Researchers have systematically evaluated antibiotic use in patients and concluded that antibiotics are still being overused.
Adverse drug effects are any injuries or negative reactions caused by taking a medication and are common even in everyday medications such as antibiotics. Recent recommendations have advised fewer antibiotic prescriptions, however, research has shown that as much as 20-30% of antibiotic therapy for inpatients may not be required. Currently, more than 50% of patients receive a minimum of one antibiotic during their hospital stay.
The use of antibiotic medications is necessary to treat infections and help reduce the burden of bacteria within the body. Older management plans advocating higher antibiotic use as a preventative measure have persisted even after the discovery of multi-drug resistant bacteria strains that resulted due to over usage of antibiotics. While it is known to be the best therapy for infectious diseases, there are some reasons as to justify reducing the administration of antibiotics for non-infectious syndromes. Administration of these antibiotics may lead to acute adverse drug effects such as severe allergic reactions, or end-organ toxic effects, and may reduce the individual’s immune system and increase their susceptibility to more lethal infections.
A recent article published in JAMA Internal Medicine aimed to describe the incidence of adverse drug effects that occurred due to possible over-usage of antibiotics with patients who are hospitalised. This research was performed by Dr Tammand colleagues at the John Hopkins University School of Medicine. The study looked at the medical records of 1488 patients for 30 days after beginning the antibiotics. The researchers reviewed antibiotic-induced adverse drug effects within the digestive tract, skin, muscles, bones, blood, liver, gall bladder, kidneys, hearts, and nervous system. Also, the researchers looked for the development of Clostridium difficile infections 90 days after antibiotic use. If any infections were present due to multi-drug resistant organisms were noted as well. These infections were assessed and confirmed by trained internal medicine clinicians.
Twenty percent of patients in the study had at least one adverse drug event that confirmed the presence of adverse drug reactions caused by antibiotic usage. Non-clinical prescription of antibiotics also met with an adverse event, and 7 of those participants ended up acquiring Clostridium Difficile infections. Results showed that with the increase in antibiotic usage the risk of experiencing an adverse drug event increase by 3% for every ten days. Digestive tract abnormalities were the most common after 30 days accounting for 42% of total participants. The kidneys (24%) and blood (15%) were the next organs in line to demonstrate abnormalities. Specific antibiotics were noticed to correlate with some particular events, thus making it easier to identify symptoms in potential antibiotic overuse.
This data is significant for health professionals who prescribe antibiotics to inpatients on a regular basis. The results show that conservative use of antibiotics can help reduce unnecessary organ symptoms in hospitalised patients. This judicial use, in turn, could improve their quality of hospital stay. Health professionals must be cautious and outweigh the pros and cons of antibiotic prescriptions for the best outcomes of the patients.
Written by Dr. Apollina Sharma, MBBS, GradDip EXMD
Tamma, Pranita D., et al. “Association of Adverse Events with Antibiotic Use in Hospitalized Patients.” JAMA Internal Medicine (2017).