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Preserving Antibiotic Effectiveness: Everybody’s Responsibility

Posted on by CDC's Safe Healthcare Blog
Ramanan Laxminarayan, PhD.
Ramanan Laxminarayan, PhD

Guest Author – Ramanan Laxminarayan, PhD
Director, Center for Disease Dynamics, Economics & Policy

To many, antibiotic resistance may seem like an evergreen issue that reappears in the news cycle periodically. However, recent reports of the emergence and spread of carbapenem-resistant Enterobacteriaceae, described in CDC’s March 2013 Vital Signs Report remind us that we stand at the threshold of the post-antibiotics era and that we have a responsibility to bring broader attention to this serious public health threat.

In November of last year, a group of 26 organizations came together to sign the Joint Statement on Antibiotic Resistance, an agreement that put forth bold principles for protecting our current supply of working antibiotics while urging the development of new ones. Among the goals listed is the need for continued efforts to educate a wider audience about the looming danger of running out of effective antibiotics.

Last week, Extending the Cure released an animated video that explains in clear and engaging terms how antibiotic resistance emerges, what it costs to society, and why antibiotics must be conserved as a communal resource, like water and trees.

The video explains the link between individual responsibility to use antibiotics appropriately and its effect on the likelihood that we will collectively have effective antibiotics. It is a call to action that encourages parents, patients, and doctors to limit their antibiotic use in order to preserve the effectiveness of these drugs for generations to come.

As a community of public health professionals, we have a responsibility to respond to this crisis as it unfolds. While CDC and healthcare experts are doing more every year to promote rational prescribing at US hospitals and primary care providers, initiatives like Get Smart Week and this video are making sure consumers can meet them half way and internalize the message of responsible antibiotic use. Let’s not pass the buck. We are all responsible for whether future generations will have effective antibiotics.

Posted on by CDC's Safe Healthcare Blog

22 comments on “Preserving Antibiotic Effectiveness: Everybody’s Responsibility”

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    I review residents in a rehab facility after they have been hospitalized. I do not see a reduction in the use of antibiotics in the hospitals, even after the labs are back. There are normal WBC rates, negative urine and blood cultures and negative chest xrays, yet they continue with high dose broad spectrum antibiotic use. I am always happy to see an infectious disease MD consulted, and the result is usually DC the antibiotic therapy. The patients that are seen by resident MD’s in the hospital, rather than a personal primary care physician, usually have a higher use of antibiotics without a confirmed diagnosis. Until physicians are taught in medical school and residency programs to be more selective we are not going to see a decrease in antibiotic usage.

    Dear Mickey,
    Clinical practice guidelines are increasingly being optimized to shorten antibiotic courses, ranging from common outpatient indications such as urinary tract infections, to serious nosocomial infections such as ventilator-associated pneumonia. Cutting unnecessary days of therapy and saying no in cases where bacterial infections can be reasonably ruled out is a cornerstone of rational antibiotic use that many physicians may have been less insistent on in the past. That being said, use of cultures and the development of cheaper and faster diagnostic methods should be advocated as a way to safely navigate the fine line between suspicion of serious infection and the need to conserve antibiotics.

    Dear Salisu,
    We could not agree more. Infection control should be a priority, as most healthcare associated infections (HAIs) are preventable. Unfortunately, it is often more cost-effective for an individual hospital to fall back on antibiotics as a cheaper substitute for infection control. We need more research to support cost-effective infection control interventions. In addition, some of the work we have done has shown that HAI prevention strategies need to be implemented in a coordinated, centralized manner to see the most benefit.

    Dear Sally,
    We completely agree that patients should not be blamed single-handedly, particularly when taking an antibiotic is warranted. The development of resistance is an inevitable consequence and a necessary cost to using these drugs to fight infections. However, everyone needs to take responsibility to minimize that collective cost – patients should not insist on a prescription for self-resolving viral infections; clinicians should make sure their prescriptions are appropriate, and that they can explain their decision in clear and simple terms to patients. Progress on this patient-prescriber relationship is already evident in primary care, where rates of antibiotic use among children are steadily decreasing as pediatricians and parents are becoming more judicious.

    Dear Ellen,
    Our video acknowledges that agricultural use is a big part of the problem. We agree that the issue merits more attention, and that regulatory, veterinary and industry partners need to work together to gather more data and promote judicious antibiotic use in food animals.

    Dear Yesenia,
    Pseudomonas infections have always posed a significant treatment challenge to physicians. One reason why they are not in the news as often may be that they still affect a relatively small and contained set of critically ill patients in intensive care. Another may be that, although difficult to treat, the proportion of resistant Pseudomonas aeruginosa clinical isolates has remained relatively constant over the past decade, in contrast to other emerging MDROs.

    Dear Bridget,
    You have very appropriately referred to urinary tract infections (UTIs) and long-term care in your example. Two out of three nursing home residents receive antibiotics, and a third of those are for UTIs. Most (30-50%) of these are to treat conditions that may yield a positive bacterial culture, but do not require antibiotics in the first place. Educational interventions have been shown to have a positive impact on improving rational use. A lot of work remains to be done as facilities are so different, but the encouraging news is that CDC’s GetSmart campaign is now turning towards long-term care: tailored educational materials were distributed to nursing home prescribers during the latest campaign last fall.

    Dear Remy,
    The point you make about antibiotics “that may be harmful” ultimately is very relevant and should be made clearer to patients who blindly insist on a prescriptions. Despite their reputation as generally safe drugs, antibiotics can have dangerous side effects: adverse reactions to antibiotics account for over 140,000 ED visits annually, and drugs such as Cipro or Levaquin commonly used to treat pneumonia and complicated UTIs have had to carry a ‘Black Box’ warning due to increased risk of tendon ruptures.

