Well­ness Arti­cles

CDC: Overuse of Antibi­otics is Killing Amer­i­cans

antibiotics overuse

By Lisa Col­lier Cool, Sep­tem­ber 16, 2013

More than two mil­lion Amer­i­cans fall prey to drug-​resistant infec­tions annu­ally, and 23,000 of them die, fed­eral offi­cials announced in the first esti­mate of this toll. The lead­ing killer is C. dif­fi­cile, which causes at least 250,000 ill­nesses and 14,000 deaths each year, accord­ing to a land­mark new report on the most deadly super­bug threats.

About half of all antibi­otics are pre­scribed need­lessly, the Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC) reveals in the report. And overuse of antibi­otics has made exist­ing “won­der drugs that worked for decades” use­less against bac­te­ria that have mutated to resist them, warns CDC direc­tor Tom Frieden, MD, MPH.

Many bac­te­ria are mak­ing dan­ger­ous advances against antibi­otics,” which are increas­ingly inef­fec­tive against life-​threatening infec­tions,” says Dr. Frieden. “We’re get­ting closer and closer to the edge of the cliff when we’re deal­ing with untreat­able infec­tions. When we no longer have that second-​tier drug to rely on, that’s when it becomes a mat­ter of life and death.”

With­out imme­di­ate action, adds Dr. Frieden, “many patients will be in the post-​antibiotic era. For some organ­isms and some patients, it’s already too late.” For exam­ple, the CDC recently iden­ti­fied highly lethal “night­mare bac­te­ria” that “can resist all antibi­otics, kill a high pro­por­tion of peo­ple it infects, and spread from per­son to per­son,” he added.

What’s more, very few new antibi­otics are in the drug pipeline, so it could take a decade or more before new weapons against these killer infec­tions are available.

The Most Dan­ger­ous Superbugs

For the first time, the CDC has ranked the 18 most dan­ger­ous drug-​resistant super­bugs into three cat­e­gories: urgent, seri­ous, and con­cern­ing. “If we don’t act now, our med­i­cine cab­i­net will be empty and we won’t have the antibi­otics we need to save lives,” cau­tions Dr. Frieden.

The urgent cat­e­gory con­sists of the three scari­est super­bug threats:

C. dif­fi­cile. This infec­tion causes life-​threatening diar­rhea and typ­i­cally tar­gets peo­ple who have had both recent med­ical care and antibi­otics. It’s most likely to strike hos­pi­tal­ized or recently hos­pi­tal­ized patients, caus­ing 250,000 infec­tions and 14,000 deaths a year. Fatal­i­ties from this infec­tion have soared by 400 per­cent between 2000 and 2007, largely because a stronger strain emerged that is resis­tant to flu­o­ro­quinolone antibi­otics com­monly used for other infections.

Carbapenem-​resistant enter­obac­te­ri­aceae (CRE). These are the night­mare bac­te­ria that are resis­tant to all or nearly all antibi­otics, includ­ing car­bapenem, usu­ally con­sid­ered the antibi­otic of last resort. They cause more than 9,300 infec­tions a year and up to half of cases are fatal.

Drug-​resistant Neis­se­ria gon­or­rhoeae. This sex­u­ally trans­mit­ted dis­ease is highly con­ta­gious and infects 246,000 Amer­i­cans a year. It is resis­tant to many types of antibi­otics. If this super­bug becomes wide­spread in the US over the next decade, the CDC esti­mates that an addi­tional 75,000 women will develop pelvic inflam­ma­tory dis­ease, a major cause of infer­til­ity, and an addi­tional 15,000 men will be stricken with epi­didymi­tis (swelling and infec­tion of the tube that con­nects the tes­ti­cles to the vas deferens.)

The report also includes a dozen more super­bugs with a threat level of “seri­ous” or “con­cern­ing.” These include MRSA (methi­cillin resis­tant staphy­lo­coc­cus aureus) and drug-​resistant forms of pneu­mo­nia, tuber­cu­lo­sis, can­dida (a fun­gus), sal­mo­nella (a cause of food poi­son­ing), and group B strep (bac­te­ria that cause severe ill­nesses, rang­ing from blood­stream infec­tion to pneu­mo­nia, menin­gi­tis and skin infections).

A 4-​Point Action Plan to Fight Antibi­otic Resistance

To com­bat the loom­ing antibi­otic apoc­a­lypse – the day when none of the avail­able treat­ments will work against cer­tain microbes – the CDC has iden­ti­fied 4 impor­tant steps that health­care providers, the gov­ern­ment, indus­try, and patients should take:

Pre­vent­ing the spread of infec­tion. The best way to com­bat overuse of antibi­otics is to reduce the risk of get­ting sick in the first place. These mea­sures include get­ting vac­cines for pre­ventable dis­eases, bet­ter infec­tion con­trol in health­care facil­i­ties, safe food prepa­ra­tion, and hand wash­ing, which as I recently reported, is the eas­i­est, cheap­est way to stay healthy.

Bet­ter track­ing of super­bugs. Dr. Frieden says that even the alarm­ing toll of more than two mil­lion ill­nesses and 23,000 deaths annu­ally in the US from resis­tant infec­tions is “a very con­ser­v­a­tive esti­mate.” Addi­tion­ally, sev­eral super­bugs that orig­i­nated in Europe and Asia were not iden­ti­fied as major threats until they spread to the US. The CDC will con­tinue to gather data on new and exist­ing super­bugs, risk fac­tors for their spread, and what can be done to van­quish these threats.

Smarter use of antibi­otics. What the CDC calls “stew­ard­ship” is the most impor­tant action to tackle antibi­otic resis­tance, since up to half of all antibi­otics in peo­ple and almost all in ani­mals (such as use in live­stock) is unnec­es­sary. Patients shouldn’t pres­sure doc­tors to pre­scribe antibi­otics for viral infec­tions (they don’t work on these ill­nesses) and doc­tors shouldn’t reach for their pre­scrip­tion pad merely to please patients. Many com­mon ail­ments can be best treated with­out antibi­otics, so always ask what other options there are if your doc­tor advises them.

Devel­op­ing new drugs and diag­nos­tic tests. Since microbes will always mutate to out­smart the treat­ments designed to kill them, it’s essen­tial to increase the num­ber of new antibi­otics in the drug pipeline and come up with bet­ter tests to track devel­op­ment of resis­tance. As I reported recently, only seven new drugs are cur­rently in devel­op­ment to com­bat the most lethal super­bugs, such as CRE.

Ran­dom Article

From the May 8, 2002 issue of The Jour­nal of the Amer­i­can Med­ical Asso­ci­a­tion ( JAMA) reports a study that sug­gests that the longer

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