SuperbugsInfection control: why doctors over-prescribe antibiotics
The modern antibiotic era began with the discovery of penicillin in 1928, which led to dramatic improvements in our ability to treat common infections. This was probably the most important discovery in the history of modern medicine. And for a long time, antibiotics reigned supreme in the battle against previously deadly bacterium. The dramatic improvements of the twentieth century, however, are now being undone by overuse and misuse of antibiotics. Resistant superbugs and poor use of antibiotics are together leading us toward an “antimicrobial perfect storm” in the next few decades. This may sound apocalyptic but it’s simple epidemiology: increasing resistance combined with decreasing antibiotic options will worsen to the point where we will have no capacity to treat previously highly treatable infections.
Health authorities have long warned that antibiotics should only be used when they’re genuinely needed, to restrain antibiotic-resistant superbugs and avoid potentially serious side-effects. But many doctors aren’t complying, with between 20 percent to 50 percent of antibiotic prescriptions deemed inappropriate, depending on the individual hospital.
New research I’m presenting today (27 March) at the annual scientific meeting of the Australasian Society for Infectious Diseases shows that doctors understand the community-wide risks of antibiotic resistance but over-prescribe because they want the best outcomes for individual patients.
The rise of antibiotics – and superbugs
The modern antibiotic era began with the discovery of penicillin in 1928, which led to dramatic improvements in our ability to treat common infections. This was probably the most important discovery in the history of modern medicine. And for a long time, antibiotics reigned supreme in the battle against previously deadly bacterium.
The dramatic improvements of the twentieth century, however, are now being undone by overuse and misuse of antibiotics.
Major resistant organisms including multi-resistant gram negative bacilli (MRGNB), methicillin-resistant Staphylococcus aureus (MRSA), and Vancomycin resistant Enterococci (VRE) are already present in Australia, and for some bacteria, there are literally no treatment options available. Patient survival in such cases is consistent with that seen in the pre-antibiotic era.
Resistant superbugs and poor use of antibiotics are together leading us toward an “antimicrobial perfect storm” in the next few decades. This may sound apocalyptic but it’s simple epidemiology: increasing resistance combined with decreasing antibiotic options will worsen to the point where we will have no capacity to treat previously highly treatable infections.
The “antibiotic pipeline” of drug development, as it is termed, has been extremely limited for some time now, with only five new chemical classes of antibiotics developed since the 1970s. There are now resistance mechanisms identified to each of these classes.
It is now widely recognized that the development of new antibiotics is not a sustainable strategy in the war against resistant bacteria. As outlined by the World Health Organization, among others, our only option is to protect our current antibiotics by judicious use; retaining their integrity for significant infections. The problem is, this is simply not happening.
