Antibiotic misuse explained

Antibiotic misuse, sometimes called antibiotic abuse or antibiotic overuse, refers to the misuse or overuse of antibiotics, with potentially serious effects on health. It is a contributing factor to the development of antibiotic resistance, including the creation of multidrug-resistant bacteria, informally called "super bugs": relatively harmless bacteria (such as Staphylococcus, Enterococcus and Acinetobacter) can develop resistance to multiple antibiotics and cause life-threatening infections.[1]

History of antibiotic regulation

Antibiotics have been around since 1928 when penicillin was discovered by Alexander Fleming. In the 1980s, antibiotics that were determined medically important for treatment of animals could be approved under veterinary oversight. In 1996, the National Antimicrobial Resistance Monitoring System (NARMS) was established.[2] Starting in 2010, publications regarding antimicrobial drugs in food became an annual report. Starting in 2012, there was publicly solicited input on how data is to be collected and reported for matters relating to the use of antimicrobials for food-producing animals. Resulting from this, the FDA revised its sampling structure within NARMS with the goal of obtaining more representative livestock data for the key organisms under surveillance.[2] "NARMS partners at CDC and USDA have published over 150 peer-reviewed research articles examining the nature and magnitude of antimicrobial resistance hazards associated with antibiotic use in food-producing animals." In 2014, the FDA began working with the United States Department of Agriculture (USDA) and the Centers of Disease Control and Prevention (CDC) to explore additional mechanisms to obtain data that is representative of antibiotic use in food-producing animals. In 2015, the FDA issued the Veterinary Feed Directive (VFD) final rule, under which veterinarians must authorize the use of antimicrobials within feed for the animals they serve.[2]

In addition to antibiotic regulation in food production, there have been numerous policies put in place to regulate antibiotic distribution in healthcare, specifically in hospital settings. In 2014, the CDC officially recognized the need for antimicrobial stewardship within all U.S. hospitals in their publication of the Core Elements of Hospital Antibiotic Stewardship Programs. These programs outline opportunities for reducing unnecessary antibiotic usage, and provide guidelines for antibiotic prescription for common infections. The CDC highlighted post-prescription tactics for antibiotic regulation, such as reassessing dosages and the class or type of antibiotic used, in order to optimally treat each infection.[3] The CDC also emphasized the need for evidence-based prescribing, a practice that focuses on the utilization of evidence and research to make informed medical decisions;[4] these sentiments were echoed by the American Dental Association (ADA) which works to provide detailed guidelines for dentists considering prescribing their patients antibiotics.[5] In 2019, the CDC published a report concerning the issue and updating the public on the effectiveness of past policy. This report, titled Antibiotic Resistance Threats in the United States, 2019, indicated which pathogens posed the greatest threat of resistance, and highlighted the importance of infection prevention, providing recommendations for prevention strategies.[6]

There has also been a substantial effort to educate not only prescribers, but patients too on the issue of antibiotic misuse. The World Health Organization (WHO) has designated a "World Antimicrobial Awareness Week" in November. In 2021, the week's theme was "Spread Awareness, Stop Resistance" and the organization published many different forms of media including podcasts, articles, and infographics to raise awareness for the issue.[7] In the United States, the CDC has published posters and other materials for the purpose of educating the public on antibiotic resistance.[8] State health departments, such as Colorado's Department of Public Health & Environment, have partnered with the CDC to distribute these materials to healthcare providers.[9]

Instances of antibiotic misuse

Antibiotics treats bacterial infections rather than viral infections.Common situations in which antibiotics are overused include the following:[10]

Social and economic impact of antibiotic misuse

Antibiotics can cause severe reactions and add significantly to the cost of care.[20] In the United States, antibiotics and anti-infectives are the leading cause of adverse effect from drugs. In a study of 32 States in 2011, antibiotics and anti-infectives accounted for nearly 24 percent of ADEs that were present on admission, and 28 percent of those that occurred during a hospital stay.[21]

If antimicrobial resistance continues to increase from current levels, it is estimated that by 2050 ten million people would die every year due to lack of available treatment[22] and the world's GDP would be 2 – 3.5% lower in 2050.[23] If worldwide action is not taken to combat antibiotic misuse and the development of antimicrobial resistance, from 2014 – 2050 it is estimated that 300 million people could die prematurely due to drug resistance and $60 – 100 trillion of economic output would be lost. If the current worldwide development of antimicrobial resistance is delayed by just 10 years, $65 trillion of the world's GDP output can be saved from 2014 to 2050.

