Misuse and Abuse of Antibiotics - Essay Example

Misuse and Abuse of Antibiotics The development of drugs those are able to prevent and cure bacterial infections has undoubtedly contributed to human quality of life by countering an infective process, and this is considered one of the major advancements of Medicine and pharmaceutical science in this era. Antibiotics are among the most commonly prescribed drugs in clinical practice in USA and other parts of the world. Used appropriately and with ample rationality and clinical sense, these drugs are lifesaving on the face of a life-threatening infective disease. However, indiscriminate use of these agents drives up cost of healthcare, leads to many side effects, and most importantly, favors the emergence of bacterial resistance. The emergence of bacterial resistance makes the situation worse in the sense that it renders a useful drug useless and creates a situation that favors persistence of infection. In this essay, indiscriminate use of antibiotics in the state-of-the-art medical practice, its implications, and probable solution will be discussed taking a look into the history of antibiotic development and how resistance emerges. Until 1930s, infectious diseases were treated as dreadful since there was no suitable chemical treatment available to combat bacterial infections. Researches continued, and the first ray of hope emerged from the concept of antibiosis that suggested that one bacteria can be used to destroy other bacterial pathogens. Alexander Fleming could first extract an antibacterial factor from Penicillium mould in 1928. It was a very crude method to start with, and it was extremely difficult to extract the product. Presently, antibacterial agents are chemically synthesized. It began with the discovery of sulfonamides that can destroy bacteria. Following that, technology of chemical synthesis and biological research led to many newer compounds with many activities and side effects. As a result, it demanded specialized knowledge of the physicians who treat infectious conditions (Drews, J., 2000). From the very beginning, it was recognized by the medical profession that there is possibility of development of resistance, and the prescription of these drugs must be regulated. Despite the Penicllin Act of 1948, more and more resistant strains of bacteria kept evolving, and continued research led to development of newer and newer antibiotics. The effect was devastating. In 1950s, a resistant strain of the bacteria, Staphylococcus aureus led to catastrophic events throughout the world, especially in the hospital setting and especially in children admitted to the hospital. Thus, the mechanism of resistance was probed into, and researches ultimately found that development of resistance is produced by indiscriminate use of the antibiotics, and such use may well be termed as misuse or abuse (Wenzel, R.P., 2002). The rational use of antibiotics is dependent on understanding of their mechanisms of action, pharmacokinetics, toxicities, interactions; bacterial strategies of resistance; and bacterial susceptibilities in vitro. The acquired resistance is a well-known major limitation to effective antibacterial chemotherapy. Bacterial resistance to antibiotics develop by mutation of the resident bacterial genes or by acquisition of new genes that resist antibiotics to cause bacterial death. Almost all bacteria have cellular mechanisms of transmission of genetic traits by a system of mobile genetic elements, such as, plasmids, transposons, and bacteriophages (Martnez, J.L. and Baquero, F., 2002). As a result, the new genes mediating resistance are spread from bacteria to bacteria to create a colony of resistant bacteria. Such populations flourish in areas of high antibiotic use where they enjoy a selective advantage over susceptible population. To answer the question how resistance becomes operative, one can deduce that the antimicrobial agent can no longer exert its fatal or suppressive action against the bacterial population that demonstrates resistance. Thus resistant strains inactivate the antibiotic compound. This inactivity can result from one of the several mechanisms. Alteration or overproduction of antibacterial target, decreased permeability of the cell envelop to the agent, and active and increased elimination of the agent from the interior of the bacterial cell (Leibovici, L., Soares-Weiser, K., Paul, M., Goldberg, E., Herxheimer, A., and Garner, P., 2003). Use of antibacterial agents in the hospitals in United States accounts for 20% to 50% of all drug costs and represents the largest expenditure for any pharmacologic class worldwide. In the outpatient setting, the usage and cost of drugs are second only to those of cardiovascular agents. A survey of office-based physicians revealed that between 1980 and 1992, there was a marked increase in the use of broad- spectrum antibiotics. Therapy with a new oral antibiotic now costs $50 to $60. With this, one should add costs of administration, costs of monitoring, and pharmacy charges (Baquero, F., Baquero-Artigao, G., Cantn, R., and Garca-Rey, C., 2002). Some newer antibiotics undeniably represent important advances in therapy, but in most of the cases a newer agent is not always cost effective since they demonstrate no advantage over the other. In many cases, physicians commit this mistake due to lack of knowledge. Sometimes, the drug companies misrepresent facts by catchy promotional materials and physicians fall for that. This will translate to misuse and abuse, since these drugs can promote bacterial resistance at a faster pace. This can make the clinical situation worse leading to more suffering on the part of the patient (Metlay, J.P., Shea, J.A., and Asch, D.A., 2002). Clinicians are understandably confused by the bewildering array of