It’s hard to dispute the claim that antibiotics are one of the miracles of the modern age. I don’t even hesitate to use the word miracle to describe them; the effect of antibiotics has been so vast and drastic. Diseases like scarlet fever and pneumonia which were often deadly less than one hundred years ago can now be cured quickly, with little danger. Antibiotics have revolutionized the way that we live; yet, ironically, the overuse of these life-saving drugs may soon cause us to revert back to a society in which a bacterial infection was unstoppable.
It seems like the dangers of overuse of antibiotics are becoming common knowledge. At the very least, awareness is rising about the development of antibiotic resistant bacteria—diseases for which we run out of options. It is known that antibiotics should only be taken for a bacterial infection and that, when they are taken, the recommended dosage should be completed. It is known that if they’re taken too often, or the prescribed treatment plan isn’t completed, there is a greater chance for the pathogens to develop resistance to the antibiotic, rendering the antibiotic useless. Given this knowledge it stands to reason that antibiotic use should be going down across the country.
But is it?
A recent study published in JAMA Internal Medicine states quite the opposite, with frightening implications. Its assertion that from 2006-2012 antibiotic prescription remained basically constant is almost the most reassuring part of the results. Far more worrisome was the discovery that during those six years, prescription of broad-spectrum antibiotics like cephalosporins and beta-lactam inhibitors had risen very significantly, and that 55.1% of all patients who enter a hospital will leave after having taken at least one dose of an antibiotic. This seems to be the first broad study done on this topic, and it’s causing scientists and doctors to fear that this could mean the evolution of more and more antibiotic resistant bacteria.
One of the troubling aspects of this study is that the antibiotics being most overused are broad-spectrum antibiotics in which one antibiotic is used for many different kinds of bacterial infections. Scientists worry that this could lead to the development of bacteria which are broadly resistant to other antibiotics. Ironically, the authors of the study believe that one of the reasons why usage of these broad spectrum antibiotics is increasing is as a reaction to the fact that these bacteria are more and more often becoming resistant to other antibiotics.
Another aspect of the problem is over-prescription—fifty-five percent of hospital patients receive at least one dose of antibiotics before being released. Additionally, antibiotics are administered on 775 out of every 1000 days in hospitals. For many of these patients, antibiotics weren’t necessary. These numbers don’t even include the many people who take antibiotics for off-label uses or without the prescription of a medical professional. In a statement to Reuters Health, Dr. Ateev Mehrotra of Harvard Medical School said that he doesn’t believe that this is particularly due to doctors’ cluelessness or mistakes, saying, “Doctors are human, they’re worried, they’re behind, they’re concerned about what the patient wants.” If a patient demands antibiotics, a doctor may feel compelled to prescribe them even against his or her better judgment. Dr. James Baggs, the lead author of the JAMA Internal Medicine study, adds that some of these unnecessary prescriptions can be due to doctors prescribing before all medical results have come in, misdiagnoses, and general unawareness of treatment guidelines. Dr. Mehrotra told the press that rather than change antibiotic administration protocols, psychological tactics should be pursued. Doctors should be asked to explain why they have prescribed so many antibiotics in the past, with the hope that they will think twice before prescribing in the future.
Some scientists, worried about the rise in antibiotic resistance, are starting to think about what should been done in a potential post-antibiotic world. Most efforts are devoted to making sure that that era never comes, whether by trying to curb inappropriate antibiotic use or by creating more antibiotics as previous ones become obsolete. However, there have been notable efforts by ethnobotanists (who examine the chemical structures of medicinal plants) to find antibiotics and other antibacterial agents that will distribute harmful bacteria into inert clumps rather than killing them.
While antibiotics and their ability to consistently and effortlessly defeat pathogenic bacteria are wonderful, we should be careful not to rest on our laurels. We should certainly be hopeful about the innovations and plans being forged to make sure that we continue to be safe from these diseases and we should make sure to finish our courses of antibiotics. But remember: for bacterial infections only.