Antibiotics: More Progress to Be Made

February 28, 2011

In 1995, the Centers for Disease Control (CDC) launched a major initiative to reduce the overuse of antibiotics. While many people think that taking an antibiotic for viral infections is either beneficial or benign, the CDC knew that the overuse of antibiotics was leading to a significant increase in infections that were drug resistant.

National efforts like the CDC’s, along with local efforts like the Michigan Antibiotic Resistance Reduction Coalition (MARR), focused significant resources on pediatricians and families to educate practitioners and consumers about the dangers associated with overuse of antibiotics. While many people seem to have heard of these concerns, data we are releasing today[CHRT ANTIBIOTIC PRESCRIBING] show that the overuse of antibiotics continues to be a major problem in Michigan, particularly in some parts of the state.

Our issue brief notes that between 2007 and 2009, antibiotic prescribing increased in Michigan for children covered by Blue Cross and Blue Shield of Michigan (BCBSM). Of particular concern is an increase in the percentage of antibiotics prescribed for children that are considered “broad spectrum” – from 44.9 percent of perscriptions in 2007 to 46.4 percent in 2009. Compared to narrow spectrum antibiotics, which are specifically targeted at particular infections, broad spectrum antibiotics are “heavy hitters” – those that should be reserved for difficult to treat infections. High use rates of broad spectrum antibiotics are of concern because when these drugs are no longer effective, there are few, if any, alternative treatments.

That is the precisely the problem in the treatment of MRSA (Methicillin-resistant Staphylococcus aureus). MRSA is a bacterial infection that is highly resistant to many antibiotics. The CDC estimated that in 2005, MRSA was responsible for more than 94,000 infections and almost 19,000 deaths in the US. That’s more than those caused by AIDS in that same year.

Using a broad spectrum antibiotic when a narrow spectrum antibiotic would work is considered a misuse of the drug. The overuse of antibiotics in general is also a serious contributor to antibiotic resistance. In particular, the use of antibiotics for viral infections is of major concern. In 2009, almost 22 percent of children covered by Blue Cross and Blue Shield of Michigan who had an upper respiratory infection received an antibiotic. This is better than statistics we have from 20 years ago, but since antibiotics don’t improve outcomes in upper respiratory infections, still too high. Infections can be tested to determine whether they are viral or bacterial, but only 56 percent of children who received an antibiotic received the appropriate test in advance of the prescription.

Use of antibiotics to treat viruses was also evident in adults. For example, most cases of bronchitis are viral in nature and yet in 2009, 77 percent of BCBSM-covered adults with bronchitis were given antibiotics.

Our data also show considerable geographic variation in the use of antibiotics in Michigan. For example, more than 62 percent of BCBSM-covered children in West Branch were prescribed antibiotics for upper respiratory infections compared to only a little more than 10 percent in Holland. Overall, southeast Michigan had lower rates of antibiotic use and more appropriate prescribing than the rest of the state. For children, parts of the state that had high overall use also had high rates of use of antibiotics for viral infections. And, regions with a high rate of use of antibiotics for viral infections also had a lower rate of testing for bacterial infections prior to prescribing antibiotics. So, it does appear that the high use areas of the state are also using these medications less appropriately than the low use areas.

More needs to be done to change this picture. With all of the focus on high tech medicine and complex diseases like cancer and heart disease, we often forget that there are many – far too many – deaths that are preventable in low tech and conservative ways. We can all be part of this solution. Too much medical care – that is, care that is it not needed or higher tech than needed – isn’t good for you. We need to remember: when it comes to medical care, more is not necessarily better.