available drugs. Numerous surveys have reported that approximately 50% antibiotics in some way are used inappropriately. Aside from the monetary costs of unnecessary antibiotics, the health system is burdened by the costs of abuse; these are the costs of excess morbidity from adverse effects and drug interactions and the eventual costs of treating more resistant organisms (Raymond, J. et al., 2007). The clinicians must understand that they are in a significant position to stop misuse by avoiding unnecessary prescriptions. This is acclaimed to be the most common cause of overprescription. The physicians may fail to convince the patient about non- requirement of an antibiotic. Absolutely unscientific notion like giving something powerful to achieve dramatic. Fear of lawsuits for acts of omission in case of non- prescription is another reason despite the fact that the patients are happy to consume less drugs when the trivial nature of the disease is explained. Peer pressure is another reason throughout the world for overprescription. (Polly, S.M., 2002). The physician becomes defensive due to the idea that he may lose the practice to his next door colleague in case he prescribes an antibiotic and get a result. In this present era, the patients also pressurize the physician and impose their informed choices over that of the doctor. The result is that the physician yields to this pressure to avoid any hassles, particularly in case of children and elderly. Last but not the least as mentioned earlier, is the company pressure (Zintzaras, E. and Ioannidis, J.P.A., 2003). With innumerable pharmaceutical companies and more medical representatives, it is possible that some pressure is exerted on the physician. The intent of the business is to earn handsome profits from the drug industry. The most dangerous trend is that, the companies mislead the physicians about the indications, totally suppressing the facts on adverse effects, not mentioning the incidences of resistance, and hiding the facts of cost. To make things worse, the companies combine antibiotics and market them for concocted indications, and the art of presentation is so professional that the physicians forget their education and start believing their story to the extent of prescribing those (Davenport, L.A.P., Davey, P.G., Ker, J. S. on behalf of the BSAC Undergraduate Education Working Party, 2005). Thus to avoid this, modern medicine prescribes legitimate use of antibiotics. The diagnosis and identification of the bacteria is the most important step to prevent abuse or misuse. A susceptibility testing would help the clinician to choose the right antibiotic and can serve as a guide for the resistance pattern. The physician must never forget that the choice of antibiotic is guided by pharmacokinetics of the compound and other factors. Statistically, the three most common conditions where antibiotics are abused are any fever, any sore throat, and any diarrhea. To avoid misuse in all such situations, the physicians should depend on their educated understanding and knowledge, not on any company literature. The merits of the newer drugs should be learned from authentic publications. The clinicians should resist temptations of overprescription. They should be strictly guided by recommendations made by experts. They should avoid prescribing a new drug until the merits are clearly established. The clinician should and must become familiar with local bacterial susceptibility profile. Finally with regard to inpatient use of antimicrobial drug, appropriate empirical treatment with one or more broad-spectrum agents can be narrowed to a simpler therapy. The culture and snsitivity profile of the bacteria would guide that. If these guidelines are followed rigorously, the care of the patient will not be undermined. It can avoid many unnecessary complications. The expenses can be reduced, and the useful lives of many valuable drugs will be extended by prevention of emerging resistance. Reference List Baquero, F., Baquero-Artigao, G., Cantn, R., and Garca-Rey, C., (2002). Antibiotic Consumption And Resistance Selection In Streptococcus pneumoniae. Journal of Antimicrobial Chemotherapy; 50: pp. 27 - 38 Davenport, L.A.P., Davey, P.G., Ker, J. S. on behalf of the BSAC Undergraduate Education Working Party, (2005). An Outcome-Based Approach For Teaching Prudent Antimicrobial Prescribing To Undergraduate Medical Students: Report Of A Working Party Of The British Society For Antimicrobial Chemotherapy. Journal of Antimicrobial Chemotherapy; 56: 196 - 203. Drews, J., (2000). Drug Discovery: A Historical Perspective. Science; 287: 1960. Leibovici, L., Soares-Weiser, K., Paul, M., Goldberg, E., Herxheimer, A., and Garner, P., (2003).Considering Resistance In Systematic Reviews Of Antibiotic Treatment. Journal of Antimicrobial Chemotherapy; 52: 564 - 571. Martnez, J.L. and Baquero, F., (2002). Interactions among Strategies Associated with Bacterial Infection: Pathogenicity, Epidemicity, and Antibiotic Resistance. Clinical Microbiologic Review; 15: pp. 647 - 679. Metlay, J.P., Shea, J.A., and Asch, D.A., (2002). Antibiotic Prescribing Decisions of Generalists and Infectious Disease Specialists: Thresholds for Adopting New Drug Therapies. Medical Decision Making; 22: 498 - 505. Polly, S.M., (2002). The Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative Powers. JAMA; 288: 2898. Raymond, J. et al., (2007). Multidrug-Resistant Bacteria in Hospitalized Children: A 5-Year Multicenter Study. Pediatrics; 119: e798 - e803. Wenzel, R.P., (2002). The Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative Powers. New England Journal of Medicine; 347: 1213. Zintzaras, E. and Ioannidis, J.P.A., (2003). Modelling Of Escalating Outpatient Antibiotic Expenditures. Journal Of Antimicrobial Chemotherapy; 52: 1001 - 1004. Read More