Antibiotic overuse remains a health care concern
By Shannon Harsh, The Review, Published April 17, 2013
A new study released by the Centers for Disease Control and Prevention (CDC) suggests one of the health care issues facing the U.S. is the overuse of antibiotics.
The study, which analyzed a national prescription drug database for 2010, found that doctors prescribed 258 million courses of antibiotics, with the most common being azithromycin. The problem is, health officials say, these drugs are not always needed.
Alliance Community Hospital pharmacists agree the overprescribing and overuse has been a problem in recent years.
ACH Clinical Pharmacy Specialist Christopher P. Shelby, who also serves as an assistant professor at Northeast Ohio Medical University, said the problem is patients are often given an antibiotic when they visit their doctor for a cough, cold or some type of respiratory infection, but more than half of those illnesses are caused by viruses rather than bacteria, which means antibiotics won't help.
"People go into the doctor's office and they want the doctor to do something, so they're not happy unless they leave there with a prescription," Shelby said. "Doctors understand the implication of this, but they're also in the business of serving that patient, so patients will leave with an antibiotic that they might not necessarily need."
Paul Witkowski, director of pharmacy at ACH, said one of the dangers of antibiotics is that in addition to the bad bacteria, they kill off good bacteria that our bodies need, which can lead to unintended consequences.
"Our entire body is covered with bacteria -- our mouth is filthy with bacteria all the way to our intestinal tract, which has a substantial amount of bacteria," Witkowski explained. "So, we live in constant balance with normal bacteria. And anytime you take an antibiotic, it creates a disruption in that normal bacteria -- something that may be significant or something that may be insignificant."
He said the loss of good bacteria may cause things like diarrhea or a fungal overgrowth.
Witkowski said another issue with antibiotic overuse is that it can lead to medication-resistant bacteria, or "super bugs."
"You have bacteria that are sensitive and bacteria that are resistant, so it's going to kill off the ones that are most sensitive and leave behind the ones that are a little stronger -- a little more resistant -- so then they can have a tendency to take over," Witkowski said. "Now that bacteria that you have is a little bit stronger, a little more potent and a little more resistant to the antibiotic they were just on."
Shelby said that is especially true in places like hospitals because of the amount of antibiotics that are used.
"What we try to do as pharmacists is we try to be good stewards of antibiotics and use them appropriately when needed, but not unnecessarily," Shelby said. "So, if we have an infection that we know is caused by one type of bug, we're going to use the rifle -- we're going to use one bullet to kill that one bug. If we've got an infection that could be caused by 50 different bugs, we'll use the shotgun approach (broad spectrum antibiotic). Once you find out what the bug is, that's when you dial it down and only use something specific to that one bug that's causing the problem. So, that helps reduce some of that resistance that you can get and the production of those super bugs."
The other thing that leads to overuse is when people use old antibiotics that have been collecting dust in the medicine cabinet or something prescribed to someone else for an issue that they haven't had diagnosed by their doctor.
Shelby said just because your doctor told you to take it doesn't mean it's right or safe for a loved one. "There's a lot of things that go into prescribing medicines, and even when the pharmacists are looking through the medicines at the drugstore where you're getting those, they're checking to make sure that is the right medicine for you -- that it's appropriate for you with the other things that you take," he explained. "With the multitude of medicines that people take nowadays, there's a lot of times that you can get a bad mix of medicines. If you take something that doesn't agree with something that you're already taking, you can run into some issues with that."
Witkowski noted it can be tricky to diagnose whether an illness is caused by a virus or bacteria because of the subtle differences in symptoms, which is why it should be left up to the physician. He added that trusting the physician's advice is an important part in preventing antibiotic overuse. "Trust your doctor's diagnosis. If your doctor says you don't need an antibiotic, trust it," he stressed.
To help spread that same message, Witkowski said a lot of physicians' offices now have signs that tell patients not to expect an antibiotic for everything. He said they are trying to change the expectation, which has been a challenge for the past 30 years.
In the hospital setting, Shelby said stewardship programs are being put into place to make sure that all the antibiotics that are being used are the most appropriate ones and that they aren't being used unnecessarily. "There's definitely a shift to be more conscious of that to help prevent the development of those resistant bugs, unnecessary treatment and unnecessary consequences," he added.
Despite the issues that can arise from overuse, Shelby stressed the importance of antibiotics to treat illnesses. "Antibiotics are lifesavers. If you need one, you need one, but if you don't need one, you don't need one, and that's what we're trying to avoid -- the overuse," he said.