This article was first published in The Montreal Gazette.
It probably won’t be the coronavirus that does us in as a species. It probably won’t be Ebola, either. If there’s one infectious disease issue that we need to worry about, it’s antibiotic resistance. It’s a growing problem and it’s happening because we prescribe too many antibiotics.
Antibiotic resistance is listed by the World Health Organization as one of the top 10 threats to global health, and with good reason. Antibiotics have prevented untold numbers of deaths since penicillin was first used clinically in the 1940s. Penicillin use during the Second World War saved many soldiers from a battlefield death caused by infected wounds. But with time and use, bacteria become resistant to existing antibiotics, which then forces medical researchers to develop new antibiotics to replace them.
While investing in research to produce new antibiotics is always going to be necessary, we can slow the process of resistance down considerably by limiting the amount of antibiotics we prescribe. This idea, called antibiotic stewardship, is becoming increasingly important.
Unfortunately, we appear to be prescribing antibiotics at high volumes and often for no good reason. A recent paper in the British Medical Journal analyzed data from the National Ambulatory Medical Care Survey. Of the 991 million doctor’s office visits that occurred in the United States in 2015, about 130 million resulted in an antibiotic prescription. What was worrisome in their analysis is that only around half (57 per cent) of antibiotic prescriptions had an appropriate reason for the prescription documented in the patient’s chart. The remaining 43 per cent either had no reason documented or were given antibiotics for inappropriate indications like for the common cold.
When we talk about overprescribing antibiotics, we typically think of antibiotics being handed out to children with mild viral illness. On average, children have between five and seven colds per year and a common refrain is that physicians and parents should not turn to antibiotics for the common cold, which is after all a viral illness that will not respond to antibiotics. And yet this research shows that adults, particularly adult males, were more likely to get antibiotics than children, which runs counter to the usual assumptions.
Another big factor in whether patients got inappropriate antibiotics or not was whether patients were seeing their regular GP or some other physician. Patients who saw their regular GP were much less likely to get antibiotics. Presumably, if you go see a doctor who is unfamiliar with your medical history they would be more likely to prescribe antibiotics just to “be safe.” And while this might be understandable, it is clearly sub-optimal.
These types of studies are important because we need to identify factors that lead to unnecessary antibiotics. One of the biggest hurdles has thankfully already been addressed. For many years, low-dose antibiotics were given to livestock as a growth supplement and were available over the counter without a prescription. In fact, some estimates suggested that about 80 per cent of the antibiotics we use were actually used in animals, not in people.
This changed in December 2018, when new rules were put into effect restricting the sales of antibiotics for animals unless you had a prescription from a vet. So while you could still get antibiotics for your livestock if they were sick, the days of feeding animals antibiotics to make them grow faster are essentially over.
Reducing antibiotic use is an important (but not the only) part of combating antibiotic resistance. If nearly half of the antibiotics we prescribe and take are unjustified, then we have a lot of room for improvement. We have taken significant steps in Canada to limit unnecessary antibiotic use in animals. Now we just need to do it in people.
