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Antibiotic misuse

antibiotic misuse, antibiotic misuse and resistance
Antibiotic misuse, sometimes called antibiotic abuse or antibiotic overuse, refers to the misuse or overuse of antibiotics, with potentially serious effects on health It is a contributing factor to the development of antibiotic resistance, including the creation of multidrug-resistant bacteria, informally called "super bugs": relatively harmless bacteria such as staphylococcus, enterococcus and acinetobacter can develop resistance to multiple antibiotics and cause life-threatening infections


  • 1 History of antibiotic regulation
  • 2 Instances of antibiotic misuse
  • 3 Social and economic impact
  • 4 Antibiotic resistance
  • 5 Inappropriate use
    • 51 Antibiotics in livestock
  • 6 See also
  • 7 References
  • 8 Further reading
  • 9 External links

History of antibiotic regulation

Antibiotics have been around since 1928 when penicillin was invented by Alexander Fleming In the 1980s antibiotics that were determined medically important for treatment of animals could be approved under veterinary oversight In 1996, the National Antimicrobial Resistance Monitoring System NARMS was established Starting in 2010, publications regarding antimicrobial drugs in food become an annual report Starting in 2012, there was publicly solicited input on how data is to be collected and reported for matters relating to the use of antimicrobials for food-producing animals Resulting from this, the FDA revised its sampling structure within NARMS with the goal of obtaining more representative livestock data for the key organisms under surveillance “NARMS partners at CDC and USDA have published over 150 peer-reviewed research articles examining the nature and magnitude of antimicrobial resistance hazards associated with antibiotic use in food-producing animals” In 2014, the FDA began working with the United States Department of Agriculture USDA and the Centers of Disease Control and Prevention CDC to explore additional mechanisms to obtain data that is representative of antibiotic use in food-producing animals In 2015, the FDA issues the Veterinary Feed Directive VFD final rule Under this rule veterinarians must authorize the use of antimicrobials within feed for the animals they serve

Instances of antibiotic misuse

Health advocacy messages such as this one encourage patients to talk with their doctor about safety in using antibiotics

Common situations in which antibiotics are overused include the following:

  • Apparent viral respiratory illness in children should not be treated with antibiotics If there is a diagnosis of bacterial infection, then antibiotics may be used
  • When children with ear tubes get ear infections, they should have antibiotic eardrops put into their ears to go to the infection rather than having oral antibiotics which are more likely to have unwanted side effects
  • Swimmer's ear should be treated with antibiotic eardrops, not oral antibiotics
  • Sinusitis should not be treated with antibiotics because it is usually caused by a virus, and even when it is caused by a bacteria, antibiotics are not indicated except in atypical circumstances as it usually resolves without treatment
  • Viral conjunctivitis should not be treated with antibiotics Antibiotics should only be used with confirmation that a patient has bacterial conjunctivitis
  • Older persons often have bacteria in their urine which is detected in routine urine tests, but unless the person has the symptoms of a urinary tract infection, antibiotics should not be used in response
  • Eczema should not be treated with oral antibiotics Dry skin can be treated with lotions or other symptom treatments
  • The use of topical antibiotics to treat surgical wounds does not reduce infection rates in comparison with non-antibiotic ointment or no ointment at all

Social and economic impact

Antibiotics can cause severe reactions and add significantly to the cost of care In the United States, antibiotics and anti-infectives are the leading cause of adverse effect from drugs In a study of 32 States in 2011, antibiotics and anti-infectives accounted for nearly 24 percent of ADEs that were present on admission, and 28 percent of those that occurred during a hospital stay

Prescribing by an infectious disease specialist compared with prescribing by a non-infectious disease specialist decreases antibiotic consumption and reduces costs

Antibiotic resistance

Main article: Antibiotic resistance

Though antibiotics are required to treat severe bacterial infections, misuse has contributed to a rise in bacterial resistance The overuse of fluoroquinolone and other antibiotics fuels antibiotic resistance in bacteria, which can inhibit the treatment of antibiotic-resistant infections Their excessive use in children with otitis media has given rise to a breed of bacteria resistant to antibiotics entirely

