Overprescribing antibiotics creating "superbugs."

USA Today (Society for the Advancement of Education), Oct, 1996

Antibiotic-resistant pathogens are emerging at an alarming rate and treatment options are shrinking, warns Terrance O. Kurtz, chief epidemiologist at Des Moines (Iowa) General Hospital and associate professor of internal medicine at the University of Osteopathic Medicine and Health Sciences College of Osteopathic Medicine and Surgery. In fact, some pathogens have developed strains that are so resistant to antibiotics that physicians are resorting to experimental drugs in an attempt to eradicate these organisms.

"Resistance is nothing new, but it's more of a concern now than it was in the previous two decades because it is occurring so rapidly," Kurtz indicates. Drug resistance is increasing among viruses, bacteria, fungi, and parasites. The U.S. Centers for Disease Control and Prevention (CDC) has reported a significant increase in resistance to vancomycin hydrochloride, an antibiotic used to treat nosocomial (hospital) infections. How should physicians handle the problem of drug resistance? According to Anthony Silvagni, dean of the University of Health Sciences College of Osteopathic Medicine, they must slow the spread of resistance to antibiotics, especially considering the speed with which common pathogens are adapting to these drugs. "The incidence of penicillin resistance in Streptococcus pneumoniae is now 25 to 35%. Just a few years ago, there was no resistance at all."

Epidemiologists have discovered that growing resistance to potentially life-saving drugs can be attributed to misuse of broad-spectrum antibiotics; increasing use of prosthetics and invasive diagnostic and therapeutic procedures; growing consumer demand for antibiotics; patients, failure to follow instructions for antibiotic therapy; routine use of penicillin in cattle and chicken feed; and lax rules governing the use of antibiotics in other countries. While both physicians and patients are to blame for some antibiotic-resistance, "it's not always somebody's fault," says Robert M. Fleigelman, director of the Infectious Disease Section, St. Francis Hospital, Blue Island, III. "Not all antibiotic resistance is preventable. Any use of antibiotics can potentially lead to the development of resistance." Health experts agree, however, that misuse and overuse of antibiotics has contributed greatly to the growing problem.

Many hospitals have responded to concerns about misuse by establishing more stringent prescribing policies. In some institutions, broad-spectrum antibiotics can be prescribed only by infectious disease specialists; the antibiotics can be prescribed. "By restricting the use of some antibiotics, we can stem the tide of resistance until new antibiotics hit the market," indicates Anthony F. Ognjan, chief of infectious diseases, Mount Clemens (Mich.) General Hospital.

Hospital laboratories are reducing antibiotic misuse by providing doctors with detailed information about the microorganisms that are causing infections and the drugs to which the organisms are susceptible. Physicians are learning to structure drug therapy so that patients with multiple risk factors (age, alcohol use, or existing disease) might receive a broader-based antibiotic, while those with few risk factors would receive a narrow-spectrum drug.

Control of antibiotic use in the outpatient setting is much more difficult. "Many physicians who have been in practice a long time have bad habits," Kurtz explains. "We all get used to using certain antibiotics. If an antibiotic does the job for us, we use it, even if a more specific antibiotic is available." He suggests that physicians refrain from prescribing by phone, favoring an office visit and appropriate tests to confirm a diagnosis before dispensing medication.

Meanwhile, patients who currently view antibiotics as "cure-alls" must learn that aches and sniffles associated with common colds and flu do not respond to antibiotic therapy. In addition to demanding drugs, patients are contributing to the rise in antibiotic resistance through noncompliance. According to a Gallup Poll released by the American Lung Association in 1995, more than half of American adults who receive antibiotics fail to take all prescribed doses of the drugs. Though they were instructed by their doctors to do so, most stopped after they began feeling better. Another two-thirds of those surveyed indicated that they forgot when they were supposed to take their medications, and 75% indicated that taking the drugs several times a day for up to two weeks was inconvenient. For patients with M tuberculosis, compliance has become a public health issue. "Nearly half the cases of multi-drug-resistant tuberculosis are caused by noncompliance," notes Ronald J. Servi, Good Samaritan Regional Medical Center, Phoenix, Ariz. "The other half are caused by the spread of multi-drug-resistant strains of M tuberculosis." The resurgence of TB poses a particular threat. While some strains are resistant to just one drug, others are showing resistance to many antituberculous medications and some strains are resistant to nearly all antibiotics. In an effort to slow its spread, patients infected with TB are being placed in programs where health care workers directly supervise patients and actually watch them take their medication. Health experts fear that the rise and spread of antibiotic-resistant TB and other potentially life-threatening pathogens may push medical technology back 50 years. As they attempt to solve this growing problem, many are supporting the implementation of preventive measures such as vaccinations that will protect patients from infectious microorganisms and recommending against prescribing antibiotics whenever possible.