Antibiotic Stewardship | Paul Green | TEDxErie

TEDx Talks

13 Feb 201816:59

Summary

TLDRThe script discusses the overuse and misuse of antibiotics, comparing it to buying a car you might not qualify for. It highlights the dangers of prescribing antibiotics unnecessarily, such as increased bacterial resistance. Despite their life-saving properties, antibiotics are often given when not needed, especially for viral infections. This misuse leads to resistant bacteria, making treatments less effective. The script calls for 'antimicrobial stewardship'—ensuring antibiotics are only used appropriately, in the correct dosage and duration, to prevent further resistance and safeguard public health.

Takeaways

🚗 The script compares the inappropriate use of antibiotics to being sold a car that may not be suitable for the buyer, drawing parallels between health decisions and poor consumer choices.
📈 Over-prescription of antibiotics is a growing problem, with 90% of doctors admitting to prescribing them even when unnecessary.
🦠 Antibiotics are being misused, particularly against viruses like the common cold or flu, which antibiotics cannot treat.
💊 The overuse of antibiotics is leading to antibiotic resistance, making it harder to treat infections and causing 'superbugs'.
📉 The production of new antibiotics has slowed dramatically, dropping from 4 per year to 1 every two years over the past 35 years.
⚠️ Antibiotic misuse leads to 2 million resistant infections and 23,000 deaths annually in the U.S., along with $20 billion in extra healthcare costs.
🔬 Antimicrobial stewardship aims to ensure antibiotics are used properly, with the right drug, dose, and duration, to reduce resistance.
👩‍⚕️ Patients should actively discuss with their healthcare providers whether they need antibiotics, especially for conditions that may resolve without them.
🧪 Doctors need to perform tests to ensure the right antibiotic is prescribed for the correct type of infection.
🤝 Patients should avoid pressuring healthcare providers into prescribing antibiotics and focus on shorter, more effective treatments when appropriate.

Q & A

What is the main issue being discussed in the transcript?
-The transcript discusses the overuse and misuse of antibiotics in healthcare, particularly the pressure on healthcare providers to prescribe antibiotics even when they are unnecessary, leading to antibiotic resistance.
Why are antibiotics often prescribed even when they are not needed?
-Doctors often prescribe antibiotics because patients expect a tangible treatment for their illness, and providers feel pressure to meet these expectations. In some cases, antibiotics are given even when the provider suspects a viral infection, which antibiotics cannot treat.
What are the consequences of overprescribing antibiotics?
-Overprescribing antibiotics contributes to antibiotic resistance, where bacteria evolve to become resistant to the drugs. This leads to infections that are harder to treat, resulting in more expensive healthcare, increased mortality, and the rise of 'superbugs.'
How many courses of antibiotics are prescribed in the United States each year, and how many are unnecessary?
-Approximately 260 million courses of antibiotics are prescribed each year in the United States, and one out of every three of these is either inappropriate or completely unnecessary.
What did Sir Alexander Fleming warn about regarding antibiotics?
-Sir Alexander Fleming, the discoverer of penicillin, warned that overuse of antibiotics would lead to bacteria becoming resistant. He predicted that people would start asking for antibiotics even when they don’t need them, leading to a scenario where antibiotics would eventually lose their effectiveness.
What is 'antimicrobial stewardship,' and why is it important?
-Antimicrobial stewardship is the practice of using antibiotics responsibly—ensuring that they are only prescribed when necessary, at the correct dose, and for the shortest duration needed. This helps prevent antibiotic resistance and preserves the effectiveness of these life-saving drugs.
Why is it difficult for pharmaceutical companies to develop new antibiotics?
-Developing new antibiotics takes a long time—often up to a decade—and is not very profitable because antibiotics are only used for short periods, unlike drugs for chronic conditions. Additionally, new antibiotics are often reserved for the most serious cases to prevent resistance.
What are some of the infections for which antibiotics are often prescribed unnecessarily?
-Antibiotics are often unnecessarily prescribed for viral infections such as the common cold or flu, as well as minor bacterial infections like ear infections or bronchitis, which can sometimes resolve on their own without antibiotic treatment.
What steps can patients take to avoid unnecessary antibiotic prescriptions?
-Patients should have open conversations with their healthcare providers about whether they truly need antibiotics, consider 'watchful waiting' to see if they recover without them, and ask for tests to confirm a bacterial infection before starting antibiotics.
How can healthcare providers ensure they are prescribing the right antibiotics?
-Healthcare providers should collect cultures to identify the specific bacteria causing an infection and test which antibiotics are most effective. They should also tailor the dose and duration of the antibiotic treatment to the patient’s needs, considering factors like organ function and other medications.

