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By Janet Weiner, MPH
National initiatives have been launched in the face of growing evidence that overuse of antibiotics is creating a new generation of bacteria that are resistant to existing medicines. A recent study in the New England Journal of Medicine found that, in the U.S., the risk of developing certain infections with resistance to at least three antibiotics rose from 9% in 1995 to 14% in 1998. "These 'superbugs' are creating life-threatening conditions for patients with infections such as meningitis, tuberculosis or pneumonia," according to Brian L. Strom, MD, MPH, Director of the Penn CERTs, which focuses on drug utilization and resistance.
The U.S. Centers for Disease Control and Prevention (CDC) estimates that about one-third of the 150 million prescriptions written for antibiotics each year are unnecessary, resulting in bacterial strains that become tougher than the antibiotics being used against them. "Too many antibiotics are being prescribed needlessly for the common cold and other viral infections," Dr. Strom said.
In January 2001, the U.S. Department of Health & Human Services unveiled an action plan to combat antibiotic resistance. It provides a blueprint for coordinated federal action to address this emerging threat, including a national public education campaign to reduce overuse and misuse of antibiotics, and clinical guidelines for health professionals. It also calls for increased surveillance, research and product development to prevent or treat resistant infections.
The Food and Drug Administration (FDA) has recently taken two actions to address this problem. First, it proposed new labeling requirements for antibiotics that would include information about the emergence of drug-resistant bacterial strains. Package inserts would encourage health professionals to prescribe antibiotics judiciously and would urge patient to take the drugs as directed. Second, the FDA took steps to revoke the approval of an antibiotic used in poultry, recognizing that some animal and agricultural uses can result in the emergence of resistant strains of bacteria that travel to people through food.
The Penn CERT s research agenda is contributing to national goals by tracking the epidemiology of antibiotic drug resistance and designing interventions to foster appropriate use of antibiotics. For example, one Penn CERTs project is testing an intervention to reduce the use of antibiotics for acute bronchitis; another project is examining the effects of using tetracyline for acne on patterns of later antibiotic resistance. For more information, see www.penncert.org.
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