Few appreciate the threat of antibiotic resistance to human medicine more than readers of this blog. You know antibiotics as lifesaving “miracle” drugs that treat sepsis, save victims of burns and trauma, and are crucial to survival of patients receiving transplants and cancer treatment. At the same time, you understand the devastating consequences when these drugs don’t work anymore—when infections become resistant.
The overuse of antibiotics breeds antibiotic-resistant infections that threaten patients, hospitals, and our entire health care system. Resistant infections mean more and longer hospitalizations, increased hospital costs, and higher mortality. As clinicians, it is our job to help our colleagues in the medical community and the American public better understand the risk posed by inappropriate use of antibiotics. Patients and the community benefit from more appropriate antibiotic use, which reduces risks for the individual patient as well as the entire community.
A new, first-of-its-kind analysis of antibiotic use in US doctor’s offices and emergency departments, published in the Journal of the American Medical Association (JAMA), highlights how common inappropriate antibiotic prescribing is. CDC, in collaboration with The PEW Charitable Trusts and other public health and medical experts, found at least a third of antibiotics are given when the patient does not need them. This overuse, largely due to overprescribing for relatively minor illnesses including common colds, sore throats, and ear infections – for which antibiotics are not effective – amounts to 47 million excess antibiotic prescriptions each year.
The report also notes that outpatient antibiotic prescribing varies dramatically by geographic region, with the highest rates in the South. In addition, patients many times get the wrong antibiotic, or the wrong dose, or for the wrong duration. Taking both overuse and misuse into account, estimates are that antibiotics are prescribed incorrectly about half the time.
While some patients may receive antibiotics unnecessarily, others may not receive them promptly enough – which is critical to combat fast-moving complications of infections, like sepsis. And we’ve now reached the point where antibiotic resistance leaves us with few or no antibiotics available to treat some infections, such as CRE, the nightmare bacteria.
Improving antibiotic use is a patient safety issue. Improved use will reduce adverse events such as Clostridium difficile infections, which cause almost half a million infections and at least 15,000 deaths each year. It can be done: in England, the number of C. difficile infections was reduced by well over 60 percent in recent years, largely due to improvements in antibiotic prescribing. This is one of the many reasons the President’s National Action Plan to Combat Antibiotic Resistant Bacteria calls for inappropriate antibiotic use to be halved in outpatient settings and reduced by 20 percent in inpatient settings.
CDC will continue to work with federal partners, state health departments, professional organizations, patient advocates, and the private sector to help health care providers and the public improve their understanding of when antibiotics are – and are not – needed. The fiscal year 2016 President’s budget allowed for $160 million in new antibiotic resistance funding, which CDC will use to transform how our nation tackles this problem, including improving antibiotic use and preventing infections. The additional $40 million proposed in the fiscal year 2017 budget will ensure the nation’s ability to stand up a full response faster, protecting Americans and today’s antibiotics from resistant germs sooner.
To slow the development and spread of antibiotic-resistant infections, it will be critical for every one of us to improve the way antibiotics are prescribed and used in this country. This is the only way we can preserve our dwindling arsenal of life-saving antibiotics and reduce the threat of resistant infections to improve the lives and health of Americans.
Tom Frieden, MD is director of the CDC.
Why are we always at war? Why not design better health?
Tough to win war against sepsis, war against dissatisfaction in ptx & war against antibiotic resistance at same time.
Good straight-forward article as far as it goes. I’d love to know how do we change physician behavior that causes this over prescribing? AND, how do we reach out to the mothers of our children who are asking/demanding antibiotics for their ill child? We need both types of education. Seems ripe for a big advertising campaign. Particularly for children. This is one of those (1) improves our health; and (2) saves money.
Thanks for the article.
We’re glad to have you on the show. ; )
I have an idea. I’m making this up.
And I’m sure my idea is politically impractical.
I have no data. And no particular expertise. It may already have been done. I haven’t measured anything. But I feel as though part of the problem is that the public does not understand the severity of the antibiotic crisis.
Would it make sense for CDC to get more directly involved?
I’m thinking a public education campaign along the lines of the water conservation campaigns here in California. Classify certain antibiotics as restricted and require a simple three step online application.
Don’t deny anybody anything but make people stop and think.
I bet it would work.
* And note: asking doctors to do this is a bad idea.
We are honored to have you on this blog. I love the CDC. Just some random questions:
I’ve had old friends die after a few febrile days of URIs and without early antibiotics. My theory is that tiny plugged airways can’t be re-opened easily in the frail patient who is not coughing robustly and these get infected distally, just as in any biologic tube like the pancreatic or salivary ducts that are blocked. Especially as these people are so often dry. So maybe err on the side of giving antibiotics? say in someone >80 yrs?
Every so often I see in Nature or Science papers suggesting that some bugs are re-acquiring sensitivity to antibiotics. Is this significant?
Are phages being explored enough? …to your liking?
What about using Crispr and Cas9 to edit bacterial resistance genes and then release these bugs into the wild? [somewhere?…hmmm?]
Thank you for this post. I hope the CDC will consider addressing the following:
1. The rise of retail clinics and the effect that has on antibiotic prescribing.
2. The lack of development of new antibiotics in favor of efforts towards chronic disease.
3. The influence of satisfaction surveys on physician behavior, especially when linked to compensation.
4. The completely unnecessary use of antibiotics in our food supply.
This is difficult work. When a physician withholds antibiotics and we “let” a patient get pneumonia, the patient does not call the CDC to complain about this. There has to be room for physician judgment when guidelines are concerned.