Getting smarter about antibiotics -- in some settings, at least

This week is Get Smart About Antibiotics Week, and CDC is promoting awareness about when these important drugs should and shouldn't be used. Overuse of antibiotics speeds the development of antibiotic-resistant bacteria, and infections from these bacteria are much harder to treat.

Many of our readers are probably already familiar with CDC's message, which boils down to the fact that antibiotics don't cure viral infections (colds, flu, most bronchitis) and the reminder that when you are prescribed antibiotics, you need take the entire course of drugs rather than stopping once you feel better. It's important for patients to know that an antibiotic probably won't cure their flu, because physicians -- especially those who need to see several patients each hour -- can be influenced to write antibiotic prescriptions for patients who request or demand them. It's often easier to just give people what they're asking for than to convince them they shouldn't want it.

Over at Superbug (always the first place I look for anything bacteria-related), Maryn McKenna points to research findings from Center for Disease Dynamics, Economics & Policy. Researchers there found that the US overall has seen a 17% decrease in the antibiotic prescriptions filled since 1999, which suggests that doctors are doing less inappropriate prescribing of these drugs. However, they report that rates of antibiotic use varied widely across the US: "residents of Appalachian and Gulf Coast states, where antibiotic use rates are highest, take about twice as many antibiotics per capita as people living in Western states." Rates of antibiotic use were highest in Kentucky, West Virginia, Tennessee, Mississippi, and Louisiana.

Patient and physician beliefs and behaviors regarding antibiotics are important for slowing the evolution of drug-resistant bacteria, but improving won't do enough to slow the evolution of antibiotic resistance. Most of the antibiotics sold in the US don't go to humans -- they go to food animals. Many livestock producers routinely feed low doses of antibiotics to their animals (as opposed to giving antibiotics only to those showing signs of bacterial infections). This practice speeds animals' growth, but also creates conditions in which resistant bacteria can develop and spread quickly. Read McKenna's in-depth Atlantic article (produced with the Food & Environment Reporting Network) "How Your Chicken Dinner is Creating a Drug-Resistant Superbug" for an example of how a particularly nasty strain of E. coli is causing antibiotic-resistant urinary tract infections, and how researchers have linked it to poultry production.

A comprehensive attack on antibiotic resistance in the US will require ending the routine use of antibiotics in livestock production -- and that will likely require major action from FDA or Congress. In the meantime, it still helps to educate ourselves and those around us about appropriate human use of these important drugs.