'Too Much Of A Good Thing': OP-ED On Antibiotic Resistance

RIVERSIDE COUNTY, CA — The consequences of society’s over-reliance on antibiotics can be seen coming through the doors of RUHS Medical Center on a regular basis and pharmacists there want to curtail the trend.

“We are seeing 3-year-old children coming in with strains of bacteria that are resistant to most antibiotics and they’ve never been hospitalized before,” said Nikita Patel, a senior clinical pharmacist who specializes in infectious diseases at the 439-bed Medical Center and teaching hospital in Moreno Valley.

With the height of cold and flu season fast approaching, Patel is joining health experts across the globe who are cautioning patients – and their providers – about the harmful and potentially deadly effects of taking antibiotics when they are not needed. Patel said RUHS Medical Center has ramped up its antibiotic education campaign to improve patient outcomes and reduce antibiotic resistance. The focus includes educating patients, providers and the public about the harmful effects of using antibiotics unnecessarily and ways to use them judiciously when they are needed.

“Patient education is critical,” Patel said. “December through February is commonly the peak of the flu season in Southern California. The common cold and flu do not need antibiotics.”

Patel said some overprescribing is due to pressure from the patients who view antibiotics as miracle drugs even though they have strict limitations. Prescription medications known as antiviral drugs can be used to treat the flu, but they must be started early (within 2 days of getting sick). Patel said these medications are different than antibiotics and they make symptoms of flu milder and shorten the time patients are sick.

Still, Patel tells patients the best way to protect against cold and flu is to wash hands frequently, avoid those who are infected and, most importantly to get a flu vaccine every flu season. Those who are sick should treat their symptoms, which antibiotics are not designed to do, she said.

According to national data at least 30 percent of antibiotic courses prescribed in the outpatient setting are unnecessary. Most of this unnecessary use is for acute respiratory conditions, such as colds, bronchitis, sore throats caused by viruses, and even some sinus and ear infections. Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections, according to the Centers for Disease Control and Prevention (CDC). The World Health Organization (WHO) has declared antibiotic resistance as a worldwide threat to public health.

Common infections that used to be treated with oral antibiotics are becoming increasingly challenging to treat as these antibiotics are losing their efficacy against constantly evolving drug-resistant bacteria and superbugs that are resistant to all antibiotics. In some cases, Patel said patients come in with simple urinary tract infections that no longer respond to oral antibiotics. In these cases, doctors are forced to move to stronger intravenous antibiotics to combat the infection.

As RUHS Medical Center’s antibiotic steward, Patel has two years additional concentrated residency training in infectious diseases than a typical pharmacist. She has helped organize trainings for physicians within the hospitals and clinics, which serve almost a half million patients annually. But after four years, Patel sees a need for more public education.

“This is a global problem, and hospitals do not have all the answers,” Patel said, adding that antibiotic use is pervasive in society, including in the production of meat, milk and eggs.

“Public awareness and understanding are the most critical next steps to achieving better use of antibiotic treatments and preserving their efficacy for future generations,” Patel said.

More resources:

• Fact sheet from the Centers for Disease Control and Prevention about Antibiotic Resistance: https://www.cdc.gov/antibiotic-use/community/about/antibiotic-resistance-faqs.html
• Summary of the September 2017 meeting of the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria: https://www.hhs.gov/sites/default/files/paccarb-9-13-17-summary-final.pdf
• The World Health Organization fact sheet: http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/
• Final report from the United Kingdom study: https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf

— SUBMITTED FOR PUBLICATION BY: Riverside University Health System—Medical Center / Patch file photo