The misuse and overuse of antibiotics continues to be a vexing problem in the United States, particularly in the southeastern part of the country, according to a new report that tracks antibiotic resistance patterns.
The survey found a decline in the number of MRSA infections—methicillin-resistant staphylococcus aureus—a potentially dangerous skin infection. However, more antibiotics are becoming resistant to the bacteria that cause urinary tract infections, which is a common infection that had been fairly easy to treat until recently.
The data were released by Extending the Cure, a project of the Center for Disease Dynamics, Economics & Policy, a nonprofit think tank with offices in Washington, D.C. and New Dehli. The organization's mission is to gather evidence on antibiotic overuse and resistance.
"People don't realize we've only had antibiotics for about 70 years. That is a very, very short period of time," Ramanan Laxminarayan, director of Extending the Cure, told Take Part. "We have these wonderful, helpful drugs that are able to do things that we've never done before—and now we're about to lose them again. I don't think people realize how much we depend on them."
Unnecessary use makes antibiotics less effective in fighting off infections because, when repeatedly exposed to certain drugs, microbes change and become resistant. Widespread publicity about antibiotic overuse has led to some positive changes in prescribing patterns. Antibiotic prescriptions in the United States fell 17 percent from 1999 to 2012, according to the report. Far fewer pediatricians, for example, prescribe antibiotics for children's mild respiratory symptoms and earaches.
"That is really good news," Laxminarayan says. "There is progress at reducing antibiotic use at things where people think they should never have been prescribed in the first place. We're not denying antibiotics when people really need it. We are denying antibiotics when we don't need it."
Moreover, the ability to treat skin infections has improved since the peak days of MRSA cases in the mid-2000s. MRSA infections have fallen by about half due to efforts to find new therapies and interventions.
However, antibiotic resistance is still a huge problem, Laxminarayan says. The report found that some of the drugs used to treat urinary tract infections are failing because bacterial resistance to those medications has increased by more than 30 percent since 1999.
Urinary tract infections, which are caused by the E. coli bacteria, account for more than 8.6 million visits to healthcare professionals each year, according to the Centers for Disease Control and Prevention. If untreated, these infections can turn into life-threatening bloodstream infections.
"Things that were commonly treatable are not as treatable anymore," Laxminarayan says.
Hospitals remain at the center of the antibiotic-resistance problem, he says. Hospital patients are typically older and sicker, and heavy antibiotic use is often necessary. But hospitals can help address antibiotic resistance by taking steps to curb the spread of infections within the hospital, he says. Five to eight percent of people develop an infection while in the hospital.
"We have sharply increased resistance around the country because it is not going down in hospitals, and hospitals are where the worse kinds of resistance are found," he says. "We've advocated for having stronger hospital infection control. If you stop the infection from spreading, you don't have to worry about resistance. We need pretty much a revolution regarding infection control in hospitals."
The survey also found eye-opening regional differences regarding antibiotic resistance, such as higher levels of antibiotic overuse in the southeastern United States. It's not clear why that area of the country has lagged behind, he says.
The survey found that residents of Appalachian and Gulf Coast states, where antibiotic use rates are highest, take about twice as many antibiotics per capita as people living in Western states. In 2010, the five states with the highest rates of antibiotic use in the nation were Kentucky, West Virginia, Tennessee, Mississippi, and Louisiana. The five states with the lowest antibiotic use in the nation were Alaska, Hawaii, California, Oregon, and Washington.
Extending the Cure displays its data online via the ResistanceMap, a tool created to track changes in antibiotic drug use and resistance. People can see how the area they live in compares to other regions.
"We want people to be knowledgeable and therefore empowered about what they can do about the problem," Laxminarayan says.
Earlier this month, the CDC, Extending the Cure and 25 other national health organizations issued a joint consensus statement on the need to preserve antibiotic effectiveness and fight over-use.
"When so many government agencies and public organizations have signed on it indicates we're all pointing in the same direction," Laxminarayan says.
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