Antibiotic misuse
Encyclopedia
Antibiotic misuse, sometimes called antibiotic abuse or antibiotic overuse, refers to the misuse and overuse of antibiotic
s, which has potentially serious effects on public health. This overuse is a contributing factor to the creation of Antibiotic resistant bacteria, or "super bugs", sometimes out of relatively harmless bacteria. Super bugs can cause multi-antibiotic-resistant life-threatening infections. Antibiotic misuse can also place the patient at unnecessary risk of adverse effects of antibiotics.
In a 1994 study of fluoroquinolone prescriptions issued within a long-term care setting, 75% of the examined prescriptions were judged to be inappropriate . In more than 50% of the cases reviewed, the fluoroquinolones used were not considered to be a first line agent.
, confusion
, anxiety
, insomnia
, agitation, and, in severe cases, psychosis
. Moxifloxacin
had the worst effect amongst the quinolones for causing CNS toxicity. The central nervous system is an important target for fluoroquinolone mediated neurotoxicity.
and others has given rise to a breed of super bacteria that is resistant to antibiotics entirely.
The overuse of fluoroquinolone and other antibiotics will eventually result in their reduced efficacy in treating antibiotic-resistant infections,, as this overuse is fueling antibiotic resistance in bacteria. The widespread use of fluoroquinolones as first-line antibiotics is leading to decreased bacterial sensitivity, which has important implications for certain serious bacterial infections, such as those associated with cystic fibrosis
, where quinolones are among the few available antibiotics.
(CAP), the use of fluoroquinolones seems to be associated with improved treatment rates; however, there are no differences found in mortality between antibiotic regimens. In spite of this caveat, the use of the fluoroquinolone instead of other antibiotic regimens to treat CAP increased by >50%, from 25% to 39% of all prescriptions. This increase was at the expense of the macrolide class of antimicrobial drugs, the use of which declined 20% during the study period.
As with other fluoroquinolones, their use as first line agents is not generally recommended. They are usually reserved for use in patients who are seriously ill and may soon require immediate hospitalization. Though considered to be a very important and necessary drug required to treat severe and life threatening bacterial infections, the associated overprescribing of fluoroquinolones remains unchecked, which has contributed to the problem of bacterial resistance. The overuse of antibiotics such as happens with children suffering from otitis media has given rise to a breed of super bacteria which are resistant to antibiotics entirely. “Fluoroquinolone resistance is an increasing problem not only in the U.S. but also worldwide, potentially due to the widespread misuse of this class of antimicrobials.” The use of fuoroquinolones had increased three-fold in an emergency room environment in the United States between 1995 and 2002, while the use of safer alternatives such as macrolides declined significantly.
Chronic pelvic pain (category IIIB) is often misdiagnosed as chronic prostatitis and needlessly treated with a fluoroquinolone drug. Within a Bulgarian study, where by definition all patients had negative microbiological results, 65% of patients experienced an adverse drug reaction who were treated with a fluoroquinolone in comparison to a 9% rate for the placebo patients. This was combined with a higher cure rate (69% v 53%) found within the placebo group. The authors stated that “The results of our study show that antibiotics have an unacceptably high rate of adverse side effects as well as a statistically insignificant improvement over placebo...” Prostatitis has been termed "the waste basket of clinical ignorance" by prominent Stanford University Urologist Dr. Thomas Stamey. Campbell's Urology
, the urologist's most authoritative reference text, identifies only about 5% of all patients with prostatitis as having bacterial prostatitis which can be "cured" at least in the short term by antibiotics. In other words, 95% of men with prostatitis have little hope for a cure with antibiotics alone since they don't actually have any identifiable bacterial infection.
There are limited indications for ciprofloxacin
as a first-line therapy within long term care facilities. Within a 1994 study it was found that 75% of the prescriptions for fluoroquinolones issued within a long term care setting were judged to be inappropriate by the authors. In more than fifty percent of the cases reviewed fluoroquinolones were not considered to be a first line agent.
Another widespread example of antibiotics overuse or abuse is the partial adherence of the dental practitioners
and dental
patient
s to the previous (1997) guidelines of the American Heart Association
for the prevention
of infective endocarditis
rather than the current (2007) guidelines
which dictate a more restricted antibiotic use.
