By Glenna Murdock, RN, contributor
September 3, 2010 - Whether or not they are the appropriate treatment, antibiotics have become the “go-to” drugs for acute respiratory illnesses. Their overuse and misuse, by health care providers and patients alike, have resulted in a proliferation of superbugs—bacteria that are resistant to antibiotics.
“Bacteria are smart and resourceful,” said Theresa Capriotti, DO, MSN, CRNP, clinical associate professor, Villanova University College of Nursing. “Each time we take an antibiotic we are teaching bacteria to get around that drug,” continued Capriotti, whose papers on the subject of antimicrobial resistance have been published in medical and nursing journals.
People infected with antimicrobial-resistant organisms are more likely to have longer, more expensive hospital stays, and may be more likely to die as a result of the infection, according to the Centers for Disease Control and Prevention (CDC).
The CDC recently launched a new Web site on antibiotic resistance to help patients and healthcare providers understand the problems that are caused by overuse of these drugs and take steps to avoid the proliferation of superbugs.
Misuse of the miracle drugs
Antibiotics first became widely used in the 1940s and quickly gained a reputation as miracle drugs for their ability to effectively treat an array of bacterial illnesses that until that time were often fatal. In the ensuing years, countless lives have been saved by these drugs, but many in the general populace have come to view them as a panacea for treating all acute upper respiratory infections (ARIs) that include colds, bronchitis, sinusitis, flu, runny nose, ear infection and sore throat.
The fact is, however, that the majority of these conditions are caused by viruses, against which antibiotics are ineffective.
“Drug resistance is a massive public health problem globally,” stated Alison Patti, MPH, CHES, health communications specialist for the Division of Bacterial Diseases at CDC. “The unwarranted prescribing of antibiotics contributes significantly to the problem.”
“It was found that patients were going to their provider’s office and leaving with a prescription that, in up to 50 percent of the cases, they didn’t need because their illness was viral and the antibiotics would do no good,” Patti stated.
Doctors, physicians’ assistants and nurse practitioners prescribe unnecessary antibiotics for a number of reasons, according to Patti.
“Diagnostic uncertainty and time constraints certainly are factors, along with patients putting pressure on the provider to prescribe an antibiotic,” Patti said. “It takes less time to write a prescription than to explain why one isn’t necessary, particularly if the patient is insistent.”
Educational efforts and campaigns
In an effort to curtail the misuse of the drugs, the CDC launched its Get Smart: Know When Antibiotics Work campaign in 2003. The campaign has three objectives: to promote adherence to appropriate prescribing guidelines, to reduce demand for antibiotics for ARIs by healthy adults and parents of young children, and to increase adherence to the prescribed course of treatment when antibiotics are used for upper respiratory infections.
Get Smart targets the general public as well as all providers, including medical and nursing students, because a cooperative effort is required to combat the problem. Posters, brochures and information sheets are available and are geared to various cultural groups, including Native Americans and the Spanish-speaking patients. Information can be easily viewed and printed from the Get Smart site.
A key component of the campaign is the Get Smart prescription pad, pre-printed with a list of viral ARIs. Patients want to be given a definite diagnosis and the provider can indicate on the pad the ARIs that apply to the patient along with recommendations for symptomatic treatments and non-prescription medications that are specific to the patient.
“The prescription pad is the talking point,” Patti said. “Patients are more accepting of the idea of no antibiotics if the provider takes the time – expedited with the prescription pad - to explain why they don’t need them. They also want to know what to expect in the next few days and that they can make another appointment if their symptoms don’t improve. Patients don’t like leaving the office empty handed, so all that information can be noted on the prescription pad for them to take home.”
But practitioners who write prescriptions are not the only ones who need to be careful. Research published in the June 2008 issue of the American Journal of Nursing pointed out why nurses must understand the seriousness of antimicrobial resistance. It is not unusual for nurses to be asked for medical advice by family and friends, including advice about ARIs and antibiotics. Yet, when surveyed, most nurses said they were given very little education regarding ARIs or the management of them. In order to help patients, family members and friends manage these conditions appropriately, nurses must be further educated in this area.
Villanova’s Capriotti agrees, adding, “Superbug resistance is escalating within the clinical setting and community at large. All health care providers need educational programs which disseminate information about antibiotic use and reinforce infection control procedures.”
In partnership with CDC, a new five-minute video will be launched by Medscape on November 8. The release is one week before the kickoff of Get Smart About Antibiotics Week, which will coincide with European Antibiotic Awareness Day, and will be on both the CDC and Medscape websites. The video demonstrates five practical tips for health care providers to use that can further patients’ acceptance of not using antibiotics for treatment of ARIs.
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