FP Report -- 1999 Post-Assembly Edition
Antibiotic resistance emerging as major public health problem
More must be done to control the growth of antimicrobial resistance among community-acquired pathogens, and family physicians can play an important role in this campaign, according to Benjamin Schwartz, M.D., deputy director of the Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention.
"The emergence of antibiotic resistance, a consequence of widespread and inappropriate antibiotic use, is a significant and troubling infectious disease threat," Schwartz said on his Assembly lecture Sept. 17 in Orlando, Fla. He announced a national campaign initiated by the CDC to promote more judicious use of antibiotics.
"I have subtitled my lecture 'An Individual Response' because this is a problem that every individual health care provider must face," he said.
He emphasized that FPs should be concerned about this problem because:
- Antibiotic resistance is a serious clinical problem that leads to adverse outcomes.
- Unnecessary prescribing of antibiotics not only endangers the health of individual patients but also is a threat to the community at large.
Abuse of antibiotics has resulted in resistant nosocomial infections, resistant foodborne infections and resistant community-acquired infections, Schwartz said. Population-based surveillance has indicated that in some areas of the United States, more than 30 percent of pneumococci strains are not susceptible to penicillin, with more than half of these being highly resistant.
"Resistance is a global problem," he said. "With international travel so common today, any of the selection of resistant pathogens plaguing various parts of the world could be presented to you in your office at any time."
Studies indicate that in recent years, some 75 percent of all outpatient antibiotic prescriptions in the United States have been issued for five conditions: otitis media, acute sinusitis, bronchitis, pharyngitis and the common cold.
"With international travel so common today, any of the selection of resistant pathogens plaguing various parts of the world could be presented to you in your office at any time."
--Benjamin Schwartz, M.D.
The CDC's campaign to decrease unnecessary prescribing focuses on educating both the public and health care providers, Schwartz said. Campaign strategies are to improve patient compliance with antimicrobial therapy, to improve antibiotic selection and dosing by physicians, and to decrease the overall use of antibiotics. At several demonstration sites, he said, active promotion of recommendations for diagnosis and management of respiratory infections and use of patient education materials have led to a 20 percent decrease in antibiotic use.
"Physicians often report that they are pressured by patients to prescribe unnecessary antibiotics," Schwartz said. "Therefore, an improved understanding by the general public, as well as a realization by physicians that patient satisfaction does not depend on prescribing an antibiotic, should help physicians in their efforts to restrict the overuse of antibiotics."
Rates of antimicrobial drug use are highest in children, Schwartz noted. Also, high income has been shown to be a significant risk factor for antibiotic-resistant infections, he said, a fact most likely related to access to health care.
"One key to judicious use of antibiotics is to make an appropriate distinction between acute otitis media and otitis media with effusion, and to use shorter courses of antibiotic therapy in uncomplicated cases of otitis media," Schwartz told the FPs.
Also, he said, prophylaxis for otitis media should be limited to recurrence, defined as three or more distinct and well-documented episodes every six months or four or more episodes every 12 months.
"The CDC has estimated that following principles for judicious use of antibiotics would prevent some 50 million unnecessary antimicrobial prescriptions annually in the United States," he said.
Schwartz pointed out that research data from other countries, and research on nasopharyngeal carriage of resistant pneumococci in the United States, suggest that reducing the spread of resistant bacterial pathogens through appropriate use of antibiotics is possible.
"The battle can be won," Schwartz said. "By using antibiotics more judiciously and by selecting treatment regimens that are less likely to select for resistant strains, trends in antimicrobial resistance can be changed or even reversed."
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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