Overuse of antibiotics is spawning antibacterial overkill

Our decades-long overreliance on antibiotics has created serious new health problems.

Editorial. July 24, 2000.

The development of antibiotics stands as one of the great scientific achievements of the 20th century. Antibiotics have eliminated the threat of death from many infectious conditions. This development has played a significant role in the gains in life expectancy in this country and throughout the world.

Now, however, our decades-long overreliance on antibiotics has created serious new health problems. New strains of drug-resistant organisms are endangering patients around the world, creating conditions not unlike those of the early part of the 1900s, when untreatable infections were a major cause of death.

A recent briefing by the American Medical Association focused professional and media attention on this growing problem. It affects virtually the entire planet: In developed nations, overprescribing of antimicrobials has brought about the evolution of resistant bacteria. Some estimates indicate that one-third of the 150 million prescriptions for antibiotics written in this country each year are unnecessary and result in strains of resistant bacteria. The quest for a germ-free home also is a factor. The widespread use of antibacterial soaps has been criticized by both the AMA and the Centers for Disease Control and Prevention, which agree that regular soap and water is equally effective.

Conversely, in developing countries, resistance is largely the result of the underuse of drugs. Patients often do not complete an antibiotic regimen, choosing to save the expensive but unused medicine for a possible subsequent illness. The rapid spread of resistant bacteria, inappropriate prescribing of antibiotics by health professionals and unskilled practitioners, and inadequate surveillance exacerbate the problem.

The compounded effect of these events is that many drugs are losing their effectiveness almost as quickly as scientists are discovering them. Further complicating the problem, antibiotic research by major drug companies has been cut back in some instances because the drugs do not generate enough revenue to cover the cost of research, development and production.

There will be no "magic bullet" to solve the pervasive and growing problem of antimicrobial resistance. At its June Annual Meeting, the AMA outlined a series of steps, including expanded research, that must be taken, beginning at once.

One step is a broad public and professional education, involving the federal government, the World Health Organization, the World Medical Assn. and the International Federation of Pharmacists, making clear the need for appropriate use of education. The AMA also is collaborating with the Food and Drug Administration, the Centers for Disease Control and Prevention, the National Health Council and several medical specialties.

The AMA also pledged to educate physicians and physicians-in-training about appropriate prescribing of antimicrobials. This education will prepare physicians for what may be the most important task of all: educating their patients about their antimicrobial therapy, the importance of compliance with the prescribed regimen and the problems of antimicrobial resistance.

Merely maintaining the status quo will endanger significant segments of the population. There is much to do for all levels of medicine: the organizations, the researchers and the practitioners. Without an active grassroots campaign to teach patients about appropriate therapy and to resist pleas for unneeded antibiotics, future generations may face some of the same health problems as their ancestors did a century earlier.