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Ramanan Laxminarayan: Americans must stop overusing antibiotics


August 24. 2013 8:48AM
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This week the Centers for Disease Control and Prevention will kick off its annual campaign aimed at reducing the overuse of antibiotics, drugs that one by one are becoming useless in the war against antibiotic-resistant microbes.The CDC campaign — “Get Smart: Know When Antibiotics Work” — urges consumers to use these drugs sparingly and many Americans have taken that message to heart. Recent data from the CDC show that antibiotic use is leveling off in the United States. In 1994, 300 out of every 1,000 pediatric office visits resulted in an antibiotic prescription. By 2007, that number had fallen to 229, a 24 percent decrease. However, interactive maps by Extending the Cure, a research project of the Center for Disease Dynamics, Economics & Policy, show regional disparities in the use of antibiotics, including very high consumption in some Southeastern states.These findings can and should be used by public health officials to understand why certain regions show high patterns of consumption and then put in place solutions, including public education campaigns tailored to stop the overuse of these powerful drugs.The new research reveals a high rate of antibiotic use in some Southeastern states and much lower rates in the Pacific Northwest, compared to the rest of the country. West Virginia and Kentucky had striking rates of antibiotic use: People living in those states took twice as many antibiotics as people living in states like Oregon and Alaska.High rates, like those seen in the southeastern United States, might reflect an environment in which consumers are anxious to get an antibiotic prescription for a case of the flu — and doctors are only too willing to comply. But antibiotics do nothing to combat viral illnesses such as common colds or influenza.At the same time, overuse of antibiotics has spawned an environment that gives microbes the advantage. Awash in antibiotics, they quickly adapt to become resistant to these drugs. And industry's development of new, more powerful antibiotics has not kept pace with the number of drugs rendered useless by resistance.The new findings on antibiotic use patterns in the United States come from ResistanceMap, an online tool that illustrates the growing problem of antibiotic resistance. Earlier data from this interactive web tool suggest that the same Southeastern states also face a growing threat from resistant “superbugs” such as methicillin-resistant Staphylococcus aureus, or MRSA.MRSA alone kills about 19,000 people per year, more than the deaths attributed to AIDS, according to the Centers for Disease Control and Prevention. Antibiotic resistance is a public health emergency that will get worse — unless we take swift action now.What can be done?First, public health officials must move quickly to reduce antibiotic prescribing where it is not necessary. One way to do this is by encouraging people to get vaccinated against the flu. During influenza season antibiotic use skyrockets due to the prevalence of secondary bacterial infections associated with flu and unnecessary prescriptions to treat viral illnesses. A 2009 policy brief by Extending the Cure suggests that up to 1 million unnecessary antibiotic prescriptions are written in the United States every year during flu season — prescriptions with no possible benefit and a lot of potential for accelerating resistance. In fact, reducing flu activity by 20 percent could lead to an 8 percent reduction in antibiotic use, according to an Extending the Cure study published in 2011.Second, policymakers must put in place comprehensive solutions, including better infection control and surveillance efforts that can identify and curb an emerging threat early on. They must give drug makers the incentives to find promising new antibiotic compounds.Finally, we must start to view antibiotics as a shared resource — just like oil reserves — that we all depend on. We must all act together to conserve these drugs to preserve their effectiveness. If we do nothing, it is only a matter of time before the drugs we have left are made useless.





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