The Use and Misuse of New Antibiotics

Abstract

Many new antimicrobial agents have become available recently. Several of the new antibiotics may offer an extended spectrum of activity or an improved toxic effect profile. However, they pose such problems as excessive cost and the emergence of drug-resistant organisms as a result of "selection pressure." The majority of common infections can be treated with conventional agents, either singly or in combination. A careful, bedside clinical evaluation, in conjunction with simple laboratory tests, often narrows down microbiologic possibilities and allows simpler antibiotic choices. This results in a cost-conscious approach of using conventional, inexpensive antibiotics in most situations, with new agents being reserved for judiciously selected indications. Such an approach will not only contain health care costs but will also help to preserve the microbiologic ecosystem.

Antimicrobial Resistance

“…In 1954, two million pounds of antibiotics were produced in the United States. Today, the figure exceeds 50 million pounds (CDC, 1999;Joshi, & Milfred, 1995).…”

“…Data from: Acar et al, 1997;Bauchner et al, 1999, Bauchner & Phillip, 1998Bax, 1997;Billstein, 1994;CDC, 1999;Fitzgerald, 1998;Goldmann & Huskins, 1997;Hamm et al, 1996;Hancock, 1997;Joshi & Milfred, 1995;Kujdych, 1999;Kunin, 1993;Levy, 1998;Levy et al, 1987;Liu, 1999;McCaig & Hughes, 1995;Murray, 1992;O'Brien, 1992;Palmer & Bauchner, 1997;Reece, 1999;Schwartz, Bell, & Hughes, 1997.…”

“…Antibiotic prescribing practices play a primary role in the emergence of resistant microorganism strains (Acar, Kaplan, & O'Brien, 1997). Inappropriate or imprudent use of antimicrobial agents has exacerbated the resistance problem (Fitzgerald, 1998;Joshi, & Milfred, 1995;Kujdych, 1999;Kunin, 1993;Levy, 1998;Reece, 1999). The Centers for Disease Control and Prevention reports that humans annually consume 235 million doses of antibiotics.…”

“…Prescription practices are among the largest contributors to the resistance problem. Medical practitioners tend to pre-scribe antibiotics for prophylactic use, in the treatment of viral URI due to pressures from patients (Bauchner & Phillip, 1998;Joshi, & Milfred, 1995;Murray, 1992). Physicians frequently prescribe antibiotics for upper respiratory infections, when they believe patients expect it.…”

“…These broadspectrum antibiotics kill many different types of bacteria, including beneficial (normal) strains. Antibiotics pose several problems that include excessive cost and the emergence of multiple drug-resistant organisms as a result of "selection pressure" ( Joshi, & Milfred, 1995). A study performed from 1980 to 1992 assessed changes in the oral antimicrobial drug prescribing by office-based physicians to treat otitis media, sinusitis, and other common infections.…”