Antibiotics were long considered to be one of the miracles of modern medicine, yet because of frequent overuse and the emergence of new forms of bacteria, the miracle is beginning to fade.
Jonathan Perlin, M.D., center, president of the Hospital Corporation of America, discusses the overuse of antibiotics during a White House event as CDC Director Tom Frieden, M.D., M.P.H., observes from the podium.
Now antibiotic resistance and inappropriate use of antibiotics are major public health concerns. To address some of the pitfalls associated with antibiotics, the Obama administration hosted the White House Forum on Antibiotic Stewardship(www.whitehouse.gov) this month. AAFP President Robert Wergin, M.D., of Milford, Neb., represented family physicians at the event.
"As we marvel at the advancements in medicine today, it was only 70 years ago that a cut to the hand could lead to death," HHS Secretary Sylvia Burwell said during the event.
But because of this advancement, 252 million Americans a year -- five out of six citizens -- receive a prescription for antibiotics. That rate is twice as high as Sweden's and three times higher than the Netherlands'. And CDC Director Tom Frieden, M.D., M.P.H., who moderated the event, said only half of those prescriptions were medically necessary.
- Antibiotic resistance and inappropriate use of antibiotics are major public health concerns, with 2 million people infected with drug-resistant bacteria each year.
- President Obama proposed doubling the amount of funding for prevention of antibiotic resistance in the 2016 budget to $1.2 billion.
- AAFP President Robert Wergin, M.D., highlighted how better coordination with family physicians could be part of the solution.
Currently, 2 million people are infected with antibiotic-resistant bacteria each year, and those illnesses cause about 23,000 deaths annually, according to the CDC. President Obama has proposed doubling the amount of funding for prevention of antibiotic resistance in the 2016 budget to $1.2 billion.
"We're not entering the post-antibiotic world, we're living in it," said Burwell.
Federal officials and panelists at the White House event identified two areas of focus:
- judicious use of antibiotics so they are not prescribed when no medical need exists, and
- encouraging farms and food-production businesses to reduce or cease their use of antibiotics to enhance animal growth.
Both are positions the AAFP supports.
Jonathan Perlin, M.D., president of the Hospital Corporation of America, noted that given patient expectations for antibiotics, the medical community needs to change both patient behavior and its own distribution practices.
"Increasingly, patients adopt the unfortunate belief that they need an antibiotic when they are not necessary," said Perlin.
Oftentimes, prescribing antibiotics is the result of a physician being cautious.
"There is an element of doubt about a diagnosis, so physicians do not want to miss something and have an adverse outcome," Wergin told AAFP News after the meeting.
Diagnostic tools that medical labs are developing to allow physicians to review blood tests and recognize sepsis earlier than traditional techniques made possible may help avert this type of overuse. Wergin said such tools, accessible by phone or tablet, could bolster a physician's confidence about a particular diagnosis.
Better coordination of care with a family physician is another solution, he added. Often, the most vulnerable point for inappropriate use or overuse comes when a patient is transferred from a hospital to a nursing home and continues to take antibiotics.
"Patients go from one setting to another, and antibiotics are continued for too long," Wergin said.
Continued supervision by the patient's primary care physician also could reduce potential overuse.
"In primary care and family medicine, having a trusting relationship with the patient provides an opportunity for education," Wergin said. "Antibiotics can be harmful. There may be more prudent treatment. You can tell the patient to follow up in three days and consider an antibiotic if their condition does not improve."
Several medical institutions have pledged to support the White House initiative by reducing the use of antibiotics in the near future. Ascension Health will establish antimicrobial stewardship programs in all of its hospitals and submit antibiotic use and resistance data to the CDC. Intermountain Healthcare in Utah plans to reduce outpatient antibiotic use for upper respiratory conditions by 50 percent by 2020.
All panelists who participated in the White House event agreed that data collection regarding antibiotic use needs to improve. The Department of Veterans Affairs now requires its facilities to report antibiotic use to the CDC. Pending legislation would require reporting the use of antibiotics in food-producing animals to the FDA. The World Health Organization recently adopted an action plan to require all nations to create a plan to counter antibiotic resistance as the United States has done.
Another factor that could be contributing to antibiotic resistance is the high use of human antibiotics in livestock to promote faster growth. In response, President Obama directed federal agencies to give preference to meat and poultry producers that use antibiotics responsibly, and the White House announced steps that corporations are taking to cut down on inappropriate use.
Tyson Foods, for example, pledged to eliminate the use of human antibiotics from broiler chicken flocks by 2017. The distributor will work with independent farmers to reduce antibiotic use on cattle, hog and turkey farms.
Walmart also is asking its meat and poultry suppliers not to use antibiotics to promote animal growth. In addition, the retailer began asking its suppliers to report on how much antibiotics they use annually.
"Antibiotic stewardship is a shared responsibility," said Frank Yiannas, vice president of food safety for Walmart. "The battle against antibiotic resistance is a winnable battle."