages and the use of a humidifier.”

Still, there are some parents who insist on the antibiotics, seeing them as a quick fix. Beyond the issue of resistance, patients are urged to consider the possible side effects associated with antibiotics such as diarrhea, rash, and nausea. “It really boils down to trust and having a relationship with patients,” Spies said. “I explain to them that if this were my child, this is what I would do.”

Further, warned, Spies, “antibiotic resistance can be transferred child to child. A patient can carry antibiotic resistance even if they’ve never taken the drug.” Fortunately, the resistance to the medicine goes away after three to six months if the patient doesn’t use the antibiotic, he said.

If there is a need for an antibiotic, best practice to reduce the risk of resistance is to use the narrowest spectrum agent that would optimally treat the infection. Doing so allows greater flexibility in case the first line of treatment doesn’t work, Spies said.

“If you come out of the gate with the biggest guns, it increases the risk of encountering antibiotic resistance,” he said.

Unfortunately, the problem of antibiotic resistance is unlikely to dissipate with the advent of new drugs. There are very few new classes of antibiotics in the drug pipeline.





Published: 11/16/2015