Antibiotic misuse, sometimes called antibiotic abuse or antibiotic overuse, refers to the misuse or overuse of antibiotics, with potentially serious effects on health. It is a contributing factor to the creation of multidrug-resistant bacteria, informally called "super bugs": relatively harmless bacteria can develop resistance to multiple antibiotics and cause life-threatening infections.
A 2003 study concerning the proper use of antibiotics in the emergency room revealed that 99% of instances contained some sort of error. Out of the 100 patients studied, 81 inappropriately received a prescription for fluoroquinolone. Out of these cases, 43 did not call for fluoroquinolone as a first-line agent, 27 presented no evidence of bacterial infection (based on documented evaluations), and 11 had questionable need for such therapy. Of the 19 cases that both called for and received fluoroquinolone, only one received both the correct dose and duration of therapy.
In a 1994 study of fluoroquinolone issued in a long-term care setting, 75% of the examined prescriptions were judged to be inappropriate. More than 50% did not call for fluoroquinolone as the first-line agent.
Social and economic impact
Antibiotics can cause severe reactions and add significantly to the cost of care. In the United States, antibiotics and antibiotics and anti-infectives are the leading cause of ADEs. In a study of 32 States in 2011, antibiotics and anti-infectives accounted for nearly 24 percent of ADEs that were present on admission, and 28 percent of those that occurred during a hospital stay.
Negative reactions to fluoroquinolones are easily misdiagnosed as a seizure disorder, CNS problems, or psychiatric problems. In Italy, doctors report fluoroquinolones among the top three prescribed drugs responsible for adverse neurological and psychiatric effects. The neuropsychiatric effects include tremor, confusion, anxiety, insomnia, agitation, and psychosis (in severe cases). Among the quinolones, moxifloxacin is reported as having the highest propensity to cause CNS toxicity.
Though antibiotics are required to treat severe bacterial infections, misuse has contributed to a rise in bacterial resistance. The overuse of fluoroquinolone and other antibiotics fuels antibiotic resistance in bacteria, which can inhibit the treatment antibiotic-resistant infections. Their excessive use in children with otitis media has given rise to a breed of bacteria resistant to antibiotics entirely.
Widespread use of fluoroquinolones as a first-line antibiotic has led to decreased antibiotic sensitivity, with negative implications for serious bacterial infections such as those associated with cystic fibrosis, where quinolones are among the few viable antibiotics.
Antibiotics have no effect on viral infections such as the common cold. They are also ineffective against sore throats, which are usually viral and self-resolving. Most cases of bronchitis (90–95%) are viral as well, passing after a few weeks—the use of antibiotics such as ofloxacin against bronchitis is superfluous and can put the patient at risk of suffering adverse reactions.
Official guidelines by the American Heart Association for dental antibiotic prophylaxis call for the administration of antibiotics to prevent infective endocarditis. Though the current (2007) guidelines dictate more restricted antibiotic use, many dentists and dental patients follow the 1997 guidelines instead, leading to overuse of antibiotics.
Antibiotics in livestock
There has been massive use of antibiotics in animal husbandry. The most abundant use of antimicrobials worldwide are in livestock; they are typically distributed in animal feed or water for purposes such as disease prevention and growth. Debates have arisen surrounding the extent of the impact of these antibiotics, particularly antimicrobial growth promoters, on human antibiotic resistance. Although some sources believe that there remains a lack of knowledge on which antibiotic use generates the most risk to humans, policies and regulations have been placed to limit any harmful effects.
In the United States the danger of emergence of antibiotic-resistant bacterial strains due to wide use of antibiotics to promote weight gain in livestock was determined by the United States Food and Drug Administration in 1977, but nothing effective was done to prevent the practice. In March, 2012 the United States District Court for the Southern District of New York, ruling in an action brought by the Natural Resources Defense Council and others, ordered the FDA to revoke approvals for the use of antibiotics in livestock which violated FDA regulations. On 11 April 2012 the FDA announced a program to phase out unsupervised use of drugs as feed additives and, on a voluntary basis, convert approved uses for antibiotics to therapeutic use only, requiring veterinarian supervision of their use and a prescription.
The use of fluoroquinolones as first-line agents is not generally recommended, except for patients who are seriously ill and may soon require hospitalization. However, the use of fluoroquinolones had increased three-fold in emergency rooms in the United States between 1995 and 2002, while the use of safer alternatives such as macrolides declined significantly.
Patients with chronic prostatitis (category IIIB) are often misdiagnosed as having bacterial forms of prostatitis and are erroneously treated with fluoroquinolone. Only 5% of patients with prostatitis have bacterial prostatitis, which can alleviated by antibiotics. A Bulgarian study examined prostatitis patients, all of whom had negative microbiological results. Of the patients given the fluoroquinolone ciprofloxacin, 65% experienced adverse drug reactions (as opposed to 9% of the placebo group). Those given fluoroquinolone also had a lower rate of recovery after six weeks (though not after six months).
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