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This poster from the U.S. Centers for Disease Control and Prevention "Get Smart" campaign, intended for use in doctors' offices and other healthcare facilities, warns that antibiotics do not work for viral illnesses such as the common cold.
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, increasing hospitalization: in the United States, this accounts for billions of dollars of expense within the healthcare system. Adverse effects from antibiotics account for nearly 25% of all adverse drug reactions amongst hospitalized patients. 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.
Antibiotic resistance 
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.
Inappropriate use 
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 April 11, 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).
See also 
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- ^ Beringer PM, Wong-Beringer A, Rho JP (January 1998). "Economic aspects of antibacterial adverse effects". PharmacoEconomics 13 (1 Pt 1): 35–49. doi:10.2165/00019053-199813010-00004. PMID 10175984.
- ^ James R. Roberts (October 2008). "Adverse Reactions to Fluoroquinolones". Emergency Medicine News (Emergency Medicine News) 30 (10): 16–18. doi:10.1097/01.EEM.0000338244.41795.9c (inactive 2010-03-01).
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- ^ "Studies examine prescribing of antibiotics for respiratory infections in hospital emergency departments". USA: U.S. Department of Health and Human Services. "From 1995 to 2002, inappropriate antibiotic prescribing for acute respiratory infections, which are usually caused by viruses and thus are not responsive to antibiotics, declined from 61% to 49%. However, the use of broad-spectrum antibiotics such as the fluoroquinolones, jumped from 41% to 77% from 1995 to 2001. Overuse of these antibiotics will eventually render them useless for treating antibiotic-resistant infections, for which broad-spectrum antibiotics are supposed to be reserved."
- ^ "Fluoroquinolone Resistance and Tuberculosis Treatment". USA: The New York City Department of Health and Mental Hygiene.
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- ^ "Cipro, Related Antibiotics Over-Prescribed, Fueling Microbe Resistance". USA: University Of California. 1 October 2002. Retrieved 13 August 2009.
- ^ K. Bassett; B. Mintzes V. Musini T.L. Perry Jr M. Wong J.M. Wright (November 2002). "Therapeutics Letter" (PDF). Canadian Family Physician 48. "Gatifloxacin and moxifloxacin have no proven clinical advantages over other fluoroquinolones, macrolides, or amoxicillin. Based on cost, they are not first-choice drugs for their approved indications."
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- ^ Little P, Gould C, Williamson I, Warner G, Gantley M, Kinmonth AL (August 1997). "Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics". BMJ 315 (7104): 350–2. doi:10.1136/bmj.315.7104.350. PMC 2127265. PMID 9270458.
- ^ Hueston WJ (March 1997). "Antibiotics: neither cost effective nor 'cough' effective". The Journal of Family Practice 44 (3): 261–5. PMID 9071245.
- ^ Zadik Y, Findler M, Livne S et al. (December 2008). "Dentists' knowledge and implementation of the 2007 American Heart Association guidelines for the prevention of infective endocarditis". Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106 (6): e16–9. doi:10.1016/j.tripleo.2008.08.009. PMID 19000604.
- ^ Elad S, Binenfeld-Alon E, Zadik Y, Aharoni M, Findler M. (March 2011). of acceptance of the 2007 American Heart Association Guidelines for the prevention of infective endocarditis: A pilot study "Survey of acceptance of the 2007 American Heart Association guidelines for the prevention of infective endocarditis: a pilot study". Quintessence Int 42 (3): 243–51. PMID 21465012.
- ^ Wilson W, Taubert KA, Gewitz M et al. (October 2007). "Prevention of infective endocarditis: guidelines from the American Heart Association". Circulation 116 (15): 1736–54. doi:10.1161/CIRCULATIONAHA.106.183095. PMID 17446442.
- ^ Silbergeld, E.K.; Graham, J.; Price, L.B. (2008), "Industrial food animal production, antimicrobial resistance, and human health", Annual review of public health 29: 151–169, doi:10.1146/annurev.publhealth.29.020907.090904
- ^ Landers, T.F.; Cohen, B.; Wittum, T.E.; Larson, E.L. (2012), "A review of antibiotic use in food animals: Perspective, policy, and potential", Public health reports 127 (1): 4–22, doi:10.1093/jac/dkg483
- ^ John Gever (March 23, 2012). "FDA Told to Move on Antibiotic Use in Livestock". MedPage Today. Retrieved March 24, 2012.
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- ^ "FDA's Strategy on Antimicrobial Resistance - Questions and Answers". U.S. Food and Drug Administration. April 11, 2012. Retrieved April 12, 2012. "“Judicious use” is using an antimicrobial drug appropriately and only when necessary; Based on a thorough review of the available scientific information, FDA recommends that use of medically important antimicrobial drugs in food-producing animals be limited to situations where the use of these drugs is necessary for ensuring animal health, and their use includes veterinary oversight or consultation. FDA believes that using medically important antimicrobial drugs to increase production in food-producing animals is not a judicious use."
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