Combating antibiotic resistance: Medicine enlists community awareness

Physicians are central to efforts that mobilize communities against the misuse of these valued infection fighters.

Editorial. Dec. 23/30, 2002. Additional information

There have been clear warning signs of a crisis ahead in combating infection. For almost a decade, high rates of antibiotic use have paralleled reports of emerging antimicrobial resistance.

As recently as October, a Centers for Disease Control and Prevention communiqué detailed a case of vancomycin-resistant Staphylococcus aureus in Pennsylvania. A similar case earlier this year in Michigan also proved resistant to vancomycin, the drug of last resort for many infections.

If this weren't enough, additional data indicate growing resistance to another high-tier infection fighter, ciproflaxin. Among other trouble signs is that Streptococcus pneumoniae bacteria are now more than 35% penicillin-resistant -- which means physicians will face limits in treatment options for at least one in three patients with this type of infection.

These facts are disturbing. They are also the reason that the AMA has long focused on raising physician awareness about the dangers of inappropriate antibiotic prescribing and has armed doctors with tools to educate their patients about appropriate use. On that point, there is some recent good news.

It comes from an analysis of data from the National Ambulatory Medical Care Survey, published in the June 19 Journal of the American Medical Association. The report found that the rate of antimicrobial prescribing overall and for respiratory tract infections by office-based physicians for children and adolescents younger than 15 decreased significantly between 1989-1990 and 1999-2000. This represents a change from 1980 to 1992, when the rate jumped 48%.

Still, the disciplined use of the prescription pad may not be enough. Though the doctor's role in reducing inappropriate antibiotic use is critical, truly addressing the problem will require attention and cooperation from a broader collection of stakeholders, including policy-makers, parent and consumer groups, pharmacist and nurse organizations, and health plans and managed care organizations.

An initiative managed by the California Medical Assn. Foundation -- the Alliance Working for Antibiotic Resistance Education or AWARE -- offers an excellent how-to model to achieve such collaboration.

AWARE began in January 2000 with the aim of mobilizing communities to reduce improper antibiotic use through education efforts geared to change physician behavior and consumer understanding.

Physicians were at the heart of the effort, bringing to the table the knowledge base and scientific understanding that allow for a critical mass to be reached. In November, AWARE's success was the cornerstone of a national conference held in Sacramento, "Diverse partners, common goal: Working together to promote appropriate antibiotic use."

Considered groundbreaking, the meeting was attended by representatives from 34 states, all of whom want to build partnerships, like the ones AWARE cultivated in California, which would move toward more prudent antibiotic use within their own communities.

The AMA was a collaborating sponsor and has been actively working within the Federation of Medicine to spread the word about AWARE's innovative strategies.

Addressing the problem takes action at all fronts -- from global organizations to federal agencies and even state and local health departments. And ultimately, success relies on education. This education occurs when doctors work with individual patients as well as on a larger scale -- including within state and local medical and specialty societies -- to reach out to other parts of the community.

The call to action is clear. The misuse of antibiotics contributes to selective pressure that works against the effectiveness of these drugs. But physicians feel pressure from patients who do not yet understand why these drugs are not always the answer. The AWARE model offers doctors a method -- through grassroots leadership and involvement -- to raise awareness in their hometowns, make a difference in their patient relationships and eventually lessen the risk of antibiotic resistance.

ADDITIONAL INFORMATION:

Weblink

CMA Foundation project, Alliance Working for Antibiotic Resistance Education (http://www.aware.md/)

Abstract, "Trends in Antimicrobial Prescribing Rates for Children and Adolescents," Journal of the American Medical Association, June 19 (vol. 287, issue 23) (http://jama.ama-assn.org/issues/v287n23/abs/joc10863.html)

AMA antibiotics and antimicrobials resources (http://www.ama-assn.org/ama/pub/category/1863.html)

Antimicrobial resistance resources from the CDC's National Center for Infectious Diseases (http://www.cdc.gov/drugresistance/)

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