Antibiotic resistance affects 2 million people in the United States and led to an estimated 23,000 deaths in 2015, according to the CDC.
AAFP President Wanda Filer, M.D., M.B.A., (left) was a panelist in a discussion about antibiotic resistance and its implications for patient treatment hosted by The Atlantic.
It is a problem with a wide array of contributing factors -- ranging from improper use of antibiotics in agriculture to overuse in patient care -- but health officials say awareness is high.
"Antibiotic resistance is one of the most serious public health threats of our time," Beth Bell, M.D., M.P.H., director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases, said at a forum The Atlantic hosted(www.youtube.com) last week to address the issue. "It threatens modern medicine. We know that antibiotics overuse drives resistance."
Family physicians can make a major contribution to a solution, and AAFP President Wanda Filer, M.D., M.B.A., of York, Pa., spoke about that role as a panelist at the forum. From a family medicine perspective, Filer said patients are more aware of the issue but physicians still have to manage patient expectations.
"The public demand for antibiotics has dropped," Filer said. "I do not see the push for antibiotics that I used to see. I think the public is getting the message."
- Antibiotic resistance now affects two million people in the U.S. and led to an estimated 23,000 deaths in 2015.
- AAFP President Wanda Filer, M.D., M.B.A., spoke about family physicians' role in a solution at a forum hosted by The Atlantic.
- Filer said she has seen patient demand for antibiotics drop as awareness spreads.
Still, she said, many patients walk into a physician's office expecting to receive medication. But when a patient complains of a head cold and mentions that coworkers or family members have the same symptoms, a family physicians can have an honest conversation about his or her needs based on their long-term relationship.
"Reaching for the antibiotic is not usually going to help you," Filer said, noting that such illnesses often are viral and patients will usually overcome them in a week or two without a prescription.
Georges Benjamin, M.D., executive director of the American Public Health Association, said reducing reliance on prescriptions will require a change in expectations among patients and a change in behavior among physicians. Patients need to stop expecting a prescription when they see a physician.
"That is why they came to see you," he said. "When you have to tell a patient they don't need an antibiotic, that is a difficult conversation."
Barry Eisenstein, M.D., who specializes in antimicrobials at Merck Inc., said one way to move away from heavy use of antibiotics would be to develop a diagnostic tool that could help physicians identify what type of infection a patient might have. He recalled a conversation with an executive of a diagnostic company who told him that while the technology is available, there is no financial incentive for such a tool. And, Eisenstein said, there are no economic incentives to continue developing antibiotics to treat acute illnesses.
"From a business standpoint it is completely understandable why the pharmaceutical industry has gotten out of the antimicrobial business," he said. "Antibiotics are acute drugs, used for short periods of time. You can't gain lifelong use as you can for Alzheimer's, cholesterol or depression."
The problem of antibiotic resistance is international in scope, given the interconnected nature of food distribution. In India, for example, physicians rely on colistin, an older antibiotic, to treat infections that cannot be addressed with other medications. It is considered a "last ditch" treatment, according to Bell. However, a colistin-resistant organism(www.thelancet.com) that has appeared in animals and humans in China now poses a serious health threat to India.
Promoting growth in animals used for food is a common use of antibiotics, a policy that panelists agreed was harmful in the long term. In 2012, more than 32 million pounds of antibiotics sold in the United States were used for food animals, according to an analysis by the Pew Charitable Trusts.(www.pewtrusts.org)
"Our goal is not to eliminate the use of antibiotics in agriculture," said William Flynn, deputy director for science policy at the FDA's Center for Veterinary Medicine. "Our goal is to eliminate the inappropriate use of antibiotics."
The FDA released new regulations(www.fda.gov) that are scheduled to take effect in January 2017 to ensure greater supervision over the use of antibiotics in animals used for food.
Antibiotics used for human health will not be permitted for use in animals without a veterinarian's supervision.
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