New series on ‘superbugs’ should prompt medical community to take action
The August issue of Consumer Reports takes on a topic near and dear to the hearts of Slow Medicine advocates: the overuse of antimicrobials. In the first of a three-part series called “America's Antibiotic Crisis,” the report provides a useful resource for us to share with our patients in discussing appropriate antibiotic use. This is particularly important, since an important driver of antibiotic overuse is patient requests. (Full disclosure: Pieter receives research support from Consumers Union, publisher of Consumer Reports.)
The article highlights several topics that have contributed to antimicrobial resistance: 1) inappropriate prescribing; 2) limited research and development committed to developing antimicrobials (largely due to low returns on investments); and 3) the overuse of antibiotics in agriculture.
The authors describe the scope of the problem:
- Drug-resistant bacteria affect at least 2 million people annually in the U.S., killing at least 23,000 each year.
- Up to half of antibiotics prescribed in the U.S. are unnecessary or used inappropriately.
They also detail what is being done to combat antibiotic resistance (and importantly critique some of the most worrisome approaches such as FDA “fast tracking”):
1) Antimicrobial stewardship
On June 6, 2015, the White House held a forum on antibiotic stewardship. The Infectious Disease Society of America (IDSA), among other organizations, has been advocating for scaling up not only more diagnostic testing for appropriate antimicrobial use and outcome studies around usage, but also stewardship programs to better coordinate the use of antimicrobials and improve patient outcomes.
We agree that these programs are imperative to decrease misuse of antimicrobials, but the devil will be in the details. For more information, check out these resources.
2) Drug development
The FDA began “fast tracking” some antimicrobials and extending patents to incentivize drug companies for research and development. While we agree that encouraging drug companies to develop new antimicrobials is extremely important, we are worried by the statement of Dr. Edward Cox, director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research, who told Consumer Reports that the FDA “is willing to accept less safety and efficacy data.” We know that antimicrobials have side effects, and the FDA should not have different standards for new antimicrobials on the market. (Find more information here.)
So what can the medical community do beyond prescribing responsibly?
- Become involved in policy and advocacy around antimicrobial resistance.
- Evidence suggests that we may be more likely to prescribe antimicrobials towards the end of office hours: We know clinic days can get long, but we should think twice about the appropriateness of prescribing antimicrobials, especially at the end of a busy session.
The take-home point: Sharing this new article will not only help the medical community be more thoughtful about prescribing antibiotics, but it can also empower patients to be more thoughtful about antibiotic use – both steps in the right direction.
***
Photo by Justin Kerr Sheckler via Flickr.