THE WORRYING problem of antibiotic resistance — the tendency of bacteria to fight back against antibiotics, a pillar of modern medicine — has many dimensions: The discovery of new antibiotics to replace the old ones has slowed; hospitals have become reservoirs of superbugs resistant to several antibiotics; a sizeable amount of antibiotics are given to farm animals that are not sick, for disease prevention. As a result of resistance, people suffer infections that are untreatable. It leads to 23,000 deaths and some 2 million illnesses a year in the United States, according to the Centers for Disease Control and Prevention.
Added to the above list is a very big factor: human behavior. As patients — and especially as parents anxious about sick children — we fill clinics and doctors’ offices and ask for an antibiotic. This elemental desire for something that will make us feel better is entirely understandable, but it is also the crux of a common and serious mistake. When patients make an emotional appeal, clinicians find it hard to say no. This leads to overuse of antibiotics for conditions on which they have no effect. Antibiotics are intended to fight bacteria but are ineffective and inappropriate against illnesses caused by viruses, such as the flu. They should not be used to fight allergies either, or asthma. The overuse of antibiotics and the inappropriate prescribing of them just leads to more resistance, as the bacteria evolve to fight off the drugs.
The problem is often described as a tragedy of the commons — as a society, we understand that overuse of antibiotics is wrong, but as individuals we still demand them. The failure is a global phenomenon, too; other nations overuse antibiotics on an even larger scale than the United States.
A revelatory picture of the situation in this country was just published in the Journal of the American Medical Association, authored by specialists from the CDC , the Pew Charitable Trusts and independent experts. The study, examining in detail the use of antibiotics in outpatient clinics, found that in 2010-2011, for every 1,000 people, there were an estimated 506 antibiotic prescriptions, of which only 353 were appropriate for the illness at hand. That means that 153 were not, or about a third. This study, the first to break down the data nationally by age and diagnosis, suggests antibiotics are being drastically overprescribed and there is enormous room to cut down on their use.
How to change behavior? For clinicians, the key is better antibiotic “stewardship” — the tools and training to avoid using them when inappropriate. Patients also need to be told that antibiotics may not be right for them, perhaps with something as simple as a poster in the waiting room. A White House action plan on antibiotic resistance calls for slicing in half inappropriate outpatient use by 2020. To meet that goal, everyone will have to pay heed to the higher calling of the commons.