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Antibiotic Use: An Update

Tuesday, 07 October 2008 11:11
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Antibiotic Use: An Update
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A Look at the Usage

The introduction of antibiotics, once hailed as "miracle drugs" in the 1940’s is reminiscent of the words of William Heberden when he wrote 200 years ago that "new medicines, and new methods of cure, always work miracles for a while" (1). Today, the widespread and often inappropriate use of antibiotics within the last 50 years has contributed to the emergence of bacteria that are resistant to not just one but several types of antibiotics. As a result, parents and healthcare professionals alike are confronted with challenges to diagnosis and treatment options, rising healthcare costs and an increased risk in patient morbidity and mortality particularly with the very young and the very old.

An informed public, the medical profession and non-allopathic healthcare practitioners recognize the disturbing trends in antibiotic resistance and now feel a sense of urgency in addressing the problem. For the medical profession, there is the recognition that antibiotic prescribing by its practitioners are often inappropriate. For example, it has been estimated that approximately 20-50 percent of antibiotic prescriptions in hospital (with 190 million defined daily doses annually) and community (with 145 million defined doses annually) settings are believed to be unnecessary.

The resulting resistant pathogens are staphylococci, enterococci and gram-negative rods, pneumococci, gonococci, group A streptococci, E. coli and mycobacterium tuberculosis (2). Schwartz et.al. (3) attributed these prescribing patterns to unreasonable patient demands and expectations, inadequate time to explain to parents why antibiotics are unnecessary and misdiagnosis of nonbacterial infections. Another study by Butler et.al. (4) found that even when physicians know that the use of antibiotics has marginal efficacy (if any), antibiotics are still prescribed to maintain good relationships with their patients. Harrison and Lederberg (2) summarized the factors responsible for inappropriate antibiotic prescribing by medical doctors.(See Fig.1)

After reviewing the factors, I was not surprised by the reasons associated with inappropriate antibiotic prescribing by medical doctors. I see lack of patient education (5), selfish personal and professional incentives as well as a general lack of confidence in their ability to provide adequate care for their patient as reasons why medical doctors inappropriately depend on and prescribe antibiotics.

Perhaps the challenges faced by the medical profession with respect to the problem of antibiotic-resistant pathogens is reflective of the problems faced by the medical profession in general. It is beyond the scope of this paper to address all the patient conditions treated in a family practice setting wherein antimicrobial agents may be prescribed inappropriately. The following information is a sampling of the problem and is provided for the reader so that they may be better informed.