Outlines

00:00

🚗 Selling You the Perfect Car, or Is It?

The paragraph starts with a hypothetical scenario where a salesperson offers a car with great features but with a significant catch. If the buyer is not qualified to purchase the car, its benefits, like gas mileage, could deteriorate. Additionally, driving the car without proper qualification might lead to serious issues, even a 'nasty limp.' This absurd analogy is then linked to the U.S. healthcare system, where patients are often given unnecessary treatments, particularly antibiotics, even when they aren't needed.

05:03

🦠 The Rise of Antibiotic Misuse

The paragraph discusses the growing issue of antibiotic overuse, highlighting that patients often expect some form of treatment, like antibiotics, even when they are unnecessary. The statistics are alarming: 90% of general practitioners admit to prescribing antibiotics due to patient pressure, and half of these prescriptions are given for viral infections like the cold or flu, which do not respond to antibiotics. This misuse has led to the rise of antibiotic-resistant bacteria, a dangerous trend costing the healthcare system billions and causing thousands of deaths annually.

10:05

🧑‍⚕️ Antibiotic Resistance: A Foreseen Crisis

The text traces antibiotic resistance back to warnings from Sir Alexander Fleming, the discoverer of penicillin, in 1945. Fleming predicted that the overuse of antibiotics would lead to resistant bacteria, a prophecy that has come true. The paragraph then explains how bacteria like MRSA (Methicillin-resistant Staphylococcus aureus) have become resistant to antibiotics. The pharmaceutical industry's slow development of new antibiotics and the cautious use of the few available ones have worsened the crisis, leading to fewer treatment options as bacteria evolve.

15:06

🧪 Antimicrobial Stewardship: The New Frontier

The concept of antimicrobial stewardship is introduced as a way to combat antibiotic resistance. The goal is to use antibiotics correctly by prescribing the right type, dose, and duration for specific bacterial infections. Monitoring and optimizing the use of antibiotics can prevent further resistance and ensure that antibiotics remain effective. Patients are urged to ask their healthcare providers important questions, such as whether antibiotics are necessary, what specific drug should be used, and whether there are shorter, more effective treatment options.

🧐 Do You Really Need Antibiotics?

This paragraph emphasizes the importance of determining whether an infection even requires antibiotics. Many infections, such as the cold or flu, are viral and self-limiting, meaning antibiotics will not help. The paragraph encourages patients to engage in conversations with their healthcare providers about whether they should adopt a 'wait and see' approach instead of immediately starting antibiotics. It also stresses the need for proper diagnosis, such as culturing bacteria to identify the right antibiotic for treatment, to avoid unnecessary and ineffective prescriptions.

💊 The Right Dose, The Right Treatment

Getting the correct dosage of antibiotics is essential for effective treatment. Patients must share information about any other medications they are taking, as these can affect the antibiotic dose. Sometimes, blood tests are necessary to check how the body processes the medication, especially for people with liver or kidney issues. The message is clear: proper dosing not only improves treatment outcomes but also prevents toxicity and further antibiotic resistance.

⏳ How Long Should You Take Antibiotics?

This paragraph discusses how the duration of antibiotic treatment varies depending on the infection. While simple infections might require only a few days of treatment, more complicated cases can take weeks or even months. Patients should talk to their healthcare providers to ensure that they are taking antibiotics for the shortest effective duration, which minimizes the risks of resistance and other side effects associated with prolonged use.

💼 Be a Steward of Your Own Health

The final paragraph wraps up by encouraging patients to take control of their health and not pressure healthcare providers into prescribing unnecessary antibiotics. Instead, they should actively discuss their treatment options, focusing on whether antibiotics are necessary, the appropriate dosage, and the shortest effective treatment time. By doing this, patients can help in the global effort to curb antibiotic misuse and prevent the rise of resistant bacteria.

Mindmap

Keywords

💡Antibiotic Resistance

Antibiotic resistance refers to the ability of bacteria to withstand the effects of antibiotics that once killed them or stopped their growth. In the video, it is explained that the overuse and misuse of antibiotics contribute to this resistance, leading to the evolution of 'superbugs' that are harder to treat. The theme highlights the growing global health threat where bacteria become resistant, making standard treatments ineffective.

💡Antimicrobial Stewardship

Antimicrobial stewardship is the practice of using antibiotics responsibly to ensure their effectiveness is preserved. The video stresses the need for healthcare providers and patients to carefully manage antibiotic use, only using them when necessary, in the correct dosage, and for the shortest time required. This is presented as a crucial step in combating antibiotic resistance.

