Good news, bad news on US antibiotic use and resistance

Nov 13, 2012 (CIDRAP News) – Research groups offered a mix of bad news and good news today on antibiotic usage and resistant microbes, including big geographic differences within the United States, as a large coalition of health and medical groups vowed to increase efforts to conserve the nation's arsenal of effective antibiotics.

The developments are part of "Get Smart About Antibiotics Week," an observance promoted by the Centers for Disease Control and Prevention (CDC) and other medical groups.

The effectiveness of antibiotics used to treat urinary tract infections (UTIs) is rapidly eroding, with a 30% increase in the overall share of resistant bacteria from 1999 to 2010, according to the Center for Disease Dynamics, Economics and Policy (CCDEP), a nonprofit think tank in Washington, DC.

In a press release today, the CCDEP said overall antibiotic usage in the United States shows signs of declining, but there is "staggering geographic variation." The group spoke of an overall 17% drop in antibiotic prescriptions filled since 1999.

"Residents of Appalachia and the Gulf Coast states, where antibiotic use rates are highest, take about twice as many antibiotics per capita as people living in western states," the group said.

In 2010, the five states with the highest antibiotic use were Kentucky, West Virginia, Tennessee, Mississippi, and Louisiana, the statement said. States with the lowest usage were Alaska, Hawaii, California, Oregon, and Washington.

The CCDEP also said the burden of antibiotic resistance to UTI drugs is highest in the Southeast.

On the bright side, the ability to treat skin infections, a common reason for outpatient visits, has improved since the peak of drug-resistant infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in the mid 2000s, the CCDEP said. At its height, MRSA caused 19,000 deaths a year, but infection rates have declined thanks to increased awareness and research on new therapies and interventions.

In addition, national use of fluoroquinolones—antibiotics commonly used to treat respiratory infections such as pneumonia—increased from 2000 to 2007 but fell by 24% from 2007 to 2010, the organization said. The decrease could be due to a warning the Food and Drug Administration placed on levaquin, a fluoroquinolone that had serious side effects, it said.

The findings come from the center's "Extending the Cure" project and its Drug Resistance Index, a tool that integrates data on resistance trends and antibiotic use into a single measure.

Meanwhile, an alliance of 25 health, medical, and consumer organizations, including the CDC, issued a joint statement on antibiotic resistance, vowing to honor 12 principles.

Among other things, the principles include:

  • Seeking greater coordination among all stakeholders in antibiotic effectiveness
  • Improving antibiotic use through antibiotic stewardship programs
  • Improving surveillance for drug-resistant infections
  • Recognizing that global collective action is necessary to address the problem
  • Working with regulatory, industry, and veterinary partners to promote the judicious use of antibiotics in food animals

In another development, a poll by the Pew Health Group found that more than a third of Americans believe that antibiotics are appropriate treatments for viral infections such as colds, the group announced yesterday.

See also:

Nov 13 CCDEP press release

Nov 12 coalition statement on antibiotics resistance

Nov 12 Pew press release about survey

May 1 CIDRAP News item about surge in E coli resistance to UTI drugs

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