New research suggests a pattern of outpatient antibiotic overuse in parts of the United States– particularly in the Southeast –a problem that could accelerate the rate at which these powerful drugs are rendered useless, according to the Extending the Cure project.
These findings come out just as the Centers for Disease Control and Prevention (CDC) kicked off an annual effort to reduce overuse of antibiotics called “Get Smart: Know When Antibiotics Work.” The campaign urges Americans to use antibiotics wisely.
The CDC estimates that $1.1 billion is spent annually on unnecessary antibiotic prescriptions for adult upper respiratory infections alone. These prescriptions also speed the development of resistance to important antibiotic therapies.
Trends in Antibiotic Use Paint a Troubling Picture
Interactive maps released by Extending the Cure track antibiotic use in the United States from 1999 to 2007 and show how overall antibiotic dispensing has decreased; consumption fell by about 12% over this time period. However, they also highlight alarmingly high antibiotic use across the Southeast compared to states in the Pacific Northwest. For example, residents of West Virginia and Kentucky, where antibiotic use rates are highest, take about twice as many antibiotics per capita as people living in Oregon and Alaska.
High per capita antibiotic use rates could reflect an environment in which consumers mistakenly demand antibiotics – and physicians prescribe them — when they have a cold or the flu, which are caused by viruses and cannot be treated with these drugs. However, additional research must be done to better understand the driving factors behind antibiotic use.
The data was released as part of Extending the Cure’s ResistanceMap, an interactive web-based tool that tracks drug resistance.
Novel Way to Track Resistance: Drug Resistance Index (DRI)
In a report published in the British Medical Journal Open, Ramanan Laxminarayan, Director of Extending the Cure, and Keith P. Klugman, Professor of Global Health at Emory University, describe a first-of-its-kind index for tracking resistance. Like a Consumer Price Index (CPI) for drug resistance, the tool aggregates information about resistance trends and antibiotic use into a single measure of antibiotic resistance over time.
In this paper, researchers explain how the index can be used by assessing trends in resistance associated with two disease-causing micro-organisms: Escherichia coli and Acinetobacter baumannii. The index can also illuminate how physicians adapt to trends in resistance. For example, in this analysis, the index showed how physicians were able to use other drugs to treat infections caused by resistant strains of E. coli but had very few options left for treating Acinetobacter, a superbug that increasingly is resistant to all available antibiotics.
“Mapping the geography of antibiotic use and summarizing their effectiveness with a Drug Resistance Index bring us one step closer to the solutions we urgently need in order to curtail this public health crisis,” Laxminarayan said. “If we do nothing, resistance will continue to develop and our most valuable antibiotics ultimately will fail.”
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British Medical Journal Open. Published Online November 14, 2011. “Communicating trends in resistance using a drug resistance index,” Ramanan Laxminarayan, Keith P Klugman Author Affiliations: Center for Disease Dynamics, Economics & Policy, Washington, DC, USA, Princeton Environmental Institute, Princeton, New Jersey, USA, Public Health Foundation of India, New Delhi, India, MRC/Wits Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa, Hubert Department of Global Health Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA