After the remarkable discovery of the first
antibiotic therapy, US general surgeon William H. Stewart made the infamous declaration that “it is time to
close the book on infectious diseases and declare the war against pestilence
won” (Spellberg et al., 2008, p.
156). This statement reflected the general attitude of medical professionals
toward antibiotics at that time; however, it has been proven wildly inaccurate
over the past 30 years. In fact, “closing the book on infectious diseases” is a great distance away considering the evidence that infectious
diseases continue to be the second cause of death worldwide, and the third in the US and other developed countries, despite the
development of newer antibiotics. The main factor
contributing to the failure to conquer infectious diseases is commonly believed
to be the inappropriate use of antibiotics.
Antibiotics are vastly being
misused in both medical and agricultural fields which have tremendous impacts
on patients and healthcare professionals. According to the Centers
of Disease Control and Prevention (CDC), as many as 50
percent of all antibiotics
prescribed in healthcare have been misused as they are used to treat acute respiratory
tract infections which are mostly caused by self-limiting viruses
11). This misuse provides opportunity for bacteria to
develop new resistant strains, resulting in the more powerful and broad-spectrum antibiotics have to be prescribed as a
vicious cycle. Then the resistant genes proliferate and are transferred to other
patients. Nevertheless, there is a debate that bacterial
resistance is an unavoidable and continuing process so the issue of bacterial
resistance will continue to exist even if antibiotics are being used
appropriately (Spellberg et al., 2008, p.
157). This essay will firstly explain the extent of
antibiotic misuse, then, proceed to evaluate the causes and consequences of the
misuse before discussing the its implications for patients and healthcare
the action plans for the reduction of the misuse will be outlined.
The misuse of antibiotics refers to the
situation where antibiotics are prescribed intentionally or unintentionally for
other purposes rather
than to cure the bacterial infection or the given doses are higher or lower
than the therapeutic level. There is plenty
evidence supporting the significant
misuse of antibiotics in hospitals, outpatient settings and long-term
care settings. A report from the
CDC in 2010 stated that antibiotics were prescribed 55.7 percent of
patients in 300 hospitals during their hospitalization.
Even though the
evidence of antibiotic misuse in outpatient setting in the US was rare, the CDC
presumed that up to 30 percent of antibiotics administered during ambulatory
care visits in both 2010 and 2011 were unnecessary.
studies revealed that 75
percent of all antibiotics administered in long-term care places were
inappropriate. As in the surveys carried out in 4 nursing homes in
the US, 40.5, 28.4, 24.3 and 8.1 percent of patients
received antibiotics with inaccurate durations, lack of
choices and wrong doses of antibiotics, respectively (Cook, 2016 pp. 346-349).
Apart from the
misuse of antibiotics in medical field, they were also extensively
misused for agricultural purpose as approximately 80 percent of all antibiotics
consumption in the US in 2010 was allocated to the promotion of growth and the prevention of diseases in
livestock. The use of antibiotics in food animals selects for bacteria
resistant to antibiotics used in humans, and these might spread via the food to
humans and cause human infection. They colonize in the human gut, and probably transfer
resistance genes to the others.
The causes of the antibiotic misuse in a medical
field occur from many factors such as medical professionals, patients and pharmaceutical
companies. In the first case, there are several reasons contributing
to the unnecessary prescriptions.
Firstly, nearly 50
percent of UK general practitioners (GPs) prescribed the broad-spectrum antibiotics
in advance to prevent secondary bacterial infections such as quinsy and
mastoiditis after viral respiratory tract infections (Shallcross &
Davies, 2014, pp.604-605).
often order antibiotics to avoid under-treatment when the uncertain
diagnosis is made. Another reason for antibiotic prescriptions is to
maintain a doctor-patient relationship to
avoid medical legal action (Llor & Bjerrum, 2003,
p. 231). Regarding
patients’, antibiotics were intensively
misused in the community as a survey by Infectious Diseases Society of America reported that more
than 10 percent of patients exaggerated their conditions in order to receive antibiotics but
nearly 25 percent of patients
did not complete their courses (Pechere, 2001). The control and regulation of antibiotic use is not
established in many developing countries as the drugs are available to purchase
in a pharmacy without a prescription, making self-prescribing
extremely common (Ventola, 2015, p. 278).
is also one of the most crucial factors contributing to the overdependence on
antibiotics. A massive amount of the
agents is being consumed in livestock in order to treat illnesses, prevent
infections or promote growth. Moreover, there were some
cases in which certain groups of livestock are infected but the entire herd
receive antibiotics without the order from veterinarians.
Some farmers have a
common misconception that antibiotics should be used as a growth promoter,
leading to the addition of the drugs to animals’
food for long periods at
sub-therapeutic concentrations (Carlet et al., 2012, p. 8).
The antibiotic misuse is the main cause of
bacterial resistance. The development of new antibiotics has been a race
with bacteria resistance over the past 30 years.
Bacteria have often developed their resistance within a few
years as soon as new antibiotic drugs have been discovered (CDC, 2013). It is a
general belief that the misuse of antibiotics is the only cause of antibiotic
resistance. However, this might be a misconception because the genetic
analysis of microbial metabolic pathways revealed that b-lactamase gene which destroys b-lactam antibiotics has been found in bacteria from 2
billion years ago (Spellberg et al., 2014 , p. 156) which means antibiotic resistance might be an unavoidable process. Bacteria have developed
their resistance genes by a random process of mutation without relying on the
misuse of antibiotics. Nonetheless, the misuse of antibiotics
has a profound impact in accelerating the rate of antibiotic resistance by
introducing a selective pressure into the bacteria community as normal flora
are destroyed. This results in the less
interspecific competition between bacteria, allowing resistant bacteria to
develop and reproduce rapidly. Finally, some invasive bacteria have developed themselves
to become superbugs which are resistant to all antibiotics such as Carbapenam-resistant
Enterobacteriacaea (CRE). The incidences of antibiotic resistance
have been increasing significantly as the early
generation of antibiotics are no longer effective in treating gram-negative
bacterial infections (CDC, 2013). Furthermore, merely half of the drugs
available at present were not effective in treating multidrug-resistant
tuberculosis as they were in the past decades (WHO, 2014). This results
in a minimum of 2 million patients in the
US suffered annually from
severe bacterial infections, and more than 230,000 patients died as a direct effect of
antibiotic resistance (CDC, 2013).