Antibiotic Resistance: A Case Study and Solutions

Though the discovery of penicillin was a god-send to modern medicine in the early 20th century, Alexander Fleming’s technology has now reached a dangerous point of overuse. The CDC reports that at least 30% of antibiotics prescribed in the U.S. are unnecessary, and that between 20-50% of antibiotics used in hospitals are considered inappropriate.[1] In addition, approximately two million Americans suffer from antibiotic-resistant illnesses annually, resulting in 23,000 deaths.[2] Though the dangers of excessive antibiotic use have been documented many times, how to prevent the problem is less often addressed. Therefore, we present one case study to demonstrate one of the complications of over utilizing antibiotics followed by a list of ways to address this problem and the thousands of lives it claims.

The vicious cycle of C. difficile

The main concern of using antibiotics as an easy prescription for something as minor as the common cold is that overuse can lead to the evolution of resistant strains of bacteria.[3] However, another consequence is that overuse can wipe out healthy gut bacteria that the body needs.[4]

A good demonstration of this problem is the increase in C. difficile that has been found to be associated with antibiotic use to treat sepsis.[5] Clostridium difficile is a bacterium that can cause anything from diarrhea to a life-threatening inflammation of the colon.[6] Researchers found that when sepsis protocol is implemented, the overall use of antibiotics increased significantly in order to combat infection. However, increased antibiotic use kills many healthy bacteria that protect the body from infection, causing harmful bacteria like C. difficile to quickly grow out of control.[7] Sadly, in an attempt to prevent bacterial infection, over using antibiotics can actually cause other infections, creating a vicious cycle the body can’t stop.[8]

What can be done?

In order to prevent antibiotics from causing more harm than good, here are some solutions to consider:

  • Acknowledge action doesn’t always help: One of the tendencies of physicians is to prescribe medication unnecessarily in an attempt to provide immediate satisfaction to patients.[9] Patients see this as “doing something” about a problem, as providing a solution, when in reality, simply waiting for the illness to run its course might be a better idea. Both doctors and patients need to understand that the pressure to prescribe can be a habit that simply results in unnecessary risk, cost, and inconvenience.
  • Pledge to guidelines: One study found that if physicians had signed posters in their exam rooms that vowed to follow guidelines on antibiotic prescription, they felt pressure to act consistently with their public statement.[10] The study found that inappropriate prescriptions declined by 20% in doctors who displayed such a poster.[11]
  • Reorganizing information: Even changing the way in which doctors view medication lists can assist with eliminating unnecessary antibiotic prescriptions. Researchers have found that physicians prescribe less aggressive medications when such options are presented less prominently in a chart.[12]
  • Provide more (and frequent) information: Informing and reminding patients and doctors alike of antibiotic risks can never hurt the situation. One study found that sending a monthly email to doctors informing them of their performance as it related to that of their peers, with special congratulatory messages for those who were “top performers,” almost completely eliminated inappropriate prescribing among the doctors studied.[13]

Changing behavior is hard, so no one can expect to see a decline in inappropriate antibiotic usage overnight. However, with diligence and effort on the parts of all parties, there is hope that steady improvement will prevail.

[1] Pronovost, Peter, “How to Keep Doctors From Overprescribing Antibiotics,” The Wall Street Journal, June 30, 2017,  https://blogs.wsj.com/experts/2017/06/30/how-to-keep-doctors-from-overprescribing-antibiotics/

[2] Fox, Craig R., Jeffrey A. Linder, and Jason N. Doctor, “How to Stop Overprescribing Antibiotics,” The New York Times, March 25, 2016, https://www.nytimes.com/2016/03/27/opinion/sunday/how-to-stop-overprescribing-antibiotics.html

[3] Pronovost, “How to Keep Doctors”

[4] Ibid

[5] “Antibiotic use, C. difficile increase under electronic sepsis protocol,” healio.com, Oct. 5, 2017, https://www.healio.com/infectious-disease/nosocomial-infections/news/in-the-journals/%7Bab86c3b0-4aa5-4795-9cf2-add8503a8c70%7D/antibiotic-use-c-difficile-increase-under-electronic-sepsis-protocol

[6] “C. difficile infection,” Mayo Clinic, n.d., http://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

[7] Ibid

[8] “Antibiotic use”

[9] Pronovost, “How to Keep Doctors”

[10] Ibid

[11] Ibid

[12] Ibid

[13] Ibid

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