ATLANTA, Ga. — Antibiotic resistant bacteria are gaining added attention as a worldwide public health challenge.
Prudent use is emphasized in human medicine, yet the Centers for Disease Control in the United States estimates that 30 to 50 percent of all antibiotics prescribed for American patients are inappropriate.
Bacteria naturally evolve and inevitably over time develop resistance to the antibiotics used to control them.
Recently, there has been added emphasis on physicians to ensure they prescribe antibiotics only when necessary, but statistics show that is not happening.
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Public Health Agency of Canada data from 2000-11 shows that pharmacy dispensing of antibiotics was down, but hospital use increased.
The report found that 75 percent of antibiotics were prescribed for urinary tract infections, 62 percent for ear infections and 46 percent for respiratory tract infections.
The U.S. saw a decrease in antibiotic prescriptions for young children about 10 years ago, probably as a result of extensive health-care campaigns.
However, the dispensing rate has since plateaued, said Theoklis Zaoutis, a pediatrician at the University of Pennsylvania and a member of the Centers for Disease Control’s infectious disease board. He is also part of the centre’s antimicrobial resistance working group.
Alternatives to current drugs are hard to find. Many companies favour developing drugs for common baby boomer conditions, such as acid reflux, cholesterol and high blood pressure because there are high profit potentials there.
“Which company wants to develop a drug that doctors and veterinarians want to use less of?” Zaoutis said.
Faced with fewer choices, physicians may prescribe more broad spectrum antibiotics, which are not necessary for many illnesses, he said. Children receive significant amounts of antibiotics compared to medications for asthma, pain, allergies, coughs and cold medication.
“It is the most commonly prescribed out patient drug in children,” he said.
Ear infections are the most common complaint to be treated with antibiotics.
However, one out of three prescriptions for children are for illnesses such as respiratory tract infections that do not respond to antibiotics.
“Bronchitis and upper respiratory tract infections in children are mostly viral, and yet we see significant prescribing across all age categories for conditions we do not need to prescribe,” he said.
Doctors often surrender to parental pressure when more effort should be devoted to preventing infections through immunization, washing hands, safe food preparation, tracking infections and improved diagnostic tests.
The risk of inflammatory bowel disease is a side-effect of the overuse of antibiotics. The human colon is full of beneficial bacteria, and antibiotics can eliminate the good ones along with the bad.
“The more antibiotics you give, the more the risk of a child developing inflammatory bowel disease,” Zaoutis said.
Steve Solomon, director of antimicrobial resistance with the CDC said although antibiotic use is common in hospitals, it may not be the best treatment.
The CDC has published a good stewardship program calling for reduced drug use, accountability and developing pharmaceutical expertise to properly advise on medication use.
It also calls for improving the way antibiotics are prescribed, tracking success, reporting information and providing more education for health professionals and patients.
He said 600 to 1,200 antibiotic prescriptions are written every year for every 1,000 people. Thirty to 50 percent of those are probably inappropriate or inaccurately prescribed.
In addition to improved patient health, lower antibiotic use brings lower health-care costs for infections and complications, as well as lower consumer costs for antibiotics.
barbara.duckworth@producer.com
