Antibiotics are the go-to treatment for many types of infections. Doctors prescribe them, and/or patients demand them, for a wide variety of ailments. However, antibiotics are a mixed blessing. Are antibiotics helpful or harmful? Sometimes they don’t help you recover, sometimes they can make you sicker, and collectively they are causing great harm.
Doctors are prescribing too many antibiotics.
To learn more about antibiotic prescription use, researchers examined the medical records for over 19 million patients. They classified the appropriateness of an antibiotic prescription as related to diagnoses. What they found is troubling. They discovered that:
- 23.2% of prescriptions are likely inappropriate – given when the diagnoses almost never justify the use of antibiotics.
- 35.5% potentially appropriate – given for situations in which antibiotics could be appropriate.
- 12.8% were considered appropriate – given for conditions that almost always respond well to antibiotics.
- 28.5% had no diagnosis code in the record on which to base any judgment.
And the numbers for “likely inappropriate” or “potentially inappropriate” are probably conservatively low since the researchers were lenient in their categorizations. The study’s lead author, Dr. K. Chua, thinks these numbers are “likely just the tip of the iceberg.”
Furthermore, antibiotic use is widespread in hospitals, but often unnecessary. Researchers found that about 1/2 of all hospitalized patients receive antibiotics during their stay. But research shows that “a substantial proportion of antimicrobial use in US acute care hospitals may be inappropriate, based on factors such as lack of indication or incorrect drug selection, dosing levels, or treatment duration.”
Antibiotics can harm hospitalized patients.
A study of almost 1,500 patients at Johns Hopkins found that 20% of patients developed at least 1 antibiotic related adverse drug event (ADE). These events include abnormalities or harm to the gastrointestinal, skin, musculoskeletal, blood, kidney, cardiac, and neurological systems. Sounds fun, right?
The research found that 20% of those who developed an ADE received antibiotics that were not clinically necessary. Seven of these patients developed a dangerous C difficile infection. Researchers found that each 10-day course of antibiotics increased the risk of patients getting an ADE by 3%. The longer patients take antibiotics, the greater their risk of developing a dangerous adverse reaction.
Fortunately, none of the patients in the study died from their ADE. However, it is possible for serious harm or death to occur from these types of events.
Antibiotic-resistant superbugs – a growing problem.
The overuse of antibiotics has led to the rise of antibiotic-resistant superbugs that, as the name suggests, do not respond to treatment. There is speculation that antibiotic-resistant superbugs may kill more people than cancer in the coming decades.
The Centers for Disease Control (CDC) estimates that in the US, “more than two million people are sickened every year with antibiotic-resistant infections, with at least 23,000 dying as a result. The estimates are based on conservative assumptions and are likely minimum estimates.”
It’s a global issue.
The overuse of antibiotics is an international concern. The World Health Organization (WHO) just released guidelines that provide advice on “which antibiotics to use for common infections and which to preserve for the most serious circumstances.” The goal of these new guidelines is to “ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections.”
Can the antibiotic problems be solved?
WHO expects their guidelines will improve patient outcomes, reduce the development of drug-resistant bacteria, and maintain effectiveness of “last resort” antibiotics that are essential when all other options don’t work.
Of course, it could be awhile before we see improvements in this regard. Doctors and other clinicians will have to change their prescribing habits. Furthermore, patients will have to stop demanding antibiotics even when advised against it.
The authors of the Johns Hopkins article sum up the problem in their statement: “Although antibiotics may play a critical role when used appropriately, our findings underscore the importance of judicious antibiotic prescribing to reduce the harm that can result from antibiotic-associated ADEs.”
What can you do?
Follow these recommendations to reduce your risk of antibiotic related problems and to help reduce global antibiotic resistance:
- First of all, try to avoid getting infections so you won’t need antibiotics. According to the CDC, you can prevent drug-resistant infections by:
- receiving recommended immunizations (talk to your doctor)
- safe food preparation
- regular handwashing with soap and water
- using antibiotics as directed and only when necessary
- When prescribed an antibiotic, ask if it is necessary, or if the doctor is prescribing it as a precaution. If the doctor is giving an antibiotic as a precaution, ask if there are other options.
- Use antibiotics only as prescribed – take the appropriate dosage each day and be sure to take all the medication.
- If you are taking antibiotics and miss a dose, ask your doctor what to do.
- Never take leftover antibiotics or another patient’s antibiotics.
- Don’t pressure your doctor to give you an antibiotic. If your doctor doesn’t think you need them, ask for advice for managing your symptoms.