Since the 1940s, there have been tremendous advancements in infectious disease prevention efforts, vaccinations, antibiotics, and other treatments. These successes have made it possible for the majority of Americans to live significantly longer lives, which has also led to a shift in attention and resources toward managing and treating chronic disease at the expense of focusing on the significant dangers infectious diseases continue to pose.
Just last year, the Centers for Disease Control and Prevention (CDC) issued the Antibiotic Resistance Threats in the U.S. 2013 report, in which the agency published a list of 18 “nightmare bacteria” that are resistant or increasingly resistant to antibiotics or have become more common because of widespread use of antibiotics.
In a recent Vital Signs, CDC issued another warning that antibiotic prescribing practices are posing a significant threat to the future health and wealth of the United States, and the agency estimates that up to half of antibiotic use in humans and most antibiotic use in animals is unnecessary.
At the end of the year, we at the Trust for America’s Health along with the Robert Wood Johnson Foundation released Outbreaks: Protecting Americans from Infectious Diseases, which noted that the number of antibiotics currently prescribed for humans per year in the United States is enough to treat four out of five Americans.
According to Outbreaks, each year, more than 2 million Americans develop antibiotic-resistant infections and at least 23,000 of these individuals die as a result. Antibiotic resistance leads to more than 8 million extra days that Americans spend in the hospital a year and costs the country an extra $20 billion in direct medical costs and at least $35 billion in lost productivity. Experts warn that antibiotic resistance is expected to continue to grow and become increasingly difficult to manage if the problem is left unaddressed.
In a Q&A for Outbreaks, Tom Inglesby, MD, chief executive officer and director of the University of Pittsburgh Medical Center’s Center for Health Security, said, “Antibiotic resistance is finally getting recognized as the potentially grave problem that it is. However, many people are still unclear how widely and dangerous the consequences of antibiotic resistance could become. For example, if pathogens continue to develop multidrug resistance…there could be a time where elective surgery…might not be possible, because the types of antibiotics that would allow for these minor surgeries would be ineffective.”
In reality, the effectiveness of antibiotics has been its own worst enemy. Antibiotics have been used to successfully treat countless numbers of bacterial infections for more than 70 years. As repeated treatments occur, some infections, also called superbugs, have adapted so that antibiotics can no longer effectively treat them.
This coupled with the fact that antibiotics have been overused in treatment and in the nation’s food have led CDC and others to sound the alarm that continuing these practices could lead the country to a public health disaster. To reverse course, we should start taking action right now.
Perhaps the single most important step is to change the way antibiotics are used. A commitment to use antibiotics appropriately (i.e., only when they are needed to treat disease, also known as antibiotic stewardship) is essential.
The Centers for Medicare & Medicaid Services (CMS) should have an effective antibiotic stewardship program as a condition of participation for all CMS-enrolled facilities. Also, the U.S. Department of Health and Human Services should drive the development and adoption of quality measures related to appropriate prescription and use of antibiotics across all relevant providers and health care settings.
CMS, CDC, accrediting organizations, health care facilities, and medical organizations must work together to reduce overprescribing and misuse of antibiotics by tracking and publicly reporting prescribing data, educating providers and patients about the harm of inappropriate prescribing, and providing clinical decision support through health information networks.
The nation must reduce the use of antibiotics in agriculture. It has been 36 years since the Food and Drug Administration (FDA) began addressing overuse of medically important antimicrobials on farms, but the actions to date have been highly limited.
The FDA should ensure full implementation and evaluation of two voluntary FDA Guidances for Industry, numbers 209 and 213, which provide guidelines for drug makers on the judicious use of antibiotics in food animals. Also, the FDA should finalize, implement, and evaluate the proposed regulation amending the Veterinary Feed Directive to ensure that it will have a substantial impact on reducing the overuse of antibiotics in agriculture.
Eventually, the United States should phase out all unnecessary use of antibiotics (i.e., all uses of antibiotics for reasons other than treating and controlling disease) in food animals, as has been done in countries such as Denmark with minimal economic impact.
Fighting infectious disease requires constant vigilance. Policies and resources must be in place to allow scientists and public health and medical experts to have the tools that they need to control ongoing outbreaks. Public awareness is an important step, but the danger of this problem necessitates quick action to curb the overuse of antibiotics.