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Overuse of antibiotics is public health threat

Posted on Dec. 5, 2012 at 12:00 a.m.

DAVID TEMPLETON

Pittsburgh Post-Gazette

When patients demand antibiotics for a cold, the flu or any other viral infections, physicians sometimes appease them with a prescription. On other occasions, doctors prescribe antibiotics for infections most commonly caused by viruses but sometimes caused by bacteria or that progress to a bacterial infection.

Antibiotics kill germs — bacteria — and have no effect on viruses, making the above practices unnecessary and dangerous to health.

The overuse of antibiotics not only boosts health care costs but also causes bacterial resistance to the drugs. Examples include the growing difficulty in treating serious and sometimes fatal bacterial infections, methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C diff), both of which are on the rise.

Researchers also are linking health problems during childhood to early use and overuse of antibiotics.

When given in the first six months of life, antibiotics are now suspected of leading to obesity and even type 2 diabetes, with a lifelong ripple effect on health. Recent research completed at New York University’s Langone Medical Center determined that early doses of antibiotics kill off the natural flora in the gut. Early doses of antibiotics also intensify the metabolism, causing extraction of more calories than normal from food, leading to weight gain.

Antibiotics can alter a child’s immune system, although the health impacts are not yet clear.

“Antibiotic resistance is one of the world’s most pressing public health threats,” the U.S. Centers for Disease Control and Prevention states. More than 50 percent of antibiotics are unnecessarily prescribed in doctors’ offices for upper respiratory infections including coughs and colds, most of which are caused by viruses. Half of all antibiotics used in hospitals are unnecessary or inappropriate, the CDC says.

Reactions that children have to antibiotics “are the most common cause of emergency department visits for adverse drug events,” according to the CDC.

But the overuse of antibiotics isn’t limited by age group.

A University of Pittsburgh-based research team, using Medicare Part D data from 2007 to 2009, found that one in five people 65 and older are taking at least one course of antibiotics during any three-month season of the year, with 47 percent taking at least one dose of antibiotics sometime during the year.

The study was published Sept. 24 online in the Journal of the American Medical Association’s Archives of Internal Medicine.

For the past 70 years, antibiotics have been powerful tools for all age groups, but their overuse is changing that.

“Antibiotic resistance occurs when bacteria change in a way that reduces or eliminates the effectiveness of antibiotics,” the CDC’s “Get Smart” program states. “Infections with resistant bacteria have become more common in health care and community settings, and many bacteria have become resistant to more than one type or class of antibiotics.”

It also is getting more difficult to develop new antibiotic drugs.

“The problem is that we expect antibiotics to work for every illness, but they don’t,” the CDC says, calling for more effective antibiotic stewardship programs.

Arjun Srinivasan, associate director of CDC’s health-care-associated infection prevention programs, said the “Get Smart” programs are making progress in improving how antibiotics are used, but the problem is far from being resolved.

“Certainly the situation with antibiotic resistance is getting worse,” Srinivasan said. “Bacteria are developing resistance to more antibiotics, making it more difficult to treat patients or to find the right treatments for the right patients.”

The Mayo Clinic offers these tips for avoiding overuse of antibiotics:

Ÿ Don’t expect to take antibiotics every time you are sick.

Ÿ Don’t pressure your doctor for antibiotics if you have a viral infection.

Ÿ Take antibiotics exactly as prescribed, including taking the full course.

Ÿ Never take antibiotics without a prescription, including leftover prescriptions.

Ÿ Prevent the spread of germs.

Ÿ Get recommended vaccines.



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