Author – Ramanan Laxminarayan, Ph.D.,
director of Extending the Cure (ETC)
Patients in the United States are among the most intensive users of antibiotics in the world, but you may be surprised to learn that overall per capita outpatient antibiotic prescribing in the United States has decreased in recent years. In fact, between 1999 and 2007, the number of dispensed antibiotic prescriptions per thousand inhabitants dropped from 975 to 858 – a 12% decline.
Extending the Cure’s ResistanceMap shows new visualizations documenting this downward trend in prescribing. But enthusiasm should be tempered by some troubling patterns of antibiotic use.
For example, while penicillins still account for one out of every three antibiotic prescriptions filled, the use of more powerful, broad-spectrum antibiotics is increasingly rapidly. Dispensing of one powerful class of antibiotics, fluoroquinolones, increased by 49% over the time period.
To a certain extent, the increase is warranted by the emergence of drug resistance to other antibiotic therapies. However, doctors often indiscriminately turn to fluoroquinolone antibiotics because they are broad-spectrum and therefore effective against a range of bacterial infections.
But it is precisely because quinolones are powerful and widely effective that we should be using them prudently. Their effectiveness is much like a shared resource that we all benefit from. Already, resistance to fluoroquinolones among E. coli samples in the United States has risen from just 3.3% in 1999 to 21.74% in 2010.
The situation with fluoroquinolones demonstrates the perils of antibiotic resistance. As dangerous resistant organisms like carbapenem-resistant Klebsiella pneumoniae (CRKP) and multidrug-resistant Acinetobacter baumannii continue to spread globally, we need to ensure that we don’t lose our effective antibiotics to resistance.
The first step is to stop using antibiotics when they are not indicated, such as for treatment of viral illnesses including cold and flu. But ResistanceMap also shows how stewardship messages will need to be tailored to different classes of antibiotics, as well as to geographical regions. The maps highlight vast regional variations in use – in some areas of the Southeast, antibiotic dispensing levels are twice those in the Pacific states. Experience from Europe has shown how targeting these high-consumption regions with information campaigns can aid conservation efforts.
Research remains to be done to determine how and why variations in prescribing patterns emerge. “Get Smart Week” is an important reminder to think twice before using antibiotics and preserve these life-saving therapies for future generations.