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A link has been identified between poor antibiotic prescribing practices and antimicrobial resistance in humans and food producing animals. This comes from separate reports from the Center for Disease Control in the USA, and three European agencies. The CDC report “Antibiotic Use in the United States 2017; Progress and Opportunities”, and the Joint Interagency Antimicrobial Consumption and Resistance Analysis (JIACRA), published by the European Center for Disease Prevention and Control (ECDC), European Food Safety Authority (EFSA) and European Medicines Agency (EMA), highlights the importance of reducing unnecessary antibiotic use and prevent antimicrobial resistance.

The CDC report states “Efforts to improve antibiotic use will succeed only if everyone plays a role. Success will depend upon coordinated efforts to promote and adopt principals of responsible antibiotic prescribing and use across the globe, from government agencies, foundations, professional organisations, companies, health systems, hospitals, clinics, nursing homes, patients and healthcare providers”.

CDC review – the numbers

There has been a marked improvement in the prescribing of antibiotics in the community and healthcare setting in the United States. In the years between 2011 – 2014, there was a 5% decrease in prescribing in outpatient settings. Despite this reduction, the agency estimates around 30% of prescriptions are still unnecessary.

“Even when antibiotics are needed, prescribers often favour drugs that may be less effective and carry more risk over more targeted first-line drugs recommended by national guidelines” the report states.

Even in hospital settings, the CDC estimates around 30% of prescriptions for antibiotics are unnecessary or incorrectly prescribed. The CDC conducted a study in 2016 found that the use of the most powerful antibiotics in hospitals increased significantly in the six years between 2006 – 2012. The most increases were seen in 2 antibiotics; carbapenem use rose by 37% and vancomycin use rose by 32%.

More worrying data obtained from the CDCs National Healthcare Safety Network demonstrates substantial variation in prescribing practices, with some professionals prescribing up to 3 times as many antibiotics as others in the same catchment area.

The CDC report also noted an increase in figures on antibiotic use in nursing homes. Between 50%-70% of resident received an antibiotic within a year and up to 75% of prescriptions are incorrect. The CDC performed another analysis involving nine facilities in four states showed that 11% of residents received antibiotics on any single day and 38% of orders lacked important documentation around the prescribing process. In a bid to further understand the level of incorrect and over prescribing of antibiotics in nursing homes, the CDC is conducting a larger scale study, in partnership with nursing home networks, pharmacies and other companies, to identify areas of improvement.

Infections

The CDC report has identified acute respiratory infections as the primary cause for incorrect and over prescribing in outpatient settings. In nursing homes and hospitals, urinary tract infections and pneumonia are the main causes of over prescribing. In an effort to improve antibiotic prescription rates, the CDC has provided a number of tools to help health care professionals. The Core Elements of Antibiotic Stewardship Programs and similar tools are designed to assist health care professionals in antibiotic prescribing practices.

Although the CDC has focussed on antibiotic prescribing in humans, the report also stresses the importance of managing antibiotic prescribing in agriculture and animal health. In a recent JIACRA report, a link was identified between antimicrobial use in humans and food-producing animals to an increasing incidence of antimicrobial-resistant bacteria.

Data was examined from EU countries between 2013 – 2015. Overall, antimicrobial consumption (AMC) was higher in people than in food-producing animals. Multivariate analyses revealed that Escherichia coli with resistance to third – and fourth-generation cephalosporins and fluoroquinolones in humans was associated with AMC in humans. Meanwhile, Salmonella spp. and  Campylobacter spp. with resistance to fluoroquinolones in humans was associated with AMC in animals.

The report concluded that there is “potential in both sectors to further develop prudent use of antimicrobials and thereby reduce (antimicrobial resistance)”.