Prescribing by an infectious disease specialist compared with prescribing by a non-infectious disease specialist decreases antibiotic consumption and reduces costs.[24]

Antibiotic resistance

See main article: Antibiotic resistance. Though antibiotics are required to treat severe bacterial infections, misuse has contributed to a rise in bacterial resistance.[25] The overuse of fluoroquinolone and other antibiotics fuels antibiotic resistance in bacteria, which can inhibit the treatment of antibiotic-resistant infections.[26] [27] [28] Their excessive use in children with otitis media has given rise to a breed of bacteria resistant to antibiotics entirely.[29] Additionally, the use of antimicrobial substances in building materials and personal care products has contributed to a higher percentage of antibiotic resistant bacteria in the indoor environment, where humans spend a large majority of their lives.[30]

Widespread use of fluoroquinolones as a first-line antibiotic has led to decreased antibiotic sensitivity, with negative implications for serious bacterial infections such as those associated with cystic fibrosis, where quinolones are among the few viable antibiotics.[31] [32] [33]

Inappropriate use

Human health

Antibiotics have no effect on viral infections such as the common cold. They are also ineffective against sore throats, which are usually viral and self-resolving.[34] Most cases of bronchitis (90–95%) are viral as well, passing after a few weeks—the use of antibiotics against bronchitis is superfluous and can put the patient at risk of developing adverse reactions.[35] If you take an antibiotic when you have a viral infection, the antibiotic attacks bacteria in your body, bacteria that are either beneficial or at least not causing disease. This misdirected treatment can then promote antibiotic-resistant properties in harmless bacteria that can be shared with other bacteria, or create an opportunity for potentially harmful bacteria to replace the harmless ones.[36]

Official guidelines by the American Heart Association for dental antibiotic prophylaxis call for the administration of antibiotics to prevent infective endocarditis. Though the current (2007) guidelines dictate more restricted antibiotic use, many dentists[37] and dental patients[38] follow the 1997 guidelines instead, leading to overuse of antibiotics.[39]

A study by Imperial College London in February 2017 found that of 20 online websites, 9 would provide antibiotics (illegally) without a prescription to UK residents.[40]

Studies have shown that common misconceptions about the effectiveness and necessity of antibiotics to treat common mild illnesses contribute to their overuse.[41] [42] Antibiotics should also be used at the lowest dose for the shortest course. For example, research in the UK has shown that a 3-day course of antibiotics (amoxicillin) was as effective as 7-day course for treating children with pneumonia.[43] [44]

Livestock

See main article: Antibiotic use in livestock. There has been significant use of antibiotics in animal husbandry. The most abundant use of antimicrobials worldwide is in livestock; they are typically distributed in animal feed or water for purposes such as disease prevention and growth promotion.Debates have arisen surrounding the extent of the impact of these antibiotics, particularly antimicrobial growth promoters, on human antibiotic resistance. Although some sources assert that there remains a lack of knowledge on which antibiotic use generates the most risk to humans, policies and regulations have been placed to limit any harmful effects, such as the potential of bacteria developing antibiotic resistance within livestock, and that bacteria transferring resistance genes to human pathogens[45] Many countries already ban growth promotion, and the European Union has banned the use of antibiotics for growth promotion since 2006.[46] On 1 January 2017, the FDA enacted legislation to require that all human medically important feed-grade antibiotics (many prior over-the-counter-drugs) become classified as Veterinary Feed Directive drugs (VFD). This action requires that farmers establish and work with veterinaries to receive a written VFD order.[47] The effect of this act places a requirement on an established veterinarian-client-patient relationship (VCPR). Through this relationship, farmers will receive an increased education in the form of advice and guidance from their veterinarian. Resistant bacteria in food can cause infections in humans. Similar to humans, giving antibiotics to food animals will kill most bacteria, but resistant bacteria can survive. When food animals are slaughtered and processed, resistant germs in the animal gut can contaminate the meat or other animal products.Resistant germs from the animal gut can also get into the environment, like water and soil, from animal manure. If animal manure or water containing resistant germs are used on fruits, vegetables, or other produce as fertilizer or irrigation, then this can spread resistant germs.[48]

