Type: Process Essays
Sample donated: Arnold Carson
Last updated: September 19, 2019
After the remarkable discovery of the firstantibiotic therapy, US general surgeon William H. Stewart made the infamous declaration that “it is time toclose the book on infectious diseases and declare the war against pestilencewon” (Spellberg et al., 2008, p.156). This statement reflected the general attitude of medical professionalstoward antibiotics at that time; however, it has been proven wildly inaccurateover the past 30 years.
In fact, “closing the book on infectious diseases” is a great distance away considering the evidence that infectiousdiseases continue to be the second cause of death worldwide, and the third in the US and other developed countries, despite thedevelopment of newer antibiotics. The main factorcontributing to the failure to conquer infectious diseases is commonly believedto be the inappropriate use of antibiotics.Antibiotics are vastly beingmisused in both medical and agricultural fields which have tremendous impactson patients and healthcare professionals. According to the Centersof Disease Control and Prevention (CDC), as many as 50percent of all antibioticsprescribed in healthcare have been misused as they are used to treat acute respiratorytract infections which are mostly caused by self-limiting viruses(p.11). This misuse provides opportunity for bacteria todevelop new resistant strains, resulting in the more powerful and broad-spectrum antibiotics have to be prescribed as avicious cycle. Then the resistant genes proliferate and are transferred to otherpatients. Nevertheless, there is a debate that bacterialresistance is an unavoidable and continuing process so the issue of bacterialresistance will continue to exist even if antibiotics are being usedappropriately (Spellberg et al.
, 2008, p.157). This essay will firstly explain the extent ofantibiotic misuse, then, proceed to evaluate the causes and consequences of themisuse before discussing the its implications for patients and healthcareprofessionals. Lastly,the action plans for the reduction of the misuse will be outlined.The misuse of antibiotics refers to thesituation where antibiotics are prescribed intentionally or unintentionally forother purposes ratherthan to cure the bacterial infection or the given doses are higher or lowerthan the therapeutic level. There is plentyevidence supporting the significantmisuse of antibiotics in hospitals, outpatient settings and long-termcare settings.
A report from theCDC in 2010 stated that antibiotics were prescribed 55.7 percent ofpatients in 300 hospitals during their hospitalization.Even though theevidence of antibiotic misuse in outpatient setting in the US was rare, the CDCpresumed that up to 30 percent of antibiotics administered during ambulatorycare visits in both 2010 and 2011 were unnecessary.Furthermore, manystudies revealed that 75percent of all antibiotics administered in long-term care places wereinappropriate. As in the surveys carried out in 4 nursing homes inthe US, 40.5, 28.4, 24.3 and 8.
1 percent of patientsreceived antibiotics with inaccurate durations, lack ofindications, incorrectchoices and wrong doses of antibiotics, respectively (Cook, 2016 pp. 346-349).Apart from themisuse of antibiotics in medical field, they were also extensivelymisused for agricultural purpose as approximately 80 percent of all antibioticsconsumption in the US in 2010 was allocated to the promotion of growth and the prevention of diseases inlivestock. The use of antibiotics in food animals selects for bacteriaresistant to antibiotics used in humans, and these might spread via the food tohumans and cause human infection. They colonize in the human gut, and probably transferresistance genes to the others.The causes of the antibiotic misuse in a medicalfield occur from many factors such as medical professionals, patients and pharmaceuticalcompanies. In the first case, there are several reasons contributingto the unnecessary prescriptions.
Firstly, nearly 50percent of UK general practitioners (GPs) prescribed the broad-spectrum antibioticsin advance to prevent secondary bacterial infections such as quinsy andmastoiditis after viral respiratory tract infections (Shallcross &Davies, 2014, pp.604-605).Secondly, doctorsoften order antibiotics to avoid under-treatment when the uncertaindiagnosis is made. Another reason for antibiotic prescriptions is tomaintain a doctor-patient relationship toavoid medical legal action (Llor & Bjerrum, 2003,p.
231). Regardingpatients’, antibiotics were intensivelymisused in the community as a survey by Infectious Diseases Society of America reported that morethan 10 percent of patients exaggerated their conditions in order to receive antibiotics butnearly 25 percent of patientsdid not complete their courses (Pechere, 2001). The control and regulation of antibiotic use is notestablished in many developing countries as the drugs are available to purchasein a pharmacy without a prescription, making self-prescribingextremely common (Ventola, 2015, p. 278).
Agricultural useis also one of the most crucial factors contributing to the overdependence onantibiotics. A massive amount of theagents is being consumed in livestock in order to treat illnesses, preventinfections or promote growth. Moreover, there were somecases in which certain groups of livestock are infected but the entire herdreceive antibiotics without the order from veterinarians.
Some farmers have acommon misconception that antibiotics should be used as a growth promoter,leading to the addition of the drugs to animals’food for long periods atsub-therapeutic concentrations (Carlet et al., 2012, p. 8).
The antibiotic misuse is the main cause ofbacterial resistance. The development of new antibiotics has been a racewith bacteria resistance over the past 30 years.Bacteria have often developed their resistance within a fewyears as soon as new antibiotic drugs have been discovered (CDC, 2013). It is ageneral belief that the misuse of antibiotics is the only cause of antibioticresistance. However, this might be a misconception because the geneticanalysis of microbial metabolic pathways revealed that b-lactamase gene which destroys b-lactam antibiotics has been found in bacteria from 2billion years ago (Spellberg et al.
, 2014 , p. 156) which means antibiotic resistance might be an unavoidable process. Bacteria have developedtheir resistance genes by a random process of mutation without relying on themisuse of antibiotics. Nonetheless, the misuse of antibioticshas a profound impact in accelerating the rate of antibiotic resistance byintroducing a selective pressure into the bacteria community as normal floraare destroyed. This results in the lessinterspecific competition between bacteria, allowing resistant bacteria todevelop and reproduce rapidly. Finally, some invasive bacteria have developed themselvesto become superbugs which are resistant to all antibiotics such as Carbapenam-resistantEnterobacteriacaea (CRE). The incidences of antibiotic resistancehave been increasing significantly as the earlygeneration of antibiotics are no longer effective in treating gram-negativebacterial infections (CDC, 2013).
Furthermore, merely half of the drugsavailable at present were not effective in treating multidrug-resistanttuberculosis as they were in the past decades (WHO, 2014). This resultsin a minimum of 2 million patients in theUS suffered annually fromsevere bacterial infections, and more than 230,000 patients died as a direct effect ofantibiotic resistance (CDC, 2013).