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
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
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
“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
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.