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s, which has potentially serious effects on public health. This overuse is a contributing factor to the creation of Antibiotic resistant bacteria, or "super bugs", sometimes out of relatively harmless bacteria. Super bugs can cause multi-antibiotic-resistant life-threatening infections. Antibiotic misuse can also place the patient at unnecessary risk of adverse effects of antibiotics.
Epidemiology
A 2003 study concerning the proper use of antibiotics in the emergency room revealed that 99% of these prescriptions were in error. Out of the 100 total patients studied, 81 received a prescription for fluoroquinolone for an inappropriate indication. Out of these cases, 43 (53%) were judged to be inappropriate because another agent was considered first line, 27 (33%) because there was no evidence of a bacterial infection to begin with (based on the documented evaluation), and 11 (14%) because the need for such therapy was questionable. Out of the 19 patients who received a fluoroquinolone for an appropriate indication, only one patient out of 100 received both the correct dose and duration of therapy.In a 1994 study of fluoroquinolone prescriptions issued within a long-term care setting, 75% of the examined prescriptions were judged to be inappropriate . In more than 50% of the cases reviewed, the fluoroquinolones used were not considered to be a first line agent.
Social and economic impact
Increased hospitalizations attributed to adverse drug reactions account for billions of dollars of expenses each year within the US healthcare system. Severe reactions do occur with antibiotics and can add significantly to the cost of care. Antibacterial adverse effects account for nearly 25% of all adverse drug reactions amongst hospitalized patients. Adverse drug reactions to fluoroquinolones are easily misdiagnosed as seizure disorder or regular CNS or psychiatric symptoms. The diagnosis of quinolone toxicity or adverse reaction is also missed. Adverse event reporting in Italy by doctors showed fluoroquinolones among the top 3 prescribed drugs for adverse neurological and psychiatric effects. These neuropsychiatric effects included: tremorTremor
A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving to-and-fro movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the...
, confusion
ConFusion
ConFusion is an annual science fiction convention organized by the Stilyagi Air Corps and its parent organization, the Ann Arbor Science Fiction Association. Commonly, it is held the third weekend of January. It is the oldest science fiction convention in Michigan, a regional, general SF con...
, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
, agitation, and, in severe cases, psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
. Moxifloxacin
Moxifloxacin
Moxifloxacin is a fourth-generation synthetic fluoroquinolone antibacterial agent developed by Bayer AG . It is marketed worldwide under the brand names Avelox, Avalox, and Avelon for oral treatment. In most countries, the drug is also available in parenteral form for intravenous infusion...
had the worst effect amongst the quinolones for causing CNS toxicity. The central nervous system is an important target for fluoroquinolone mediated neurotoxicity.
Antibiotic resistance
Though antibiotics are required to treat severe and life-threatening bacterial infections, antibiotic abuse has contributed to the problem of bacterial resistance. The overuse of antibiotics by children suffering from otitis mediaOtitis media
Otitis media is inflammation of the middle ear, or a middle ear infection.It occurs in the area between the tympanic membrane and the inner ear, including a duct known as the eustachian tube. It is one of the two categories of ear inflammation that can underlie what is commonly called an earache,...
and others has given rise to a breed of super bacteria that is resistant to antibiotics entirely.
The overuse of fluoroquinolone and other antibiotics will eventually result in their reduced efficacy in treating antibiotic-resistant infections,, as this overuse is fueling antibiotic resistance in bacteria. The widespread use of fluoroquinolones as first-line antibiotics is leading to decreased bacterial sensitivity, which has important implications for certain serious bacterial infections, such as those associated with cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a recessive genetic disease affecting most critically the lungs, and also the pancreas, liver, and intestine...
, where quinolones are among the few available antibiotics.
