The overuse of antibiotics in human patients and farm animals has been linked to the development of so-called “superbugs” that are resistant to most traditional antibiotics. In a new report, the Centers for Disease Control and Prevention presents the “worrisome” news that hospitals are increasingly turning to stronger and broad-spectrum antibiotics to treat patients.
The study, published this morning in JAMA Internal Medicine, looked at data on antibiotics use at around 300 acute care hospitals over the course of six years, from 2006 through 2012.
Interestingly, the CDC found no significant change in overall antibiotics use during this time, even though researchers and public health advocates have called for physicians to be prudent about providing antibiotics only to patients who need them.
What did change, however, were the antibiotics being used.
While the use of more traditional antibiotics like penicillin and first- and second-generation cephalosporins declined, a number of other drug categories increased in use. These included a 37% increase in the use of carbapenems, a type of antibiotic usually reserved for patients exhibiting resistance to multiple antibiotics. The data collected doesn’t tell researchers whether hospitals upped their use of these drugs to treat resistant infections or as a response to concerns about the possibility of such infections.
“This trend is worrisome in light of the rising challenge of antibiotic resistance,” concludes the report.
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Vancomycin, a particularly harsh antibiotic of last resort, likewise saw a 27% increase in use during the six-year period. This is likely attributable, note the researchers, to the drug’s effectiveness in treating methicillin-resistant Staphylococcus aureus (MRSA).
One antibiotic class that saw a steep drop in use was fluoroquinolones, a group that includes ciproflaxicin. While it remained the most frequently used class of antibiotics in hospitals in 2012, the use of fluoroquinolones sank by 20% during the time period of the study.
The researchers can’t say for certain, but believe that this is likely due to increasing resistance to this popular class of drugs. A recent CDC report found that fluoroquinolone resistance in gonorrhea patients had jumped from nearly 0% to around 20% since 2000.
In an editorial accompanying the CDC study, Drs. Ateev Mehrotra and Jeffrey Linder of Harvard Medical School ask why physicians are sometimes all too willing to write prescriptions for antibiotics that aren’t needed.
“The overuse of antibiotics is not a knowledge problem or a diagnostic problem; it is largely a psychological problem,” reads the report. “We, as physicians, want to appear capable to our patients and not give the impression they have wasted either our time or their own. In addition, it feels easier for us as physicians to do something now rather than wait for a problem to arise.”
So when a doctor doesn’t know for certain if a bacterial infection is what’s making a patient ill, they may nonetheless prescribe antibiotics “just to be safe” because it “feels like it decreases the chance of serious complications.”
It can also be easier and more expeditious, write Mehrotra and Linder, for a physician to simply prescribe an antibiotic to a patient who is expecting one rather than having to go through the process of explaining why that might be a good idea.
“In contrast, the reasons against antibiotic prescribing, such as antibiotic resistance and concerns about complications, are remote and less emotionally salient,” explains the editorial. “Given the clear imbalance in this tradeoff, it is not surprising that many physicians inappropriately prescribe an antibiotic.”
by Chris Morran via Consumerist