The CDC’s report on the overuse of antibiotics raises concerns that the infectious disease community has been aware of for decades. Unfortunately, systemic action to address these concerns is hindered by misperceptions about antibiotic therapy: that it is safe, inexpensive, easy to prescribe, and that early administration is the best approach.
At first blush, antibiotic therapy appears to be safe. But there can be dangerous complications to its use. Clostridium difficile, an unintended effect of antibiotic therapy, is epidemic in our country with over 250,000 cases developing in U.S. hospitals, and associated with up to 14,000 deaths annually.
Many antibiotics are now in generic form, thereby bringing down their direct cost. In the U.S., some of the large, national pharmacies have made antibiotics available at no cost. But it’s the indirect costs from complications that we need to be concerned about. Clostridium difficile results in nearly $9 billion in excess costs according to the report.
Another significant indirect cost is the development of “superbugs,” bacteria resistant to all antibiotics. The isolation required for patients infected by these superbugs in order to prevent further spread adds to the cost of providing care. When transmission isn’t contained, the costs of providing care rise even further and with limited or no treatment options, these superbugs may ultimately cost lives. What may seem like inexpensive care at first glance can indeed be rather costly.
Antibiotics are easy to prescribe. However, it is not the prescribing we should be worried about — it is the proper diagnosis. Many patients are given antibiotics for too long, or for conditions that do not require antibiotic therapy. Too often, “broad spectrum” antibiotics are prescribed when a more focused treatment would be appropriate. So, despite the accessibility of antibiotic therapy, making the right diagnosis and providing the right care is, in fact, not easy.
Finally, a lack of understanding of the appropriate use of early antibiotic treatment is the root cause of much of the over prescription of these drugs. Many patients are continued on antibiotic therapy simply because there appears to be improvement. A clinician trained in infectious disease understands the importance of diagnosis, the risk to patients from infection and the risk associated with inappropriate antibiotic use. In other words, an infectious diseases specialist will know what antibiotic therapy to start, how long to treat, and when to stop treatment safely.
The CDC has outlined a number of steps toward improving antibiotic use in hospitals, an antibiotic stewardship checklist which includes senior leadership, clinical leadership, pharmacy leadership and appropriate team members. All are critically important to success but of absolute certainty is the role of the infectious disease clinician as the clinical leader on this team, the specialist who can create clarity from the uncertainty.
Ronald G. Nahass is president, ID Care.