Widespread use of fluoroquinolones as a first-line antibiotic has led to decreased antibiotic sensitivity, with negative implications for serious bacterial infections such as those associated with cystic fibrosis, where quinolones are among the few viable antibiotics

Inappropriate use

Unused pharmaceuticals collected as part of a university research project into pharmaceuticals waste

Antibiotics have no effect on viral infections such as the common cold They are also ineffective against sore throats, which are usually viral and self-resolving Most cases of bronchitis 90–95% are viral as well, passing after a few weeks—the use of antibiotics against bronchitis is superfluous and can put the patient at risk of suffering adverse reactions

Official guidelines by the American Heart Association for dental antibiotic prophylaxis call for the administration of antibiotics to prevent infective endocarditis Though the current 2007 guidelines dictate more restricted antibiotic use, many dentists and dental patients follow the 1997 guidelines instead, leading to overuse of antibiotics

A study by Imperial College London in February 2017 found that of 20 online websites, 9 would provide antibiotics illegally without a prescription to UK residents

Antibiotics in livestock

Main article: Antibiotic use in livestock

There has been massive use of antibiotics in animal husbandry The most abundant use of antimicrobials worldwide is in livestock; they are typically distributed in animal feed or water for purposes such as disease prevention and growth promotion Debates have arisen surrounding the extent of the impact of these antibiotics, particularly antimicrobial growth promoters, on human antibiotic resistance Although some sources assert that there remains a lack of knowledge on which antibiotic use generates the most risk to humans, policies and regulations have been placed to limit any harmful effects, such as the potential of bacteria developing antibiotic resistance within livestock, and that bacteria transferring resistance genes to human pathogens On January 1, 2017, the FDA enacted legislation to require that all human medically important feed-grade antibiotics many prior over-the-counter-drugs become classified as Veterinary Feed Directive drugs VFD This action requires that farmers establish and work with veterinaries to receive a written VFD order The effect of this act places a requirement on an established veterinarian-client-patient relationship VCPR Through this relationship, farmers will receive an increased education in the form of advice and guidance from their veterinarian

