FOR SEVERAL YEARS, HEALTH OFFICIALS HAVE FAVORED LIMITING THE USE OF ANTIBIOTICS AS A WAY TO MAINTAIN THEIR UTILITY. HAS THIS AFFECTED YOUR WILLINGNESS TO PRESCRIBE ANTIBIOTICS FOR YOUR PATIENTS?
The World Health Organization, or WHO, reported in June that antibiotic resistance is a growing threat.
"We currently have effective medicines to cure almost every major infectious disease," said Gro Harlem Brundtland, M.D., M.P.H., director-general of WHO. "But we risk losing these valuable drugs—and our opportunity to eventually control many infectious diseases—because of increasing microbial resistance."
The report describes how almost all major infectious diseases are becoming resistant to existing medications. In Estonia, Latvia and parts of Russia and China, more than 10 percent of patients with tuberculosis have strains resistant to two of the most powerful TB medicines.
The report concludes that the most effective strategy to combat resistance is to do the job right the first time by killing the microbes before they develop resistance. To achieve this goal, the report continues, doctors in poorer countries need to encourage patients to finish their medications, and those in wealthier countries should prescribe antibiotics only when necessary.
When JADA readers were asked in June if the threat of antibiotic resistance has affected their willingness to prescribe antibiotics for their patients, 72 percent of the respondents said yes.
"I have always been concerned about over- prescribing and this has reinforced my conservatism regarding dispensation of antibiotics," said a reader.
"If an infection is there," said another, "we can often treat the cause. We should then let the human body try to fight the remaining infection by itself before prescribing antibiotics."
While one reader agreed, he did say, "Patients still feel that they need to get medications when they are not warranted and will pressure you into prescribing them."
Another said, "We see a daily conflict with cardiac and prosthetic patients needing premedication, and their physicians are always preferring to premedicate."
Twenty-eight percent of respondents said their willingness to prescribe antibiotics for their patients has not been affected by the threat of antibiotic resistance.
Several of those who commented said they already are cautious when prescribing antibiotics. "I have ‘prudently’ prescribed antibiotics for more than 30 years," said one.
Another echoed this view, "For several years, we have decreased prescribing antibiotics, and we rarely use them in minor localized infections."
Other readers said that when they do prescribe antibiotics, it is on a case-by-case basis, and they always consider the patient’s history first.
The ADA’s guidelines for antibiotic use in bacterial endocarditis prophylaxis and for patients with total joint replacements are available on ADA.org at, respectively, "www.ada.org/adapco/jada/9708/endo-01.html" and "www.ada.org/adapco/jada/9707/pro-01.html". These guidelines also were published in JADA in August 1997 and July 1997, respectively.
