Antibiotic misuse

This poster from the U.S. Centers for Disease Control and Prevention "Get Smart" campaign, intended for use in doctors' offices and other healthcare facilities, warns that antibiotics do not work for viral illnesses such as the common cold.

Antibiotic misuse, sometimes called antibiotic abuse or antibiotic overuse, refers to the misuse or overuse of antibiotics, with potentially serious effects on health. It is a contributing factor to the development of antibiotic resistance, including the creation of multidrug-resistant bacteria, informally called "super bugs": relatively harmless bacteria can develop resistance to multiple antibiotics and cause life-threatening infections.^[1]

Instances of antibiotic misuse

Health advocacy messages such as this one encourage patients to talk with their doctor about safety in using antibiotics.

Common situations in which antibiotics are overused include the following:

• Apparent viral respiratory illness in children should not be treated with antibiotics. If there is a diagnosis of bacterial infection, then antibiotics may be used.^[2]
• When children with ear tubes get ear infections, they should have antibiotic eardrops put into their ears to go to the infection rather than having oral antibiotics which are more likely to have unwanted side effects.^[3]
• Swimmer's ear should be treated with antibiotic eardrops, not oral antibiotics.^[4]
• Sinusitis should not be treated with antibiotics because it is usually caused by a virus, and even when it is caused by a bacteria, antibiotics are not indicated except in atypical circumstances as it usually resolves without treatment.^[5]
• Viral conjunctivitis should not be treated with antibiotics. Antibiotics should only be used with confirmation that a patient has bacterial conjunctivitis.^[6]
• Older persons often have bacteria in their urine which is detected in routine urine tests, but unless the person has the symptoms of a urinary tract infection, antibiotics should not be used in response.^[7]
• Eczema should not be treated with oral antibiotics. Dry skin can be treated with lotions or other symptom treatments.^[8]
• The use of topical antibiotics to treat surgical wounds does not reduce infection rates in comparison with non-antibiotic ointment or no ointment at all.^[8]

Social and economic impact

Antibiotics can cause severe reactions and add significantly to the cost of care.^[9] In the United States, antibiotics and anti-infectives are the leading cause of adverse effect from drugs. In a study of 32 States in 2011, antibiotics and anti-infectives accounted for nearly 24 percent of ADEs that were present on admission, and 28 percent of those that occurred during a hospital stay.^[10]

Prescribing by an infectious disease specialist compared with prescribing by a non-infectious disease specialist decreases antibiotic consumption and reduces costs.^[11]

Antibiotic resistance

Though antibiotics are required to treat severe bacterial infections, misuse has contributed to a rise in bacterial resistance. The overuse of fluoroquinolone and other antibiotics fuels antibiotic resistance in bacteria, which can inhibit the treatment antibiotic-resistant infections.^[12][13][14] Their excessive use in children with otitis media has given rise to a breed of bacteria resistant to antibiotics entirely.^[15]

Widespread use of fluoroquinolones as a first-line antibiotic has led to decreased antibiotic sensitivity, with negative implications for serious bacterial infections such as those associated with cystic fibrosis, where quinolones are among the few viable antibiotics.^[16][17][18]

Inappropriate use

Unused pharmaceuticals collected as part of a university research project into pharmaceuticals waste.

Antibiotics have no effect on viral infections such as the common cold. They are also ineffective against sore throats, which are usually viral and self-resolving.^[19] Most cases of bronchitis (90–95%) are viral as well, passing after a few weeks—the use of antibiotics against bronchitis is superfluous and can put the patient at risk of suffering adverse reactions.^[20]

Official guidelines by the American Heart Association for dental antibiotic prophylaxis call for the administration of antibiotics to prevent infective endocarditis. Though the current (2007) guidelines dictate more restricted antibiotic use, many dentists^[21] and dental patients^[22] follow the 1997 guidelines instead, leading to overuse of antibiotics.^[23]

A study by Imperial College London in February 2017 found that of 20 online websites, 9 would provide antibiotics (illegally) without a prescription to UK residents.^[24]

Antibiotics in livestock

There has been massive use of antibiotics in animal husbandry. The most abundant use of antimicrobials worldwide are in livestock; they are typically distributed in animal feed or water for purposes such as disease prevention and growth promotion.^[25] Debates have arisen surrounding the extent of the impact of these antibiotics, particularly antimicrobial growth promoters, on human antibiotic resistance. Although some sources assert that there remains a lack of knowledge on which antibiotic use generates the most risk to humans,^[26] policies and regulations have been placed to limit any harmful effects.

See also

• Alliance for the Prudent Use of Antibiotics
• Natural growth promoter

References

Further reading

• Blaser, Martin J. (2014). Missing microbes : how the overuse of antibiotics is fueling our modern plagues. Henry Holt and Company. ISBN 978-0805098105. 

External links

• Get Smart: Know When Antibiotics Work, provided by the Centers for Disease Control and Prevention
• Antibiotics: Misuse puts you and others at risk provided by the Mayo Clinic