Improvement Will Require a Sea Change
PHILADELPHIA -- (July 17, 2000) Current patterns of antibiotic use reflect cultural and economic forces as much as clinical need, according to an article in the July 18 issue of Annals of Internal Medicine. If policy makers and physicians do not recognize this, there is little hope of reversing the overuse of antibiotics which leads to the global threat of antibiotic resistant microbes, says Jerry Avorn, MD, lead author of the article and Chief, Division of Pharacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital and Harvard University.
The article, "Cultural and Economic Factors That (Mis)Shape Antibiotic Use: The Nonpharmacologic Basis of Therapeutics," will be accessible on the Annals of Internal Medicine Web site, http://www.annals.org, on July 18, 2000. Annals of Internal Medicine is published twice monthly by the American College of Physicians-American Society of Internal Medicine, headquartered in Philadelphia.
Dr. Avorn and co-author, Daniel H. Solomon, MD, note that the total cost of antibiotics include more than just the cost of the drugs but also their side effects and the often hidden cost of antimicrobial resistance:
- Antibiotics cost about $15 billion per year in the U.S., according to one study, and extra hospital costs associated with drug-resistant hospital-acquired bacterial infections in the U.S. is at least $1.3 billion annually, according to another government study.
- Of 51 million visits to physicians for "colds," upper-respiratory infections and bronchitis in the U.S. in one recent year, 50 percent to 66 percent resulted in an antibiotic prescription, even though these conditions usually do not require antibiotics.
Unfortunately, say the authors, such misuse affects not just the patients being treated but can affect the entire ecosystem. Overuse and misuse probably leads to development of so-called 'superbugs' resistant to known antibiotics, with dire consequences to humans.
Physicians who overprescribe antibiotics, prescribe stronger antibiotics than are needed, or prescribe antibiotics for viral infections (not susceptible to antibiotics) are one cause of the problem, but behind the doctors stands an array of forces that keep antibiotic consumption high. These include:
- drug companies' direct-to-consumer advertising campaigns to "persuade patients to demand newer, more costly antibiotics in clinical situations in which older, generic products, or no drug at all, would often work just as well"
- patients' and consumers' "drug hunger" for magic pills -- proof that their doctors are really doing something and also are not withholding treatment
- a medical training system that puts the least experienced doctors in the hospital in charge of prescribing drugs
- a health system that wants its physicians to be more "productive," see more patients per hour, minimize return visits, and get patients out of the hospital faster
Physicians' prescribing patterns can change, although most efforts to redirect prescribing to date have focused on reducing drug expenditures rather than on promoting appropriate prescribing, the authors say.
Despite a rather bleak picture of antibiotic misuse and emerging global antibiotic resistant microbes, the authors express "guarded optimism" for "the acceptance by prescribers and patients of a set of more rational attitudes toward antibiotic use."
NOTE TO EDITORS: Drs. Avorn and Soloman can be reached by contacting Rob Hutchison, Media Relations Manager, Brigham and Women's Hospital; 617-732-5204; 617-437-1924 (fax); rhutchison@partners.org
Reporters can request an embargoed copy of the article by calling 800-523-1546, ext. 2656 or 215-351-656.
Journal
Annals of Internal Medicine