CDC Says Antibiotic Overuse Leads To Antibiotic-Resistant Bacteria

Antibiotics
Antibiotics effectively treated bacterial infections, and severe viral infections. You may not need them otherwise. Iqbal Osman, CC BY 2.0

The Centers for Disease Control and Prevention (CDC) and the American College of Physicians have come together to warn health care providers of the dangers associated with overprescribing antibiotics.

Antibiotics are prescribed at more than 100 million adult ambulatory care visits annually and 41 percent of these prescriptions are for respiratory conditions, the CDC and ACP wrote in a recent study published in the Annals of Internal Medicine. Perhaps most commonly antibiotics are prescribed to treat acute respiratory tract infections (ARTI) — this includes acute bronchitis, respiratory tract infection, pharyngitis, rhinosinusitis (sinus infection), and the common cold. The problem is antibiotics are only effective when used as intended.

Study authors conducted a narrative review of evidence about appropriate antibiotic use when it comes to ARTI syndromes, including current clinical guidelines from leading professional societies. And despite improvements made in recent years, authors found that antibiotics are often prescribed for adults when they are not needed.

For example, adults don’t need antibiotics if they have a viral infection — they don’t work in the majority of cases. Antibiotics treat bacteria, like the kind that causes strep throat and food poisoning. Different approaches are required to treat viruses, like the common cold and flu. That's why something like the CDC's "symptomatic prescription pad" exists (sample here). The pad was designed to help health care providers appropriately treat bacterial and viral infections.

If patients have a virus, the pad lists the methods preferred over antibiotics: Drink extra water and juice; use a cool mist vaporizer or saline nasal spray to relieve congestion; and, if it’s a viral sore throat, look to ice chips, sore throat spray, and lozenges (for older children and adults).

There are a couple of exceptions: Antibiotic therapy is useful to patients with bronchitis if health care providers also suspect pneumonia, and in patients with persistent acute rhinosinusitis (10 days).

"Antibiotics are terrific. Thank God we have them for really bad things," Dr. Wayne J. Riley, president of the American College of Physicians and an internal medicine professor at Vanderbilt University American College of Physicians, told the Associated Press (AP). "But we need to be judicious in the way we use them."

Overprescribing antibiotics can also lead to antibiotic-resistant bacteria. Each year in the United States, the CDC cites at least two million people become infected with antibiotic-resistant bacteria; at least 23,000 die each year as a direct result of these infections.

In fact, it’s become such a problem that back in March 2015, the White House announced its national action plan to slow the emergence of resistant bacteria and infection. The CDC has also declared an annual week-long observance of the matter in November, called "Get Smart About Antibiotics."

Study authors suggest clinicians label bronchitis as a "chest cold" or a "viral upper respiratory infection" as a way to promote appropriate antibiotic use, in addition to providing patients information sheets regarding antibiotic use and alternative methods to help manage symptoms.

They also recommend the CDC's symptomatic prescription pad, so patients can “walk away with a plan of action.”

"When it is unclear whether an antibiotic is needed, delayed or postdated antibiotic prescriptions (also known as the wait-and-see approach) offer the possibility of future antibiotic treatment if the condition does not improve," the authors added. "This approach has also been shown to increase patient satisfaction and decrease antibiotic use."

To reduce antibiotic prescriptions on a larger scale, it’s going to require a multidimensional approach, one that spans from the community, to provider-level interventions and opportunities for feedback.

"Although it is everyone's responsibility to use antibiotics appropriately, providers have the power to control prescriptions," the authors concluded. "Reducing inappropriate antibiotic prescribing will improve quality of care, decrease health care costs, and preserve the effectiveness of antibiotics."

Source: Harris AM, Hicks LA, Qaseem A. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Annals of Internal Medicine. 2016.

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