July 2015
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Did You Know?

The Dangers of Antibiotic Misuse

Patient Experience
Now Trending

Here are some common myths about antibiotics.

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  • #11215 Antibiotic Resistance: Respiratory Corollaries
  • #71915 Begin with the Endpoints in Mind: A Focus on the Utility of Inappropriate Prescribing Criteria
  • #71815 Rapid Diagnostics and Antimicrobial Stewardship
  • #71114 Medication Use Evaluation: YOU Can Shift the Paradigm

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Did You Know?

The Dangers of Antibiotic Misuse

Alarming rates of inappropriate antibiotic prescribing and use, and antibiotic resistant superbugs have been the focus of several recent reports highlighting the need for serious action to change the way antibiotics are used. In May, data published in the Journal of American Medical Association (JAMA) by the Centers for Disease Control and Prevention (CDC), in collaboration with Pew Charitable Trusts and other public health and medical experts, showed that at least 30% of antibiotics prescribed in the U.S. are unnecessary. These total more than 47 million unnecessary prescriptions each year for conditions usually caused by a virus, which do not respond to antibiotics, such as: colds, sore throats, bronchitis and sinus and ear infections. This puts patients at needless risk for allergic reactions, deadly diarrhea caused by Clostridium difficile (CDI) and creates a serious threat to public health by increasing antibiotic resistant infections that can be passed from person to person. According to the CDC, superbugs kill 23,000 Americans a year and sicken 2 million.

In May, a study published in Antimicrobial Agents and Chemotherapy, a publication of the American Society of Microbiology, revealed a strain of E. coli (CRE) resistant to the antibiotic, colistin – reserved as a drug of last resort - was recently found in a Pennsylvania woman. This is the first time this resistant strain of E. coli has been found in a person in the U.S. The CDC has called CRE among the country’s most urgent public health threats. Researchers are primarily concerned that the colistin-resistant gene could spread to other bacteria making them resistant to the same drug. CDC Director, Tom Frieden, said in an interview, “It basically shows us that the end of the road isn’t very far away for antibiotics - that we may be in a situation where we have patients in our intensive care units, or patients getting urinary-tract infections, for which we do not have antibiotics.”

There are over 15 different classes of antibiotics that differ in their chemical structure and action against bacteria. The nature of some bacteria makes them naturally resistant to certain antibiotics. The greatest concern, however, is that bacteria that are normally susceptible to certain antibiotics have developed, or are developing, resistance at an alarming rate – and in some cases, to more than one class of antibiotic.

Antibiotic resistance can occur in two ways: 1) by genetic mutation, which is a natural occurrence, or 2) by acquiring resistance from another bacterium. When exposed to an antibiotic, bacteria with resistant properties survive, multiply and pass their resistant properties to other bacteria. The more frequently antibiotics are used, the more opportunities bacteria have to develop defenses to them. When antibiotics are incorrectly prescribed or used – for too short a time, or too small a dose, at inadequate strengths or for the wrong disease – bacteria are more likely to survive and are vulnerable to acquiring resistant properties. Infections caused by resistant bacteria often result in:

  • More serious illness – even death
  • Prolonged recovery
  • Longer hospitalization
  • Less effective and more invasive treatments
  • Higher costs

In March 2015, The Obama Administration released The National Action Plan for Combating Antibiotic-Resistant Bacteria, which is a five year plan for public and private entities requiring coordinated efforts around the world to prevent and contain outbreaks of antibiotic resistant infections, and maintain the efficacy of current and new antibiotics and other therapies. The plan includes activities to improve prescribing practices across all healthcare settings and calls for establishment of Antimicrobial Stewardship Programs (ASPs) in all acute care hospitals. Studies show that 20-50% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate. A goal of the plan is a reduction of inappropriate antibiotic use in inpatient settings by 20% by the year 2020. Hospital ASPs are known to:

  • Increase the frequency of correct prescribing
  • Increase infection cure rates
  • Reduce treatment failures
  • Reduce adverse events
  • Reduce rates of CDI and antibiotic resistance, and
  • Reduce costs

According to the CDC, core elements of a successful hospital ASP are:

  • Leadership Commitment – Dedicating necessary human, financial and information technology resources
  • Accountability – Appointing a single leader responsible for program outcomes
  • Drug Expertise – Appointing a single pharmacist leader responsible for working to improve antibiotic use
  • Action – Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e. “antibiotic time out” after 48 hours)
  • Tracking – Monitoring antibiotic prescribing and resistance patterns
  • Reporting – Regular reporting information on antibiotic use and resistance to doctors, nurses and relevant staff, and
  • Education – Educating clinicians about resistance and optimal prescribing

The Patient Experience

There is clear evidence that antibiotics should not be prescribed for most upper respiratory symptoms consistent with colds, flu, sinusitis and bronchitis, but about 70% of patients from 1996 to 2010 received them for these conditions. So, why are providers authorizing their use if they aren’t effective and could be harmful? Research shows that a major reason is because patients are asking for them and providers with pressure to perform well on patient experience surveys are giving in to their demands. A study to evaluate the perceived effects of patient satisfaction ratings on clinical care, published in Patient Preference and Adherence in 2014, reported that half of physicians surveyed said they had ordered inappropriate tests and prescribed inappropriate antibiotics or opioid pain medications as a result of patient satisfaction scores.

Patients need frequent communication, reminders and education from trusted healthcare professionals on the appropriate use of antibiotics and the health risks associated with misuse. The CDC recommends these actions:

  • Explain that unnecessary antibiotic use can be harmful (e.g. adverse effects associated with antibiotic use, potential resistance development)
  • Explain that treating viral infections with antibiotics does not work
  • Explicitly plan treatment of symptoms by describing the expected normal course of the illness and instruct patients to call or come back if symptoms persist or worsen; consider providing care packages with non-antibiotic therapies
  • Educate patients if an antibiotic is needed, encourage adherence and discuss potential adverse effects
  • Create an environment that promotes a reduction in antibiotic use through videos, posters and other materials in waiting and exam rooms
  • Reinforcement of the message by staff and personnel

Zgierska A, Rabago D, Miller MM. Impact of patient satisfaction ratings on physicians and clinical care. Patient preference and adherence. 2014,8:437-446. Doi: 10.2147/PPA S59077

Protecting Patients and Stopping Outbreaks


Recommended Readings


Now Trending

Here are some common myths about antibiotics.

Myth #1 – Antibiotics can cure any type of infection.

Myth #2 – You should stop taking an antibiotic when you feel better.

Myth #3 – Antibiotic resistance means the body becomes resistant and no longer responds to a drug.

Myth #4 – Only people who frequently use antibiotics are at risk for antibiotic resistance.

Myth #5 – It’s OK to take leftover antibiotics if you get sick again.

Myth #6 – It can’t hurt to take an antibiotic just in case.

Myth #7 – Combining antibiotics is the best way to cure an infection.


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