See also

  • Alliance for the Prudent Use of Antibiotics
  • Natural growth promoter


  1. ^ Harrison JW, Svec TA April 1998 "The beginning of the end of the antibiotic era Part II Proposed solutions to antibiotic abuse" Quintessence International 29 4: 223–9 PMID 9643260 
  2. ^ a b c Food Insight 2016 "FDA Antibiotic Regulation Through the Decades" 
  3. ^ American Academy of Pediatrics, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Pediatrics, retrieved 1 August 2013 , which cites
    • American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis 2006 "Diagnosis and Management of Bronchiolitis" Pediatrics 118 4: 1774–1793 doi:101542/peds2006-2223 PMID 17015575 CS1 maint: Uses authors parameter link
    • Shulman, S T; Bisno, A L; Clegg, H W; Gerber, M A; Kaplan, E L; Lee, G; Martin, J M; Van Beneden, C 2012 "Clinical Practice Guideline for the Diagnosis and Management of Group a Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America" Clinical Infectious Diseases 55 10: e86–102 doi:101093/cid/cis629 PMID 22965026 
  4. ^ American Academy of Otolaryngology – Head and Neck Surgery, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Otolaryngology – Head and Neck Surgery, retrieved 1 August 2013 CS1 maint: Uses authors parameter link , which cites
    • Rosenfeld, R M; Schwartz, S R; Pynnonen, M A; Tunkel, D E; Hussey, H M; Fichera, J S; Grimes, A M; Hackell, J M; Harrison, M F; Haskell, H; Haynes, D S; Kim, T W; Lafreniere, D C; LeBlanc, K; Mackey, W L; Netterville, J L; Pipan, M E; Raol, N P; Schellhase, K G 2013 "Clinical Practice Guideline: Tympanostomy Tubes in Children" Otolaryngology -- Head and Neck Surgery 149 1 Suppl: S1–S35 doi:101177/0194599813487302 ISSN 0194-5998 PMID 23818543 
  5. ^ American Academy of Otolaryngology – Head and Neck Surgery February 2013, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Otolaryngology – Head and Neck Surgery, retrieved 1 August 2013 CS1 maint: Uses authors parameter link , which cites
    • Rosenfeld, R; Brown, L; Cannon, C; Dolor, R; Ganiats, T; Hannley, M; Kokemueller, P; Marcy, S; Roland, P; Shiffman, R; Stinnett, S S; Witsell, D L; American Academy of Otolaryngology--Head Neck Surgery Foundation 2006 "Clinical practice guideline: Acute otitis externa" Otolaryngology - Head and Neck Surgery 134 4: S4–23 doi:101016/jotohns200602014 PMID 16638473 
  6. ^ Consumer Reports; American Academy of Allergy, Asthma, and Immunology July 2012, "Treating sinusitis: Don't rush to antibiotics" PDF, Choosing Wisely: an initiative of the ABIM Foundation, Consumer Reports, retrieved 14 August 2012 CS1 maint: Uses authors parameter link
  7. ^ Sheikh, Aziz; Hurwitz, Brian; van Schayck, Constant Paul; McLean, Susannah; Nurmatov, Ulugbek 2012-09-12 "Antibiotics versus placebo for acute bacterial conjunctivitis" The Cochrane Database of Systematic Reviews 9: CD001211 doi:101002/14651858CD001211pub3 ISSN 1469-493X PMID 22972049 
  8. ^ American Geriatrics Society, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Geriatrics Society, retrieved 1 August 2013 
  9. ^ a b American Academy of Dermatology February 2013, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Dermatology, retrieved 5 December 2013 , which cites
    • Sheth, V M; Weitzul, S 2008 "Postoperative topical antimicrobial use" Dermatitis : contact, atopic, occupational, drug 19 4: 181–189 PMID 18674453 
  10. ^ Beringer PM, Wong-Beringer A, Rho JP January 1998 "Economic aspects of antibacterial adverse effects" PharmacoEconomics 13 1 Pt 1: 35–49 doi:102165/00019053-199813010-00004 PMID 10175984 
  11. ^ Weiss AJ, Elixhauser A Origin of Adverse Drug Events in US Hospitals, 2011 HCUP Statistical Brief #158 Agency for Healthcare Research and Quality, Rockville, MD July 2013
  12. ^ Beović B, Kreft, Seme K, Čižman M 2009 "The Impact of Total Control of Antibiotic Prescribing by Infectious Disease Specialist on Antibiotic Consumption and Cost" Journal of Chemotherapy 21 1: 46–51 doi:101179/joc200921146 CS1 maint: Multiple names: authors list link
  13. ^ Neuhauser MM, Weinstein RA, Rydman R, Danziger LH, Karam G, Quinn JP February 2003 "Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use" JAMA 289 7: 885–8 doi:101001/jama2897885 PMID 12588273 