💡Superbugs

Superbugs are strains of bacteria that have become resistant to multiple antibiotics, making them difficult to treat. The video refers to the rise of superbugs as a consequence of the over-prescription of antibiotics. The concern is that without new antibiotics or better stewardship, these superbugs will lead to more untreatable infections and deaths.

💡Over-prescription

Over-prescription is the practice of prescribing antibiotics when they are not necessary. The video explains that many physicians feel pressured to give patients antibiotics even when they are not required, such as for viral infections like the cold or flu. This behavior contributes to antibiotic resistance, as unnecessary antibiotic use allows bacteria to adapt and evolve.

💡Inappropriate Antibiotic Use

Inappropriate antibiotic use occurs when antibiotics are used incorrectly, such as for conditions that they cannot treat, like viral infections. The video highlights that many antibiotics are prescribed for conditions they cannot help, leading to resistance. For example, antibiotics are often given for the flu, despite the flu being a viral illness.

💡Methicillin-resistant Staphylococcus aureus (MRSA)

MRSA is a type of bacteria that has become resistant to many commonly used antibiotics, particularly methicillin. The video uses MRSA as an example of how bacteria evolve resistance through overexposure to antibiotics. It emphasizes that MRSA is not unique, but represents a wider problem of increasing bacterial resistance globally.

💡Penicillin

Penicillin is the first antibiotic ever discovered, and it revolutionized medicine by effectively treating bacterial infections. The video references Sir Alexander Fleming, the discoverer of penicillin, who warned that overuse of antibiotics would lead to resistance. This concept is central to the video’s message about the careful use of antibiotics.

💡Watchful Waiting

Watchful waiting is a strategy where healthcare providers delay prescribing antibiotics to see if the patient's condition improves on its own. The video suggests this approach as a way to reduce unnecessary antibiotic use, especially for self-limiting infections like minor bacterial infections, which can resolve without medication in healthy individuals.

💡Bacterial vs. Viral Infections

The distinction between bacterial and viral infections is crucial in determining whether antibiotics are appropriate. The video explains that antibiotics are only effective against bacterial infections, yet they are often misused to treat viral illnesses like colds and flu, which contributes to antibiotic resistance. Understanding this distinction helps guide better antibiotic stewardship.

💡Culture and Sensitivity Testing

Culture and sensitivity testing involves growing bacteria from a patient's infection in a lab to identify which antibiotics will be most effective. The video promotes this practice as a way to ensure that the correct antibiotic is used, thereby reducing unnecessary use of broad-spectrum antibiotics and helping prevent resistance.

Highlights

The over-prescription of antibiotics in the U.S. is alarming, with over 260 million courses prescribed yearly, many of which are unnecessary or inappropriate.

Over 90% of general care practitioners report feeling pressured to prescribe antibiotics, often yielding to patient demands even when it’s not required.

Antibiotic misuse has led to increasing bacterial resistance, resulting in over 2 million Americans being infected with resistant bacteria annually.

The healthcare system incurs over $20 billion in excess costs due to infections caused by antibiotic-resistant bacteria.

Sir Alexander Fleming, the discoverer of penicillin, predicted antibiotic resistance in 1945, warning that overuse would lead to antibiotics losing effectiveness.

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most well-known antibiotic-resistant bacteria, demonstrating the global rise in bacterial resistance.

The development of new antibiotics is slow, taking up to a decade to bring a drug to market, with only one new antibiotic being introduced every two years.

Antibiotics are not profitable for pharmaceutical companies, as they are short-term treatments, unlike medications for chronic conditions like high blood pressure.

Antibiotic stewardship is critical, ensuring patients receive the correct drug, dose, and treatment duration to combat infections while minimizing resistance.

Patients should engage in open dialogue with healthcare providers about whether they need antibiotics and explore options for shorter, more targeted treatments.

Not all infections require antibiotics. Viral infections, such as colds and the flu, do not respond to antibiotics, and many bacterial infections are self-limiting.

Antibiotics should be used for the shortest possible duration to minimize risks like toxicity and the development of bacterial resistance.

Regular monitoring of kidney and liver function is necessary when taking antibiotics, as different drugs can impact the body in varied ways.

Healthcare providers should collect bacterial cultures before prescribing antibiotics to ensure the chosen drug is appropriate for the infection.

Public awareness and patient responsibility are crucial in combating antibiotic overuse, requiring a shift in attitude towards requesting and prescribing antibiotics.