See also

Further reading

External links

Notes and References

  1. April 1998. The beginning of the end of the antibiotic era? Part II. Proposed solutions to antibiotic abuse. Quintessence International. 29. 4. 223–9. 9643260. Harrison JW, Svec TA.
  2. Web site: Food Insight . 2016 . FDA Antibiotic Regulation Through the Decades . https://web.archive.org/web/20170405013355/http://www.foodinsight.org/fda-antibiotics-regulations-fact-sheet . 2017-04-05.
  3. Web site: 2021-12-16 . Core Elements of Hospital Antibiotic Stewardship Programs Antibiotic Use CDC . 2022-05-29 . Centres for Disease Control and Prevention . en-us.
  4. Maxwell . Simon R J . 30 July 2005 . Evidence based prescribing . British Medical Journal. 331 . 7511 . 247–248 . 10.1136/bmj.331.7511.247 . 16051992 . 1181254 .
  5. Web site: Clinical Practice Guidelines and Evidence American Dental Association . 2022-05-30 . ada.org.
  6. Web site: CDC . 2022-03-29 . The biggest antibiotic-resistant threats in the U.S. . 2022-05-30 . Centers for Disease Control and Prevention . en-us.
  7. Web site: World Antimicrobial Awareness Week 2021 . 2022-05-30 . World Health Organization . en.
  8. Web site: CDC . 2021-10-08 . Patient and Healthcare Provider Information . 2022-05-30 . Centers for Disease Control and Prevention . en-us.
  9. Web site: Antibiotic Awareness Department of Public Health & Environment . 2022-05-30 . cdphe.colorado.gov.
  10. Web site: Antibiotics: Are you misusing them? . Mayo Clinic . 9 October 2020.
  11. , which cites
    • 2006. Diagnosis and Management of Bronchiolitis. Pediatrics. 118. 4. 1774–1793. 10.1542/peds.2006-2223. 17015575. American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. free.
    • Bisno. A. L.. Clegg. H. W.. Gerber. M. A.. Kaplan. E. L.. Lee. G.. Martin. J. M.. Van Beneden. C.. 2012. Clinical Practice Guideline for the Diagnosis and Management of Group a Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 55. 10. e86–102. 10.1093/cid/cis629. 7108032. 22965026. Shulman. S. T.. free.
  12. Web site: Reducing Antibiotic Exposure Procalcitonin & Bacterial Infection . 2022-04-13 . Thermo Fisher Scientific . en-US.
  13. , which cites
    • Schwartz. S. R.. Pynnonen. M. A.. Tunkel. D. E.. Hussey. H. M.. Fichera. J. S.. Grimes. A. M.. Hackell. J. M.. Harrison. M. F.. 2013. Clinical Practice Guideline: Tympanostomy Tubes in Children. Otolaryngology–Head and Neck Surgery. 149. 1 Suppl. S1–S35. 10.1177/0194599813487302. 0194-5998. 23818543. Rosenfeld. R. M.. Haskell. H.. Haynes. D. S.. Kim. T. W.. Lafreniere. D. C.. LeBlanc. K.. Mackey. W. L.. Netterville. J. L.. Pipan. M. E.. Raol. N. P.. Schellhase. K. G.. free.
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    • Brown. L.. Cannon. C.. Dolor. R.. Ganiats. T.. Hannley. M.. Kokemueller. P.. Marcy. S.. Roland. P.. 2006. Clinical practice guideline: Acute otitis externa. Otolaryngology–Head and Neck Surgery. 134. 4. S4–23. 10.1016/j.otohns.2006.02.014. 16638473. Rosenfeld. R.. Shiffman. R.. Stinnett. S. S.. Sandra Stinnett . Witsell. D. L.. American Academy of Otolaryngology–Head and Neck Surgery Foundation. 20340836. free.
  15. Web site: July 2012 . Treating sinusitis: Don't rush to antibiotics . Consumer Health Choices . 14 August 2012.
  16. Chen . Yu-Yen . Liu . Su-Hsun . Nurmatov . Ulugbek . van Schayck . Onno Cp . Kuo . Irene C. . 2023-03-13 . Antibiotics versus placebo for acute bacterial conjunctivitis . The Cochrane Database of Systematic Reviews . 3 . 3 . CD001211 . 10.1002/14651858.CD001211.pub4 . 1469-493X . 10014114 . 36912752 .
  17. , which cites
    • Weitzul. S.. 2008. Postoperative topical antimicrobial use. Dermatitis: Contact, Atopic, Occupational, Drug. 19. 4. 181–189. 18674453. Sheth. V. M.. 10.2310/6620.2008.07094.
