Francesca Tomasi received her B.A. from the University of Chicago and currently does microbiology research.
Last week, the CDC published a study with a disturbing conclusion: at least one third of antibiotics prescribed in the United States are unnecessary. The data came from an analysis of antibiotic use in doctors’ offices and hospitals across the country. The most common case of improper prescription was the administering of antibiotics to people with respiratory conditions caused by viruses, which do not respond to antibiotics. Antibiotics are medications that only treat bacteria. Nonetheless, people with the common cold, flu, and virus-caused sore throats, bronchitis, and sinus infections were prescribed antibiotics. The CDC estimated that about 47 million prescriptions every year should never have been made in the first place. That’s 47 million cases where individuals are put at risk of increasing the population of antibiotic-resistant bacteria in their bodies, of developing serious illnesses like diarrheal disease from Clostridium difficile, and of having allergic reactions or adverse side effects to strong drugs.
The data were pooled and sorted by age, location, and diagnosis. Antibiotic misuse was highest in the South and in young children. The latter point is especially critical, as antibiotic use early in life has significant implications on microbiome development throughout childhood and early adulthood. In the western United States, the yearly antibiotic prescription rate was estimated to be about 423 prescriptions per 1,000 population compared with 553 per 1,000 in the South. Alarmingly, annual rates for infants aged 0 to 2 years old were highest in these two regions with the West looking at 1,071 prescriptions per 1,000 infants and the South at 1,492 per 1,000. The national average for infants is 1,287 prescriptions per 1,000.
The most commonly mistreated condition is respiratory illness, for which the study estimates almost half of antibiotic prescriptions are inappropriate. Other conditions were pretty high up there as well. Consider this: according to the study, about 37% of pediatric sore throats are caused by the bacterium Streptococcus, which causes strep throat, an illness that should be treated with antibiotics. In adults, strep throat accounts for about 18% of sore throats. Meanwhile, 56.2% of children and 72% of adults complaining of sore throat in the US are given antibiotics. These rates far exceed the incidence of bacterial-caused sore throat; virus-caused sore throats are much more common.
As with any research study, this one has its limitations. This time, however, the limitations were likely to cause underestimation of unnecessary prescription rates as opposed to what we would rather see in this situation, an overestimation. Several outpatient settings that prescribe antibiotics were excluded from the study such as urgent care facilities, retail and federal clinics, and dental offices. Furthermore, other conditions in which antibiotic misuse may take place were excluded from the study. These include infections that are more typically caused by bacteria, such as urinary tract infections and pneumonia, but that can also be caused by viruses.
In order to reach a more appropriate rate of antibiotic prescription (baseline as defined by the CDC based on the lowest antibiotic prescription rates in the country not correlated with adverse infection outcomes), clinics and hospitals need to reduce inappropriate antibiotic prescription by about 15% over the next 5 years. Local and federal efforts, such as the CDC’s Antibiotic Stewardship Program, are being stepped up to reach this goal. Last year, the Obama administration released the 2015 National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), which aims to halve antibiotic use by the year 2020. Of course, this doesn’t mean doctors should start refusing antibiotics to patients with a bacterial infection. Instead, this calls for more thorough diagnostics and more stringent “probable cause” rules for prescribing antibiotics to treat infections for which a quick diagnosis is not possible. On another note, healthcare providers are occasionally pressured by patients to prescribe antibiotics. For instance, individuals who can’t seem to shake a cold, or parents with children complaining of sore throats and ears often just ask for the antibiotics so they or their children can feel better as soon as possible.
Antibiotic misuse is a serious problem that affects literally everybody, and it is a problem that will not go away until everyone – patients and healthcare providers – does their part in reducing misuse. Older generations today may remember a time when antibiotics were not yet widespread and people often succumbed to illnesses and infections that today can be treated in under a week with antibiotics. If we aren’t careful, however, antibiotic-resistant organisms will continue to emerge and take over and we will run out of easy treatments for basic infections, being forced to turn to second and third-line drugs which are a lot stronger and a lot more toxic. Antibiotics: they're meant for use, not abuse.