Health groups unite to battle antimicrobial resistance

November 2003

Your patients might pressure you to give them a prescription for antibiotics, but an alliance of health groups is going to make it a little easier for you to say no.

To help doctors deal with patient demand for antibiotics and to educate the public about the dangers of antibiotic resistance, the CDC, FDA and an alliance of partners including national health organizations, state and local health departments, managed care organizations, pharmaceutical companies and other groups concerned about antimicrobial resistance have joined together for the Get Smart: Know When Antibiotics Work campaign.

“Patients can wear a doctor down,” said Richard Besser, MD, the CDC’s medical director of the campaign. “This campaign component is a direct response to what we have been hearing from doctors around the country. The biggest factor promoting inappropriate prescribing [of antibiotics] was patient demand.”

The united health groups also hope to reverse the public perception that antibiotics cure everything; in reality they only cure bacterial infections.

According to the CDC, tens of millions of antibiotics are prescribed in doctors’ offices for viral infections that are not treatable with antibiotics. Doctors cite diagnostic uncertainty, time pressure and patient demand as the primary reasons for their tendency to over-prescribe antibiotics.

“Antibiotics are powerful drugs,” said CDC Director Julie Gerberding, MD, in a release. “But the truth is antibiotics only work against bacteria, not the viruses that cause colds and flu. It’s so important to get smart about antibiotic use.”

When they work and when they don’t

Over the last decade, most bacteria have become less responsive to antibiotic treatment. These antibiotic-resistant bacteria can quickly spread to family members, school mates and co-workers, threatening the community with a new strain of infectious disease that is more difficult to cure and more expensive to treat.

Besser said that emerging diseases like severe acute respiratory syndrome-associated coronavirus (SARS-CoV) and West Nile virus are examples of infectious diseases that do not respond to antibiotics — not because of resistance, but because they are viruses. During efforts to find a treatment for the two newer infections, it was determined that antibiotics were not an option.

“People are starting to learn about viral infections like SARS and West Nile,” Besser said. “Antibiotics were not the answer.”

After the discovery of antibiotics in the 1940s, medical care was transformed and illness and death from infectious diseases were dramatically reduced. However, over the decades the bacteria have developed resistance to these drugs.

Today, virtually all important bacterial infections in the United States and throughout the world are becoming resistant, according to the CDC.

“I think there are many different parts of the solution,” Besser said. “It is clear that antibiotic use – whether appropriate or inappropriate — will promote resistance.”

The campaign comes at a time when, overall, Besser said, use of antibiotics is down. However, while drugs like amoxicillin are being used less, broader spectrum agents are still heavily used.

“It is concerning to me that when people are reaching for an antibiotic, now they are reaching for a stronger agent and we really do not need to go there right now,” Besser said.

Against resistance

Get Smart: Know When Antibiotics Work campaign literature teaches the differences between bacteria and viral infections. For example, a brochure that patients can read in the waiting room informs readers that colds, influenza, most coughs and bronchitis as well as sore throats not relating to strep throat are all infections that should not be treated with antibiotics. An owl sporting a stethoscope is part of the campaign logo.

Doctors can go to the CDC’s Get Smart Web site (www.cdc.gov/getsmart) and link to educational materials and tools for patient visits. Besser said there is even a prescription pad that acts as a checklist for doctors to use to describe symptomatic relief for the viral illness he or she diagnoses.

“Our first step toward correcting the problem is to build public knowledge and awareness of when antibiotics work and when they do not,” said Besser. “We want Americans to keep their families and communities healthy by getting smart about the proper use of antibiotics … we are hoping this will make life easier for doctors.”

According to Besser, new antibiotics need to be developed, but educating the public and doctor’s offices can slow resistance.

“We want to make sure that when we use antibiotics, we use them in situations when they work,” he said. “We do need to see new antibiotics developed because resistance is inevitable. It is more of a question of how quickly it will come.”

The Get Smart campaign was introduced in September at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy, held in Chicago.

The campaign is being supported by many public health groups, including the AAP, the American Medical Association, the American Academy of Family Physicians, the Alliance for the Prudent Use of Antibiotics and the Council for Affordable Quality Healthcare.

For more information:

• Information on the campaign and antibiotic resistance is available at www.cdc.gov/drugresistance/community/ and www.cdc.gov/getsmart.