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 development of antibiotic resistance, including the creation of multidrug-resistant bacteria, informally called "super bugs": relatively harmless bacteria can develop resistance to multiple antibiotics and cause life-threatening infections.
Instances of antibiotic misuse
Common situations in which antibiotics are overused include the following:
- Apparent viral respiratory illness in children should not be treated with antibiotics. If there is a diagnosis of bacterial infection, then antibiotics may be used.
- When children with ear tubes get ear infections, they should have antibiotic eardrops put into their ears to go to the infection rather than having oral antibiotics which are more likely to have unwanted side effects.
- Swimmer's ear should be treated with antibiotic eardrops, not oral antibiotics.
- Sinusitis should not be treated with antibiotics because it is usually caused by a virus, and even when it is caused by a bacteria, antibiotics are not indicated except in atypical circumstances as it usually resolves without treatment.
- Viral conjunctivitis should not be treated with antibiotics. Antibiotics should only be used with confirmation that a patient has bacterial conjunctivitis.
- Older persons often have bacteria in their urine which is detected in routine urine tests, but unless the person has the symptoms of a urinary tract infection, antibiotics should not be used in response.
- Eczema should not usually be treated with antibiotics. Dry skin can be treated with lotions or other symptom treatments.
- The use of antibiotics to treat surgical wounds does not reduce infection rates in comparison with non-antibiotic ointment or no ointment at all.
Social and economic impact
Antibiotics can cause severe reactions and add significantly to the cost of care. In the United States, antibiotics and anti-infectives are the leading cause of adverse effect from drugs. 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.
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).
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.
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