The Dark Side of Antibiotics

Why the CDC is advising hospitals to scale back on prescriptions.

National Journal
Brian Resnick
March 5, 2014, midnight

The Cen­ters for Dis­ease Con­trol and Pre­ven­tion wants hos­pit­als to is­sue few­er pre­scrip­tions for an­ti­bi­ot­ics. Why? Be­cause the drugs that are sup­posed to make people feel bet­ter are be­ing ab­used, ac­tu­ally caus­ing ill­ness, and hasten­ing the ar­rival of in­fec­tions for which medi­cine has no cure.

That’s not to say the CDC wants to cut the drugs from treat­ment en­tirely. A bac­teri­al in­fec­tion still re­quires an­ti­bi­ot­ics. Rather, the CDC wants to stifle the ap­prox­im­ately 30 per­cent to 50 per­cent of an­ti­bi­ot­ic treat­ments that the or­gan­iz­a­tion deems un­ne­ces­sary or in­ap­pro­pri­ate. The CDC also want doc­tors to make smarter dos­ing de­cisions when an­ti­bi­ot­ic use is ap­propi­ate. 

An­ti­bi­ot­ics can cause CDI (C. dif­fi­cile in­fec­tion), a diarrhea “that of­ten re­curs and can pro­gress to sepsis and death,” as the CDC re­port re­leased Tues­day reads. CDI oc­curs when an­ti­bi­ot­ics throw off the nat­ur­al bal­ance of healthy bac­teria in the di­gest­ive tract.

In the study, the CDC pre­dicted that de­creas­ing an­ti­bi­ot­ic use by 30 per­cent would lead to a 26 per­cent de­crease in CDI. By the CDC’s es­tim­ate, that would im­prove the out­comes of 65,000 people. Fur­ther­more, the cen­ter found that one in three pre­scrip­tions for ur­in­ary tract in­fec­tions con­tained a po­ten­tial er­ror (“giv­en without prop­er test­ing or eval­u­ation, or giv­en for too long”), and some hos­pit­als pre­scribe an­ti­bi­ot­ics at rates three times as high as oth­ers.

But those prob­lems seem small when you con­sider the loom­ing threat of the over­use of an­ti­bi­ot­ics — the rise in dis­eases that do not re­spond to the drugs at all.

As re­por­ted in Septem­ber, the CDC es­tim­ates that 23,000 people a year die of such dis­eases. And bar­ring in­nov­a­tion in phar­ma­ceut­ic­als (which is lag­ging far be­hind ad­vance­ments in oth­er cat­egor­ies of drugs) or re­duc­tion ef­forts as out­lined in this cur­rent re­port, that num­ber is likely to rise.

The CDC is head­ing up an ef­fort to bet­ter track the spread of an­ti­bi­ot­ic res­ist­ance, and the Obama ad­min­is­tra­tion’s 2015 budget provides $30 mil­lion over the next five years to set up re­gion­al labor­at­or­ies to mon­it­or out­breaks.

There’s an in­ev­it­ab­il­ity to drug-res­ist­ant bac­teria, even with new ad­vances in the sci­ence. “Nature will take its course wherever an­ti­bi­ot­ics are used,” Jean Pa­tel, a re­search­er in mi­cro­bi­al res­ist­ance at the CDC, told me in Septem­ber. 

But the phar­ma­ceut­ic­al in­dustry is not even pro­du­cing those new drugs that could buy some time.

As The At­lantic demon­strates in its March is­sue, ap­provals of new an­ti­bi­ot­ic drugs are at their low­est levels in 30 years.

(The At­lantic)

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