The crisis of antibiotic misuse

Antibiotic misuse is a significant public health concern and economic burden worldwide. Misuse relates both to overuse when treating a non-bacterial disease, such as a viral infection for which antibiotics are ineffective, and to underuse in cases of bacterial disease for which antibiotic treatment was delayed or not given and would have benefited the patient.

Antibiotic overuse is a common phenomenon, with the global overuse rate estimated at 40-70%. For example, according to the US Centers for Disease Control and Prevention (CDC), over 80 million antibiotic prescriptions are given in the US annually in the outpatient setting to treat viral infections, for which they are ineffective and inappropriate. Over-prescription of unnecessary antibiotics may cause adverse events such as allergic reactions, antibiotic-associated diarrhea, intestinal yeast infection, etc. These preventable adverse events negatively impact patient care and typically are associated with prolonged hospital stay. Antibiotic overuse is also driving the emergence of multi-drug resistant bacteria–one of the biggest healthcare problems of our time.

Antibiotic underuse may lead to prolonged disease duration and increased rate of disease-related complications, both of which may be avoided with prompt treatment of the bacterial infection. Underuse is fairly common. For example, up to 15% of adult patients hospitalized for bacterial pneumonia in the US receive delayed or no antibiotic treatments even though early treatment of bacterial pneumonia is known to save lives and reduce complications. Presently, a "watchful waiting" approach is being adopted in certain clinical situations in an attempt to reduce antibiotic overuse. Namely, antibiotics are prescribed only after a waiting period, during which the disease has not proved to be self-limiting. This approach is not without limitations as it may lead in some cases to antibiotic underuse and its associated hazardous consequences.

1. Pulcini et al., Eur J Clin Microbiol Infect Dis, 2007.

2. Davey et al., Emerg Infect Dis, 2006.

3. Cadieux et al., CMAJ, 2007.

4. Linder et al., JAMA, 2001.

5. CDC (Centers for Disease Control and Prevention), the Get Smart program. 

6. Spiro et al., JAMA, 2006.

7. Little P, BMJ, 2005.

8. Zwart et al., BMJ, 2000.

9. Siegel et al., Pediatrics, 2003.