Inappropriate Use of Antibiotics

A recent national study found an increase in inappropriate antibiotic prescriptions after the COVID-19 outbreak in March 2020.1 Antibiotic misuse promotes, among other things, the development of antibiotic resistance, which is one of the greatest threats to public health worldwide.2 The US Centers for Disease Control and Prevention estimates that more than 2.8 million infections caused by antimicrobial-resistant pathogens occur in the US, resulting in more than 35,000 deaths.2 Infections due to antimicrobial-resistant organisms have been increasing in US hospitals, especially noted during the COVID-19 pandemic.3 Recent global estimates suggest that the disease burden of antibiotic resistance is at least as high as that of HIV and malaria combined, with an estimated 4.95 million deaths caused in 2019.4 If not properly addressed, antibiotic resistance could kill 10 million people every year and cost the global economy up to $100 trillion by 2050.5 Over the recent several decades, many countries invested resources in education, quality improvement, and antibiotic control initiatives.6–9 Despite the initiatives, a substantial proportion of outpatient antibiotic prescriptions still are inappropriate.10,11 Adverse events associated with antibiotic use have been reported in one-fifth of hospitalized patients, including Clostridium difficile infection, emergence of antimicrobial resistance, and drug toxicity.12Clostridium difficile infections alone affect more than 500,000 patients and are associated with more than 15,000 deaths in the US each year.13 Programs focused on improving antibiotic use or “antimicrobial stewardship program (ASP)” have proven to be effective in improving clinical outcomes while mitigating antibiotic associated adverse events.14–16 ASP promotes the optimal use of antimicrobial agents, including their dosing, route, and duration of administration. A recent systematic review and meta-analysis found that ASPs were associated with a 10% reduction in antibiotic prescriptions and a 28% reduction in antibiotic consumptions; reductions in consumption were observed across all antibiotic classes, including penicillin and β-lactamase inhibitor combinations, macrolides, fluoroquinolones, cephalosporins, and carbapenems; the study also found that ASPs were associated with reductions in antibiotic prescriptions in pediatric patients.17 During the years 2011 to 2015, US Centers for Disease Control and Prevention's emerging infections program observed a decrease in C. difficile cases in people 65 years or older in long-term care facilities; during that time, there were declines in hospital fluoroquinolone antibiotic use and C. difficile ribotype 027; improving antibiotic use may have contributed to the decrease in C. difficile cases.18 Reducing antibiotic consumption through ASP should thus contribute toward reducing the risk of antibiotic resistance and C. difficile infection.