31 December 2004
Antibiotic Misuse A Serious Concern Say Experts
by Kate Melville
A new study shows that more than half the patients in the United States are taking bacteria-destroying antibiotics for colds, flu and bronchitis, all caused by viruses. This is very worrying says Dr. Jim Wilde, pediatric emergency medicine and infectious disease physician at the Medical College of Georgia. "For uncomplicated colds, zero are necessary; bronchitis, less than 10 percent are necessary; sore throats, maybe up to 10 to 15 percent of these patients need an antibiotic," says Wilde. "Ninety to 95 percent of all infections are viral or low-acuity bacterial infections such as ear infections or sinus infections."
Wilde is a principal investigator on a National Institutes of Health-funded study seeking to educate providers as well as patients on the hazards of antibiotic misuse. He believes we are losing the war, with the spread of antibiotic-resistant bacteria running ahead of production of new antibiotics to fight them. "If you look at the history of antibiotic use in the last 60 years and you look at the history of resistance in the last 60 years, one is about two years behind the other.
As soon as a new antibiotic is introduced, bugs develop resistance to it. If it had not been for the fact that we have been developing more antibiotics in the last 50 years, we would be in big trouble right now. Even if you use antibiotics appropriately, bugs will still find a way to get around them, but we can delay the spread of resistance so we have more time to develop new antibiotics."
Wilde believes that without big change, antibiotics - needed to treat life-threatening conditions such as meningitis and pneumonia - may be useless within 50 years. "It's a federal issue. We are in big trouble in this country if we don't get our antibiotic use under control. Sounds alarmist? It's not," says the physician, who in the last year has seen children in the emergency room with abscesses, or pus pockets, containing methycillin-resistant Staphylococcus aureus. In fact, a Web-based chat room for pediatric emergency specialists across the country is buzzing with talk of this antibiotic-resistant infection showing up in otherwise healthy children. "It's nasty stuff and it's because of inappropriate antibiotic use. This is just the tip of the iceberg," he said.
"I started my career as an infectious disease physician, so I'm the first to say, if you need an antibiotic, take one," says Dr. Wilde, and take it correctly, meaning keep taking the drug until it is gone, not just until symptoms disappear. But in doctors' offices and hospitals across the country, patients have come to expect antibiotics for viral infections and too many doctors are willing to give them, says Wilde. "We need to make sure we are educating the public so if they don't get an antibiotic, they understand why."
Third-world countries, where severe physician shortages preclude prescriptions for antibiotics, already are living the nightmare of common infections that no longer have a treatment. "In this country, the most dangerous bacteria we worry about is vancomycin-resistant enterococcus (VRE), a really nasty bug that can cause bacterial heart infections, meningitis, sepsis, kidney abscesses and infections," says Wilde. "It kills a lot of people. It wasn't even on the radar screen until about 15 years ago when enterococcus found a way to get around vancomycin. The research is clear: the more a hospital uses vancomycin, the higher the rates of VRE. We must limit vancomycin use to cases where it is necessary so we can slow the spread of VRE."