Drugs are more expensive—and therefore more often out of reach for many Americans—than ever. This you probably already know. But there’s one type of drug that seems to be everywhere: antibiotics. Nothing, it seems, could be easier than getting your hands on a prescription for azithromycin or penicillin.
A recent study by the Centers for Disease Control and Prevention (CDC), reported in the New England Journal of Medicine, backs this up with shocking numbers: Four out of five Americans got a prescription for an antibiotic in 2010. That amounts to 258 million courses of the drugs (keep in mind there are only about 309 million Americans total). What’s even more worrisome is that researchers estimate that half of these prescriptions weren’t even needed.
Among the drugs most commonly overprescribed were penicillin drugs, which kill bacteria by breaking down bacteria cell walls, and macrolides, a type of antibiotic that stops bacteria from growing. Azithromycin, a macrolide antibiotic frequently used to combat bronchitis, pneumonia, and sexually transmitted diseases, was the most-prescribed antibiotic.
Prescription rates aren’t the same across the country, the CDC study of 2010 data found. Southern states—West Virginia, Kentucky, Tennessee, Louisiana, Mississippi, and Alabama—had the highest antibiotic prescription rates, while the western and northwestern states—California, Oregon, Washington, Alaska—had lower rates. You’re also more likely to get a prescription for an antibiotic if you’re under 10 years old or over 65.
You may be wondering where the problem is. Antibiotics kill bacteria, and that’s a good thing, right? And doctors wouldn’t be prescribing the drugs if they weren’t useful, no? Here’s the upshot: Improper use of antibiotics—meaning prescribing antibiotics when they aren’t actually needed—can spread antibiotic resistance. That means that the bugs the drugs are meant to fight are getting stronger and stronger—while at the same time our supply of antibiotics that can fight these more powerful bacteria is becoming more and more limited. And there is good evidence, according to the CDC, that many of the prescriptions we get for these drugs aren't useful or necessary.
So how did we get here? In 1928, Alexander Fleming was attributed with discovering the antibiotic properties of penicillin, which is derived from a fungus. Fleming himself had been motivated by his experience with war; he saw the devastating effects that bacteria could have and wanted to combat them. By the time penicillin was discovered and scientists could prove its beneficial effects in humans World War II was underway. By the end of the war, U.S. chemical companies were producing 650 billion units of penicillin each month. Penicillin changed the way we thought about bacterial infections, leading us to believe we could, finally, conquer them.
By the 1960s, the U.S. was feeling very confident about who’d be on the winning side of bacteria. Former Surgeon General William H. Stewart supposedly declared that it was “time to close the book on infectious diseases.” And no one even today would dispute that the development of antibiotics has had a profound effect on treating infectious diseases in people. However, doctors will also tell you that microbes are far older, far more prevalent, far more adaptable, and reproduce much faster than humans. So we would be wise to be a little more humble in our approach to this battle with microbes. In fact, according to the World Health Organization, infectious diseases still remain within the top 10 leading causes of death worldwide.
Perhaps most important to understand is that most of these microbes will evolve to defeat our antibiotics. Today we see frightening cases of MRSA (methicillin-resistant staphylococcus aureus), multi drug-resistant tuberculosis, and gonorrhea, for starters. There are some bacteria that are simply not vulnerable to our antibiotics, due to genetic mutations or acquiring genes from other, stronger bacteria. These bacteria will survive antibiotic treatment and multiply—passing on their resistance.
But it’s not as if everything to do with resistance is beyond our control. A lot of the antibiotic resistance we see is the result of how we use these drugs. Antibiotics are only effective against bacteria, and not just any antibiotic can be used to treat any bacterial infection. When an antibiotic is used improperly—especially when the sickness is actually caused by a virus, or if the patient stops taking antibiotics when their symptoms stop, rather than when all the bacteria has been killed—the bacteria that’s present in the body now knows a little something more about surviving attacks from antibiotics.
We have a finite amount of resources with which to fight microbes and unfortunately there’s relatively little research being done by drug companies to find new and better bacteria-fighters. Why? The U.S. has an aging population and the market for chronic disease drugs is simply better. Many infectious diseases can be relieved with only a few doses of a medication, whereas chronic diseases require long-term treatment, making drugs for chronic diseases more profitable.
So what do we do? The Alliance for Prudent Use of Antibiotics (APUA), a group based at Tufts University, calls antibiotic resistance a “societal problem,” in part because antibiotic resistance affects entire communities. Resistant bacteria can be spread from person-to-person and costs the healthcare industry billions. The APUA suggests that people practice good hygiene (yep, that means lots and lots of hand-washing), take antibiotics only when truly needed (when you have a bacterial infection, not a viral one), and carefully follow dosage instructions (finish up that entire prescription!).
Why do you think antibiotics continue to be so overprescribed? Are you afraid of getting an infection and being without an effective antibiotic to treat it?
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The Disease Daily is created by a team of medical doctors, veterinarians, and public health professionals who believe that infectious disease news should be accessible and comprehensible to everyone. As a publication from HealthMap at Boston Children's Hospital, The Disease Daily has access to real-time reporting of infectious disease events all over the world. While HealthMap alerts thecommunity to the outbreaks, The Disease Daily puts those alerts into context, showing readers the impact of infectious disease on policy, economics, and community.