  14. ^ "Studies examine prescribing of antibiotics for respiratory infections in hospital emergency departments" USA: US Department of Health and Human Services Archived from the original on 7 May 2009 From 1995 to 2002, inappropriate antibiotic prescribing for acute respiratory infections, which are usually caused by viruses and thus are not responsive to antibiotics, declined from 61% to 49% However, the use of broad-spectrum antibiotics such as the fluoroquinolones, jumped from 41% to 77% from 1995 to 2001 Overuse of these antibiotics will eventually render them useless for treating antibiotic-resistant infections, for which broad-spectrum antibiotics are supposed to be reserved 
  15. ^ "Fluoroquinolone Resistance and Tuberculosis Treatment" USA: The New York City Department of Health and Mental Hygiene 
  16. ^ Froom J; Culpepper L; Jacobs M; et al July 1997 "Antimicrobials for acute otitis media A review from the International Primary Care Network" BMJ 315 7100: 98–102 doi:101136/bmj315710098 PMC 2127061  PMID 9240050 
  17. ^ "Cipro, Related Antibiotics Over-Prescribed, Fueling Microbe Resistance" USA: University Of California 1 October 2002 Retrieved 13 August 2009 
  18. ^ K Bassett; B Mintzes; V Musini; TL Perry Jr; M Wong; JM Wright November 2002 "Therapeutics Letter" PDF Canadian Family Physician 48 Gatifloxacin and moxifloxacin have no proven clinical advantages over other fluoroquinolones, macrolides, or amoxicillin Based on cost, they are not first-choice drugs for their approved indications 
  19. ^ Ziganshina, Lilia E; Titarenko, Albina F; Davies, Geraint R 2013-06-06 "Fluoroquinolones for treating tuberculosis presumed drug-sensitive" The Cochrane Database of Systematic Reviews 6: CD004795 doi:101002/14651858CD004795pub4 ISSN 1469-493X PMID 23744519 
  20. ^ Little P, Gould C, Williamson I, Warner G, Gantley M, Kinmonth AL August 1997 "Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics" BMJ 315 7104: 350–2 doi:101136/bmj3157104350 PMC 2127265  PMID 9270458 
  21. ^ Hueston WJ March 1997 "Antibiotics: neither cost effective nor 'cough' effective" The Journal of Family Practice 44 3: 261–5 PMID 9071245 
  22. ^ Zadik Y; Findler M; Livne S; et al December 2008 "Dentists' knowledge and implementation of the 2007 American Heart Association guidelines for the prevention of infective endocarditis" Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106 6: e16–9 doi:101016/jtripleo200808009 PMID 19000604 
  23. ^ Elad S, Binenfeld-Alon E, Zadik Y, Aharoni M, Findler M March 2011 "Survey of acceptance of the 2007 American Heart Association guidelines for the prevention of infective endocarditis: a pilot study" Quintessence Int 42 3: 243–51 PMID 21465012 
  24. ^ Wilson W; Taubert KA; Gewitz M; et al October 2007 "Prevention of infective endocarditis: guidelines from the American Heart Association" Circulation 116 15: 1736–54 doi:101161/CIRCULATIONAHA106183095 PMID 17446442 
  25. ^ "No prescription needed to obtain antibiotics from almost half of online sites, study shows" Pharmaceutical Journal 17 February 2017 Retrieved 19 March 2017 
  26. ^ Silbergeld, EK; Graham, J; Price, LB 2008, "Industrial food animal production, antimicrobial resistance, and human health", Annual Review of Public Health, 29: 151–169, doi:101146/annurevpublhealth29020907090904, PMID 18348709 
  27. ^ Landers, TF; Cohen, B; Wittum, TE; Larson, EL 2012, "A review of antibiotic use in food animals: Perspective, policy, and potential", Public Health Reports, 127 1: 4–22, PMC 3234384 , PMID 22298919 
  28. ^ http://wwwsciencemagorg/news/2017/09/are-antibiotics-turning-livestock-superbug-factories
  29. ^ Beth Ferry, Madonna Benjamin, Michigan State University Extension and Megan Sprague, MDARD 2016 "Don't wait, be ready! New antibiotic rules for 2017" CS1 maint: Multiple names: authors list link

Further reading

  • Blaser, Martin J 2014 Missing microbes : how the overuse of antibiotics is fueling our modern plagues Henry Holt and Company ISBN 978-0805098105 

External links

  • Get Smart: Know When Antibiotics Work, provided by the Centers for Disease Control and Prevention
  • Antibiotics: Misuse puts you and others at risk provided by the Mayo Clinic

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Antibiotic misuse

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