  18. Margolis. David J.. Fanelli. Matthew. Hoffstad. Ole. Lewis. James D.. 2010. Potential association between the oral tetracycline class of antimicrobials used to treat acne and inflammatory bowel disease. The American Journal of Gastroenterology. 105. 12. 2610–2616. 10.1038/ajg.2010.303. 1572-0241. 20700115. 20085592.
  19. Thompson. Katherine G.. Rainer. Barbara M.. Antonescu. Corina. Florea. Liliana. Mongodin. Emmanuel F.. Kang. Sewon. Chien. Anna L.. 2020-02-01. Minocycline and Its Impact on Microbial Dysbiosis in the Skin and Gastrointestinal Tract of Acne Patients. Annals of Dermatology. en. 32. 1. 21–30. 10.5021/ad.2020.32.1.21. 33911705. 7992645. 1013-9087. free.
  20. January 1998. Economic aspects of antibacterial adverse effects. PharmacoEconomics. 13. 1 Pt 1. 35–49. 10.2165/00019053-199813010-00004. 10175984. Beringer PM, Wong-Beringer A, Rho JP. 25827533.
  21. Weiss AJ, Elixhauser A. Origin of Adverse Drug Events in U.S. Hospitals, 2011. HCUP Statistical Brief #158. Agency for Healthcare Research and Quality, Rockville, MD. July 2013. http://hcup-us.ahrq.gov/reports/statbriefs/sb158.jsp
  22. Web site: Antibiotic Overuse & Resistance Antibiotic Stewardship . 2022-04-13 . Thermo Fisher Scientific . en-US.
  23. Web site: Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations. Review on Antimicrobial Resistance.
  24. Beović B, Kreft SK, Čižman M . 2009 . The Impact of Total Control of Antibiotic Prescribing by Infectious Disease Specialist on Antibiotic Consumption and Cost . Journal of Chemotherapy . 21 . 1. 46–51 . 10.1179/joc.2009.21.1.46. 19297272 . 20534190 .
  25. Web site: Reducing Antibiotic Exposure . Thermo Fisher . 3 December 2021.
  26. February 2003. Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA. 289. 7. 885–8. 10.1001/jama.289.7.885. 12588273. Neuhauser MM, Weinstein RA, Rydman R, Danziger LH, Karam G, Quinn JP. free.
  27. Web site: Studies examine prescribing of antibiotics for respiratory infections in hospital emergency departments . U.S. Department of Health and Human Services . USA . From 1995 to 2002, inappropriate antibiotic prescribing for acute respiratory infections, which are usually caused by viruses and thus are not responsive to antibiotics, declined from 61% to 49%. However, the use of broad-spectrum antibiotics such as the fluoroquinolones, jumped from 41% to 77% from 1995 to 2001. Overuse of these antibiotics will eventually render them useless for treating antibiotic-resistant infections, for which broad-spectrum antibiotics are supposed to be reserved. . https://web.archive.org/web/20090507021140/http://www.ahrq.gov/research/nov07/1107RA29.htm . 7 May 2009 .
  28. Web site: Fluoroquinolone Resistance and Tuberculosis Treatment . The New York City Department of Health and Mental Hygiene . USA . 31 October 2009 . 7 November 2012 . https://web.archive.org/web/20121107023619/http://www.nyc.gov/html/doh///html/tb/tb4a.shtml . dead .
  29. Demelker. R. A. Green. L. A. Van Buchem. L.. Grob. P.. Heeren. T.. July 1997. Antimicrobials for acute otitis media? A review from the International Primary Care Network. The BMJ. 315. 7100. 98–102. 10.1136/bmj.315.7100.98. 2127061. 9240050. Froom J. Culpepper L. Jacobs M. 3.
  30. Hartmann. Erica. Hickey. Roxana. Hsu. Tiffany. Roman. Clarisse. Chen. Jing. Schwager. Randall. Kline. Jeff. Brown. G.. Halden. Rolf. Huttenhower. Curtis. Green. Jessica. Antimicrobial Chemicals Are Associated with Elevated Antibiotic Resistance Genes in the Indoor Dust Microbiome. Environmental Science & Technology. 50. 18. 20 September 2016. 9807–9815. 10.1021/acs.est.6b00262. 27599587. 5032049. 2016EnST...50.9807H.
  31. Web site: Cipro, Related Antibiotics Over-Prescribed, Fueling Microbe Resistance . University of California . USA . 1 October 2002 . 13 August 2009 . 30 January 2014 . https://web.archive.org/web/20140130074010/http://www.universityofcalifornia.edu/news/article/4786 . dead .
