Overuse Of Antibiotics May Make More Bacteria Drug-resistant

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Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: Public Health;  MRSA / Drug Resistance
Article Date: 11 Nov 2008 - 0:00 PST

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Between 2002 and 2006, academic medical centers in the United States increased their use of antibacterial drugs. According to new research published in the November 10 issue of Archives of Internal Medicine, a greater use of broad-spectrum agents and the antibiotic vancomycin accounted for much of this increase.

Health researchers are interested in antibacterial drug use because if they are used too frequently, it is possible for pathogens to become resistant to the drugs. Bacterial infections that are resistant to drugs are more expensive to treat and are more likely to lead to illness and death compared to pathogens that can be treated with antibiotics. "Many professional societies and national agencies have recommended monitoring antibacterial use and linking patterns of use to resistance," write authors Amy L. Pakyz, Pharm.D., M.S. (Virginia Commonwealth University, Richmond) and colleagues.

The researchers used claims data from university teaching hospitals and measured antibiotic use between 2002 and 2006. In addition, pharmacists or physicians who were specialists in infectious diseases in 19 hospitals filled out a 12-question survey in 2006 and 2007. The questions gathered data on factors thought to influence antimicrobial drug use, such as the existence of a hospital stewardship program to help control antibiotic use.

In 35 hospitals studied in 2006, about 63.5% of discharged patients (492,721 of 775,731) received an antibacterial drug. Data from five years in 22 hospitals revealed that between 2002 and 2006, the average total antibacterial use increased from 798 days of therapy per every 1,000 patient-days to 855 per 1,000 patient-days.

An analysis of antibiotic use by drug class found that fluoroquinolones were most frequently used, and over the five years their use stayed constant. However, there were five broad-spectrum antibiotic classes, acting against several different kinds of bacteria, which had significant increases in usage. "The other change contributing to the increase in total use was the marked increase in the use of vancomycin," note the authors. "During five years, the mean vancomycin use increased by 43 percent." Between 2004 and 2006, vancomycin became the most commonly used antibacterial in the hospitals.

"With few new antibacterials in development, antimicrobial stewardship programs in concert with aggressive infection control efforts represent the best chance for control of resistant pathogens," conclude Pakyz and colleagues. "Stopping antibacterials when they are not needed, switching to more narrow-spectrum drug regimens and optimal dosing using pharmacokinetic and pharmacodynamic principles [interactions between drugs and the body] are critical. Equally important will be investigations designed to identify shorter durations of antibacterial treatments for nosocomial [hospital-acquired] infections that have the potential to dramatically decrease antibacterial exposure."

Trends in Antibacterial Use in US Academic Health Centers: 2002 to 2006
Amy L. Pakyz; Conan MacDougall; Michael Oinonen; Ronald E. Polk
Archives of Internal Medicine (2008); 168[20]: pp. 2254-2260.
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Written by: Peter M Crosta
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