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.
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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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Copyright 2002 American Medical Association. All
rights reserved.
