We live in the antibiotic era of medicine.
The development of these potent weapons in the arsenal against infectious disease in the early part of the last century transformed the landscape of human health. This was rivaled perhaps only by the coincident development of vaccines to prevent common infectious diseases.
Unfortunately, the progress we have made in treating infectious diseases, especially those caused by bacterial illness, may be at risk of reversal. Our reckless overuse of antibiotics is creating a crisis of antibiotic resistant microbes. In some instances, these antibiotic resistant bugs are even more potent in causing disease than their non-resistant forebears.
In August 2015, the U.S. Centers for Disease Control and Prevention reported that 2 million Americans are infected and 23,000 die each year from antibiotic-resistant organisms. It doesn’t have to be this way.
The report identified inappropriate antibiotic prescribing practices by providers as one of the most important modifiable risk factors for antibiotic resistance. In a single year, health care providers prescribe more than 262 million courses of antibiotics, which is about 84 courses per 100 Americans per year.
Not only do providers overprescribe antibiotics, they often choose antibiotics that are unnecessarily strong for the infection that is being treated. These so-called “broad-spectrum” antibiotics are like using a cannon when sometimes only a BB gun is needed.
I am pleased to report that health care providers are now taking responsibility and taking the lead on this important issue. Earlier this month, the American College of Physicians, which represents internists, partnered with the CDC in issuing a clinical guideline about appropriate antibiotic use. The guideline included advice to health care providers about high-value care involving the management of acute respiratory tract infections.
Among the recommendations was guidance that the diagnosis of bronchitis does not typically require antibiotics and that antibiotics should not be prescribed for the common cold.
Many people operate under the mistaken impression that antibiotics will help all respiratory infections or that most are caused by bacteria. Both are false. Most acute respiratory infections, particularly in otherwise healthy people, are actually caused by viruses, for which antibiotics are ineffective. Moreover, many such viral infections produce symptoms from 10 to 12 days and will resolve on their own. Even most sinus symptoms do not require antibiotics.
It might seem like health care providers bear all the responsibility for this problem of antibiotic overprescribing. Yet, patient expectations often influence this behavior. Providers report that obtaining antibiotics is often part of patient agenda during visits for respiratory illness. There is also concern that failing to prescribe antibiotics may decrease patient satisfaction.
What is needed is an honest conversation about what is and what is not likely to help in a given situation. I’ve found that open communication most often produces the best and most mutually-agreeable choice.
It is clear that we all need to think about how we can reduce antibiotic use so that antibiotics are still useful when we really need them.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.