  32. K. Bassett . B. Mintzes . V. Musini . T.L. Perry Jr . M. Wong . J.M. Wright . November 2002 . Therapeutics Letter . Canadian Family Physician . 48 . https://web.archive.org/web/20200414051555/https://www.cfpc.ca/cfp/2002/Nov/_pdf/vol48-nov-critical-2.pdf . 2020-04-14 . Gatifloxacin and moxifloxacin have no proven clinical advantages over other fluoroquinolones, macrolides, or amoxicillin. Based on cost, they are not first-choice drugs for their approved indications. .
  33. Ziganshina. Lilia E.. Titarenko. Albina F.. Davies. Geraint R.. 2013-06-06. Fluoroquinolones for treating tuberculosis (presumed drug-sensitive). The Cochrane Database of Systematic Reviews. 2013 . 6. CD004795. 10.1002/14651858.CD004795.pub4. 1469-493X. 23744519. 6532730.
  34. August 1997. Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics. The BMJ. 315. 7104. 350–2. 10.1136/bmj.315.7104.350. 2127265. 9270458. Little P, Gould C, Williamson I, Warner G, Gantley M, Kinmonth AL.
  35. March 1997. Antibiotics: neither cost effective nor 'cough' effective. The Journal of Family Practice. 44. 3. 261–5. 9071245. Hueston WJ.
  36. Mayo Clinic
  37. Levin. Liran. Elad. Sharon. American Heart. Association. December 2008. Dentists' knowledge and implementation of the 2007 American Heart Association guidelines for the prevention of infective endocarditis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 106. 6. e16–9. 10.1016/j.tripleo.2008.08.009. 19000604. Zadik Y. Findler M. Livne S. 3.
  38. March 2011. Survey of acceptance of the 2007 American Heart Association guidelines for the prevention of infective endocarditis: a pilot study. Quintessence Int. 42. 3. 243–51. 21465012. Elad S, Binenfeld-Alon E, Zadik Y, Aharoni M, Findler M.
  39. Lockhart. P. B.. Baddour. L. M.. Levison. M.. Bolger. A.. Cabell. C. H.. Takahashi. M.. October 2007. Prevention of infective endocarditis: guidelines from the American Heart Association. Circulation. 116. 15. 1736–54. 10.1161/CIRCULATIONAHA.106.183095. 17446442. Wilson W. Taubert KA. Gewitz M. 3. free.
  40. News: No prescription needed to obtain antibiotics from almost half of online sites, study shows. 19 March 2017. Pharmaceutical Journal. 17 February 2017.
  41. Web site: Rutgers study finds antibiotic overuse is caused by misconceptions, financial incentives. Sasha. Barnes. The Daily Targum.
  42. Accounting for variation in and overuse of antibiotics among humans. Martin J.. Blaser. Melissa K.. Melby. Margaret. Lock. Mark. Nichter. 16 February 2021. BioEssays. 43. 2. 2000163. Wiley Online Library. 10.1002/bies.202000163. 33410142. 230811912.
  43. 2022-05-27 . 3 days' antibiotic is effective in childhood pneumonia . 2022-06-08 . NIHR Evidence . 10.3310/nihrevidence_50885 . 249937345 . en-GB.
  44. Barratt . Sam . Bielicki . Julia A. . Dunn . David . Faust . Saul N. . Finn . Adam . Harper . Lynda . Jackson . Pauline . Lyttle . Mark D. . Powell . Colin VE . Rogers . Louise . Roland . Damian . 2021-11-04 . Amoxicillin duration and dose for community-acquired pneumonia in children: the CAP-IT factorial non-inferiority RCT . Health Technology Assessment . EN . 25 . 60 . 1–72 . 10.3310/hta25600 . 34738518 . 243762087 . 2046-4924. free .
  45. Web site: Are antibiotics turning livestock into superbug factories?. 2017-09-28.
  46. Web site: Ban on antibiotics as growth promoters in animal feed enters into effect. European Commission. Brussels . December 2005.
  47. Web site: Beth Ferry . Madonna Benjamin . Megan Sprague . 2016 . Don't wait, be ready! New antibiotic rules for 2017 . Michigan State University Extension .
  48. CDC

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