    Dear Sam,
    Physician competition is certainly part of the explanation why professionals otherwise aware of drug resistance may still needlessly prescribe an antibiotic. There has been interesting research from abroad ( to support this, and some forthcoming work from Extending the Cure will test this hypothesis domestically. An effective way to change misaligned incentives is to focus on the demand side by making patients aware of the true cost of antibiotic use. Physicians will not compete to prescribe if patients do not see this as an advantage. Our video, CDC’s Get Smart campaign and any other initiatives that educate the public about the collective burden of resistance are a stride in that direction.

    Mr. Swol, We are sorry to hear about your recent stroke. We hope you experience a fast and full recovery.
    We have passed this information onto the New York State Health Department. Thank you for following the Safe Healthcare Blog.

    I agree with REMY! Please note that much focus seems to be placed on the hospitals. Many hospitals are far ahead of the curve on stemming antibiotic resistance. The bigger problem is in the community and the lack of education for the General Practitioners and Consumer. We need to curb the behavior of society wanting a pill (antibiotic) for every sniffle or cough or burn on urination. Oral antibiotics are prescribed in much more quantity by General Practitioners and Family Medicine. The Physician Assistant and Nurse Practioners are an ever growing prescribing population that adds to the risk. Prescribing antibiotics for viral or allergy symptoms is inappropriate and many are prescribed with steroids!

    Yes, I agree with much of the above stated material; however, as an old timer I must say there are many problems with the antibiotic issue we face today. In the last few decades too many new antibiotics have been produced that have little or no use. In some cases the number of dosages and their strengths is far too little. Gone are the days when you were prescribed 1 tab (or cap) qid for 7 to 10 days; often you may have gotten a stat dose of 2 pills to start with; of course if after 4 or 5 days you felt better and stopped the balance of the medication, you risked helping the bacteria develope immunity to the antibiotic. Today too many prescribers are against antibiotics even when required and too often will prescribe small amounts and almost never do culture testing. It seems we had fewer problems in the past than we now face today even with the numerous amounts of new products on the market. Indeed some are not at all efficacious but continue to be used even without positive results.

    Public awareness of the threat of antibiotic resistance is still far behind where it needs to be. Increased public education efforts are needed.

    I agree there should be less use of antibiotics but I think too much of the blame is being put on patients. Most of the US population either is on a medication that lowers immunity or has a disease that lowers their immunity and they need antibiotics.

    Some day you will all have the courage to talk about agricultural use, which dominates are clinical uses in the US

    I have a problem that when patients come to the practice and see me, an Advanced Practice Nurse Practitioner and I do not in my professional experience (25 years in practice) feel they need an antibiotic, they then go to my collaborating physician who gives them one. I have spoken to him about this and he insists, “Always make the patient happy so they will come back.” I do not think this subject is “out there” enough such as on television programs and in newspapers such that consumers can truly understand the danger in this blossoming resistance.

    I am a registered nurse who has worked the last 18 years in critical, acute and long term care. A good many of these years were spent as a travel nurse, and working per diem as an agency nurse locally. Hence, I have been to many facilities and without exception in long term care the minute someone is acting “different ” they get a UA and start antibiotics. I realize change in level of orientation is often a clue to an underlying UTI but many of these do come back negative, or by the time we get the sensitivity back it is often the wrong antibiotic. We must educate nurses, physicians and all healthcare personnel to get the facts before needlessly treating one with meds that are not called for. With the high incidents of CDiff in long term care I would think this thinking would be automatic. I love your website, your articles, and the work you do. I constantly quote your articles but this practice of prescribing first, test later continues. How about a healthcare bulletin to all long term care facilities. Or get JACHO in on reducing needless use.
    Thank you.

    Dr. Laxminarayan,
    Pseudomonas aeruginosa deserves perhaps equal attention, yet for some reason at most GACH’s its seen as nuisance of no importance. Please share your thoghts on this. Thanks for your blog above, I agree we do need to be more vigilant.

    There is need for all Healthcare providers pay good attention on this aspect of antibiotics resistance.All healthcare settings should give priority to infection prevention and control this will bring a good solution to this.

    I agree with the limited use of antibiotics. We have seen the surge of using antibiotics even consumers demanding antibiotics when their problem or illness may not be related to a need for antibiotics. But a cold virus or something that does not need to be treated with antibiotics but most physicians will relent to this demand for fear of being sued or making their patients unhappy and unsatisfied with the service and the provider having a negative review in practice. We do need to strongly educate the patients and families that not most sniffles and coughing need antibiotic treatment even if they think they need them. Yes, patient-centered care but that does not mean they can dictate us with things that may be harmful to them instead of helping them. We have to educate, educate and educate everyone including our families and friends!!!

    I was a recent patient at one of our local hospitals in Rochester, N. Y.
    I was admitted due to a mild stroke. When I got into the room, my
    husband and I were shocked to see that medication vials had been left
    on the tray table. The column of the tray table was filthy with brown
    matter and there were dust balls all over the floor. I asked to have some
    one from housekeeping come in and clean with a disinfectant. My husba-
    nd cleaned the drawers of the small dresser and wiped the phone and the
    call button. It was disgusting.
    I also had a problem with my medication. I take 13 pills in the A M
    and they need to be given at certain times. I always carry a 3+5 card
    with me indicating the meds and times. This was put into the computer
    and STILL was not done right. I asked to speak to the CEO of the RGH
    and he never bothered to come to my room or send an assistant. I was
    forgotten about. It was a nightmare. They need to be investigated and
    put on report.

    I think the real reason is the overuse of antibiotics and growth hormones injected into the chickens and cows and pigs. And the use of GMO plants that are dangerous to humans and animals! This nonsense has to stop!
    Thanks for listening.

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