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Antibiotic overuse in humans

Antibiotic consumption for human health is reported to have increased by 36% globally between 2000 and 2010. Continued increasing rates of antibiotic use in hospitals and the community cause selection of resistant strains, resulting in a need to use antibiotics with a broader antibacterial spectrum and further resistance development to these drugs. There is a substantial variation in antibiotic consumption between countries. Reasons for this include socioeconomic factors, cultural differences, financial incentives, fear of lawsuits and lack of treatment guidelines. It has been estimated that as much as 50% of antibiotic use is inappropriate.

Patient expectations and over-prescribing providers

Antibiotics are widely used medicines to treat bacterial infections. Most of us have taken antibiotics at some point in time, and it may have saved our lives. One big problem is that many of us have also taken antibiotics when they were not needed, or when the effect of the antibiotic is limited. Antibiotics are by many regarded as “miracle drugs” that are safe and can cure most infections, and some antibiotics are so easily accessible that they are taken for granted. Patients and antibiotic prescribers tend to have great expectations on antibiotic treatment, also for conditions such as upper respiratory tract infections, where spontaneous improvement is high and there is in fact, often none or little gain of using antibiotics. Even if the infection is bacterial, antibiotics sometimes have no or very limited effect. Patients pressuring to get antibiotics, as well as the inappropriate prescription from health care providers, contribute to unnecessary overuse of antibiotics. Providers may give antibiotics unnecessarily also for other reasons, due to for example fear of mistreating a patient, lack of knowledge, fear of lawsuits or financial gains.

Lack of rapid diagnostics tools

Another reason for the unnecessary use of antibiotics is the lack of rapid and accurate diagnostic tools. It can take several days from the time a patient leaves a sample until diagnosis of the disease is possible and resistance pattern of a pathogen is determined. If a health care provider is unsure what is causing an infection, he or she may prescribe antibiotics just to be on the safe side. Unnecessary broad-spectrum antibiotics may have to be used because the antibiotic susceptibility of the causing bacteria is not known. Better diagnostic tools would make it easier for the health care provider to prescribe appropriate treatment, and to avoid unnecessary prescriptions of broad-spectrum antibiotics. A patient is also more likely to accept that they do not need an antibiotic if there is a test confirming that it is not a bacterial infection and therefore, no need for antibiotics. One challenge is to develop diagnostic tools that are affordable and possible to use also in low-resource settings where there is no advanced laboratory equipment. If a test is too expensive or the procedure too complicated it may not be used in the end.

Over the counter sales of antibiotics

Non-prescription use has been reported to account for 19-100% of antibiotic consumption outside Europe and North America, and is predominant in many low- and middle-income countries. This contributes to inappropriate use as it makes it possible for people to self-medicate without actually consulting with a medical adviser. Antibiotics may be used when they are not needed, or the wrong type of antibiotic, dosage or treatment duration may be used. One solution to this problem is to make antibiotics prescription-only drugs, which is probably adequate in most high-income countries. However, in low- or middle-income countries, it might result in insufficient access to antibiotics due to the lack of health care providers that can provide prescriptions.

For more information on access and regulating antibiotic use, see:
POLICY: Elements of a national action plan – Rational use of antibiotics and Access.

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