Inappropriate use
Only about 5-10% of bronchitis cases are caused by a bacterial infection. Antibiotics have no effect upon viral infections such as the common head cold. Most cases of bronchitis are caused by a viral infection and are "self-limited", resolving themselves in a few weeks. The use of antibiotics such as ofloxacin to treat bronchitis is to be considered unnecessary, and thus exposes the patient to an unacceptable risk of suffering a severe adverse reaction. Nor does antibiotic treatment help sore throats. Prescribing antibiotics for sore throats encourages increased visits to the doctor. As most cases of sore throats are viral and self-limiting, it has been recommended that antibiotic treatment is delayed in most cases. For severe forms of community-acquired pneumoniaCommunity-acquired pneumonia
Community-acquired pneumonia is a term used to describe one of several diseases in which individuals who have not recently been hospitalized develop an infection of the lungs . CAP is a common illness and can affect people of all ages. CAP often causes problems like difficulty in breathing, fever,...
(CAP), the use of fluoroquinolones seems to be associated with improved treatment rates; however, there are no differences found in mortality between antibiotic regimens. In spite of this caveat, the use of the fluoroquinolone instead of other antibiotic regimens to treat CAP increased by >50%, from 25% to 39% of all prescriptions. This increase was at the expense of the macrolide class of antimicrobial drugs, the use of which declined 20% during the study period.
As with other fluoroquinolones, their use as first line agents is not generally recommended. They are usually reserved for use in patients who are seriously ill and may soon require immediate hospitalization. Though considered to be a very important and necessary drug required to treat severe and life threatening bacterial infections, the associated overprescribing of fluoroquinolones remains unchecked, which has contributed to the problem of bacterial resistance. The overuse of antibiotics such as happens with children suffering from otitis media has given rise to a breed of super bacteria which are resistant to antibiotics entirely. “Fluoroquinolone resistance is an increasing problem not only in the U.S. but also worldwide, potentially due to the widespread misuse of this class of antimicrobials.” The use of fuoroquinolones had increased three-fold in an emergency room environment in the United States between 1995 and 2002, while the use of safer alternatives such as macrolides declined significantly.
Chronic pelvic pain (category IIIB) is often misdiagnosed as chronic prostatitis and needlessly treated with a fluoroquinolone drug. Within a Bulgarian study, where by definition all patients had negative microbiological results, 65% of patients experienced an adverse drug reaction who were treated with a fluoroquinolone in comparison to a 9% rate for the placebo patients. This was combined with a higher cure rate (69% v 53%) found within the placebo group. The authors stated that “The results of our study show that antibiotics have an unacceptably high rate of adverse side effects as well as a statistically insignificant improvement over placebo...” Prostatitis has been termed "the waste basket of clinical ignorance" by prominent Stanford University Urologist Dr. Thomas Stamey. Campbell's Urology
Urology
Urology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological...
, the urologist's most authoritative reference text, identifies only about 5% of all patients with prostatitis as having bacterial prostatitis which can be "cured" at least in the short term by antibiotics. In other words, 95% of men with prostatitis have little hope for a cure with antibiotics alone since they don't actually have any identifiable bacterial infection.
There are limited indications for ciprofloxacin
Ciprofloxacin
Ciprofloxacin is a synthetic chemotherapeutic antibiotic of the fluoroquinolone drug class.It is a second-generation fluoroquinolone antibacterial. It kills bacteria by interfering with the enzymes that cause DNA to rewind after being copied, which stops synthesis of DNA and of...
as a first-line therapy within long term care facilities. Within a 1994 study it was found that 75% of the prescriptions for fluoroquinolones issued within a long term care setting were judged to be inappropriate by the authors. In more than fifty percent of the cases reviewed fluoroquinolones were not considered to be a first line agent.
Another widespread example of antibiotics overuse or abuse is the partial adherence of the dental practitioners
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...
and dental
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
s to the previous (1997) guidelines of the American Heart Association
American Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...
for the prevention
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
of infective endocarditis
Infective endocarditis
Infective endocarditis is a form of endocarditis, or inflammation, of the inner tissue of the heart, such as its valves, caused by infectious agents. The agents are usually bacterial, but other organisms can also be responsible....
rather than the current (2007) guidelines
Dental antibiotic prophylaxis
Dental antibiotic prophylaxis is the admission of antibiotics to a dental patient for prevention of harmful consequences of bacteremia, that may be caused by invasion of the oral flora into an injured gingival or peri-apical vessel during dental treatment...
which dictate a more restricted antibiotic use.