U study: Overprescribing antibiotics leading to rise in 'superbug'

U study: Overprescribing antibiotics leading to rise in 'superbug'

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SALT LAKE CITY — Health care providers over-prescribe antibiotics, according to researchers from the University of Utah, who found that some doctors give antibiotic prescriptions to nearly every patient with a cold.

The study provides insight into what the World Health Organization and Centers for Disease Control say is an alarming rise of antibiotic-resistant bacteria, also known as "nightmare bacteria" or "superbugs." The CDC estimated that at least 2 million people are infected by drug-resistant bacteria and at least 23,000 die as a result each year.

Overuse of antibiotics is a major contributor to the rise of drug-resistant infections, according to lead author and University of Utah assistant professor Barbara Jones.

"Antibiotics have saved millions of people, but in the last few decades we've started to see how there can be some side effects to that, some pitfalls on a public health level," Jones said.

Her team analyzed eight years of visits to Veterans Affairs medical centers across the country from 2005 to 2012, focusing on visits for acute respiratory infections — things like the common cold, bronchitis and strep throat.

U study: Overprescribing antibiotics leading to rise in 'superbug'

They found that health care providers prescribed antibiotics 68 percent of the time, despite the fact that 90 to 75 percent of respiratory infections are caused by viruses.

"We actually were thinking that probably a proportion of about 40 percent would be more appropriate," Jones said.

Antibiotics kill both good and bad bacteria, leaving behind only the organisms that are resistant to the drug. Those organisms then multiply and pass on their resistance to other bacteria — and other people.

"Organisms are getting smarter," said Felicia Alvarez, an epidemiologist at the Utah Department of Health.

The department tracks three kinds of drug-resistant bacteria known as carbapenem resistant enterobacteriaceae, according to Alvarez. These microbes are resistant to almost every known antibiotic.

"If you look at other states, we're considered a low-incidence report, and that's why we want to watch it — to see if it's increasing or decreasing," Alvarez said.

Last year, public health officials in Utah identified at least 47 cases of infection from these bacteria. At least 39 of those cases resulted in hospitalization and at least five resulted in death.

Eddie Stenehjem, the director of the antimicrobial stewardship program at Intermountain Medical Center, said doctors have struggled to fight those highly resistant bacteria.

"We have to use antibiotics that we haven't really needed to use until now, or we used 30 years ago and stopped because of toxicity," Stenehjem said. "We are now going back to them because they're the only drugs we have available."

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He said Jones' research is striking because it shows doctors vary widely in their prescribing habits, even when they work at the same clinic or hospital.

The top 10 percent of health care providers who wrote the most antibiotic prescriptions gave them to nearly every patient with an acute respiratory illness — 95 percent or more.

The bottom 10 percent prescribed antibiotics to patients 40 percent of the time or less.

That's "a reflection of there being quite a bit of uncertainty in what is the right thing to do," according to Jones.

Doctors are rarely able to isolate the bacteria or virus they think is causing the symptoms, so physicians who are over-cautious tend to prescribe antibiotics even if they aren't sure it's a bacterial infection.

"We do the best for our patients, we really are quite cautious, but sometimes, like this paper shows, that meets the problem of overuse," Jones said.

Stenehjem said more research is needed to educate doctors and patients alike about antibiotic overuse. In June, Intermountain pledged to reduce outpatient antibiotic use for upper respiratory conditions in half by 2020.

Stenehjem praised the White House's five-year action plan for fighting drug-resistant bacteria, unveiled in March. Among other things, the plan requires nearly all doctors working in Medicare, Medicaid, Defense Department and Veterans Affairs facilities to report their rates of antibiotic use.

"The rate of prescribing for some of these conditions hasn't changed significantly over the past 20 years, so how do we incentivize it and how do we get patients to also realize that they don't need antibiotics?" Stenehjem said. "It's culture change, it's a behavior change, and it's going to take time." Email: dchen@deseretnews.com Twitter: DaphneChen_

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