Without a doubt, the discovery of penicillin and consequently, antibiotics was one of the greatest health achievements of the 20thcentury. From Alexander Fleming’s initial finding of a mold juice that could kill harmful bacteria, to the large-scale production of penicillin during WWII, antibiotics have become a necessity in health care treatment today.4 While today, the use of antibiotics as appropriate therapy for bacterial infections is standard, there is a developing complacency that has the potential to disrupt the entire frame of health care.
From a pharmacy-based perspective in an ideal world, antibiotic use in general would be reserved for only after identification of the offending agent in order to minimize unnecessary exposure of antimicrobial mechanisms to bacteria. Essentially, when treating a bacterial infection, what doesn’t completely eradicate it can make it stronger. Bacteria reproduce at an exponentially fast rate and with each generation comes new genes, genes that can code for resistance to certain antibiotics. This process is known as acquired resistance, where a bacterium that has been sensitive to antibiotics develops resistance through either mutation or by acquisition of new DNA.1 This was a gross oversimplification of antibiotic resistance, however, the principle of it is that overuse of antibiotics can lead to the growth of “superbugs”, antibiotic-resistant threats that remain extremely difficult to control. Some examples of these as stated by the Center for Disease Control (CDC) are Carbapenem-resistant Enterobacteriaceae (CRE), Methicillin-resistant Staphylcoccus aureus (MRSA), Extended-spectrum B-lactamase producing Enterobacteriaceae, Vancomycin-resistant Enteroccus (VRE), Multi-drug resistant Pseudomonas aeruginosa, and Multi-drug resistant Acinetobacter.3 These are bacteria that have already been seen in health centers throughout the United States and present a great threat to mortality.
A study from 1996 published in JAMA surmised that the multiresistant organisms currently surveyed could be a grim warning of the possibility of the post antibiotic era without judicious use of antibiotics.2 To think that there is no doubt that without a future plan on the widespread use of antibiotics, the human species will face unprecedented consequences. One of the first steps to combat this is to identify the problem and start a discussion among all parties involved in healthcare in order to spread awareness.
As a fellow of VCHI, I along with other health care stakeholders in Virginia are committed to improving our health care system in order to better serve patients. Recently, VCHI utilized the Milliman MedInsight Health Waste Calculator in conjunction with the Virginia All-Payer Claims Database to develop a report that identifies health care services deemed to be low-value by the Choosing Wisely initiative. The 2016 report will be published in the near future and addresses low-value measures such as the ordering of antibiotics for adenoviral conjunctivitis, imaging for low back pain within the first 6 weeks of pain, and one especially pertinent measure: the prescription of oral antibiotics for patients with upper respiratory tract infections or ear infections. There is clearly a connection between low-value care and financial savings and some measures such as “prescribing of oral antibiotics for viral infection” have much farther implications into things such as the growth of antimicrobial resistance itself. Look out for the 2016 Virginia Low Value Services Report as it should prove to be a useful tool in creating dialogue between provides and patients on the value of health care services and the consequence certain measures can have on Virginia and the nation.
- Hawkey PM. The origins and molecular basis of antibiotic resistance. BMJ. 1998;317(7159):657-60.
- Tenover FC, Hughes JM. The challenges of emerging infectious diseases. Development and spread of multiply-resistant bacterial pathogens. JAMA. 1996;275(4):300-4.