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Renewed efforts are needed to curb antibiotic resistance

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7778 (Published 15 November 2012) Cite this as: BMJ 2012;345:e7778
  1. Bob Roehr
  1. 1Washington, DC

Antibiotic resistance continues to increase in the United States and has become a serious health problem, even though physicians are writing fewer prescriptions for them. Experts said at the launch of the latest data on use and effectiveness of antibiotics in the US that the cultural norm of antibiotic stewardship needed to change.

More US citizens die of MRSA (methicillin resistant staphylococcus aureus) than HIV infection but few people are aware of that, Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy, said when launching the redesigned and updated ResistanceMap report on 13 November.

Antibiotic resistance was affecting every doctor’s practice, Henry Chambers, chief of infectious disease at San Francisco General Hospital, added. You could treat a common Escherichia coli urinary tract infection with fluoroquinolones 10-15 years ago; now resistance was in the upper single digits. Oral drugs might no longer work and the patient might have to be admitted to the hospital to receive an intravenous drug.

Laxminarayan said that the number of antibiotic prescriptions written in the US declined by 17% from 966 to 801 per 1000 people per year between 1999 and 2010. The information was drawn from data gathered by the center and used to create an interactive map of antibiotic resistance.

Much of the decline in prescribing has been in the use of “drugs like penicillins and macrolides, which are not the most powerful drugs that we have,” he said. The number of prescriptions for newer more powerful drugs “has not really decreased a whole lot.”

There was more than a two-fold difference between the state with the lowest rate of prescribing in 2010 (Alaska 510/1000) and the state with the highest rate (Kentucky 1196/1000).

Some of the lowest prescribing rates were seen in states where integrated health systems such as Kaiser Permanente and Intermountain Healthcare provide a substantial share of the region’s medical services.

“Antibiotics are a shared resource and every individual should consider how each prescription or use of antibiotics impacts the overall effectiveness of the antibiotic arsenal,” said Arjun Srinivasan from the Centers for Disease Control and Prevention (CDC). “How we use and protect these precious drugs must fundamentally change.”

He read a consensus statement of a dozen principles “to conserve and replenish our antibiotic resources” that 25 national health organizations have pledged to uphold. Among them are the need for “global collective action” in the stewardship of existing antibiotics and “limiting the use of medically important human antibiotics in food animals.”

Judicious prescribing is a cornerstone of dealing with antibiotic resistance, but Laxminarayan said that policy solutions must also “require tighter infection control measures, enhanced surveillance of drug resistant infections, and better coordination among hospitals in the community because they all share the problem.”

“All of the efforts to preserve our antibiotics are woefully underfunded,” he added. The CDC could barely scrape together $10m for the Get Smart program of education and awareness to antibiotic resistance, while it cost hundreds of millions to develop a new drug.

There is also growing recognition of the contribution to drug resistance that comes from using antibiotics in feed for commercial animals to promote their growth.

“The antibiotics sold in this country for food animal use far outstrips the amount of antibiotics sold for human use,” said Gail Hansen, a program officer with the Pew Foundation Campaign on Human Health and Industrial Farming. “About 30 million pounds (13.6 million kilograms) of antibiotics are sold for animal use; about 7 million pounds are sold for human use.”

The US Food and Drug Administration has created a voluntary program where classes of antibiotics used in humans will not be used to promote growth in food animals, but it has not yet been implemented.

Notes

Cite this as: BMJ 2012;345:e7778

Footnotes