Ohioans may be at greater risk than residents of many other states for contracting drug-resistant infections known as “superbugs,” which have emerged as a serious public health threat largely because of the over-prescribing of antibiotics, experts say.
According to the Centers for Disease Control and Prevention, more than 2 million people get antibiotic-resistant infections each year, and at least 23,000 die because current drugs no longer stop their infections.
The repeated and improper use of antibiotics is a leading cause, according to the CDC, which estimates about half of the more than 268 million antibiotic prescriptions written last year were either unnecessary or inappropriate.
While prescribing rates vary dramatically by state, Ohio ranked No. 13 for overall prescriptions per capita in 2014, with a rate of 0.93 prescriptions per 1,000 residents, according to figures from the CDC. That was well above the average prescribing rate for all states — 0.80 per capita, according to the CDC.
“I can’t say exactly that this means we’re at greater risk…but it certainly is a concern,” said Dr. Mary DiOrio, medical director for the Ohio Department of Health, who noted that higher numbers of antibiotic prescriptions don’t necessarily mean they’re being over-prescribed. “Still, we would not want to have a lot of over-prescribing or a lot of people taking antibiotics unnecessarily because that could increase the risk of the development of antibiotic-resistant bacteria.”
Every time a person takes antibiotics when they don’t need them, they increase the chance that someday they’ll contract a bacterial infection, such as pneumonia or tuberculosis, that can no longer be treated by antibiotics.
But surveys have found that many doctors and health care providers find it hard to resist their patients’ demand for antibiotics even when they know the drugs are ineffective against viral infections, such as the cold or the flu.
“We have to educate providers about making sure they use the appropriate antibiotic when it’s needed,” DiOrio said. “But we also have to educate the consumer about when antibiotics are needed. Antibiotics actually don’t help some of the things that people think antibiotics will help. We all know that at this time of year there are a lot of viruses going around, but antibiotics are not going to shorten the course of illness for these viruses or prevent the spread of these viruses.”
Kindy Ghussin, owner of Heartland Pharmacy in Kettering, said part of the problem is the growing number of locations and practitioners who prescribe antibiotics but have less training an experience than most primary care doctors.
While the vast majority of antibiotics are prescribed in outpatient settings by primary care physicians, about 30 percent are prescribed by nurse practitioners, physicians’ assistants and staff at walk-in clinics and other locations outside doctors offices, according to the CDC.
“I see people coming in with prescriptions for antibiotics from these walk-in clinics, where you don’t have doctors, and they don’t have equipment to fully diagnose the problem,” Ghussin said. “I’ve had a person come in with a prescription for an antibiotic for bronchitis, and it turns out they didn’t have it. Now you’re treating a non-existent infection, which means taking an antibiotic that’s really useless. That increases the chances of developing an organism’s resistance because you prescribed the antibiotic unnecessarily.”
With a limited pipeline of new antibiotics and the increasing ineffectiveness of existing drugs, state and federal health officials are taking steps to better track drug-resistant infections.
The CDC, for example, has begun categorizing drug-resistant bacterial infections by threat level — ranging from “concerning” to “serious” to “urgent.”
The worst drug-resistant bacteria, according to threat level, is CRE bacteria — a family of germs called carbapenem-resistant Enterobacteriaceae, which includes E. Coli.
Lask week, the CDC said a particularly dangerous superbug, dubbed the “phantom menace” by scientists, is on the rise in the U.S. The superbug’s strains belong to the family of bacteria known as CRE, which are difficult to treat because they are often resistant to most antibiotics. They are often deadly, too, in some instances killing up to 50 percent of patients who become infected, according to the CDC.
Health officials have called CRE among the country’s most urgent public health threats.
Some CRE bacteria are resistant to all existing antibiotics, according to the CDC, which reports more than 9,000 infections are contracted in hospitals and other health care settings from these bacteria. As many as 50 percent of patients who are infected with CRE end up dying because there is nothing to help them fight the infections.
In Ohio, the state health department monitors VISA and VRSA types of antibiotic-resistant staph infections and is considering adding other types of drug-resistant bacteria to its surveillance, DiOrio said.
“We’ve had conversations about looking at maybe monitoring some other resistant organisms, but we have not added them to our mandatory reportable disease list,” she said. “It’s a worrisome issue. It’s an international problem. We know that there are other countries that have seen more of these resistant bacteria, and we are concerned that we could see problems with resistance in the U.S. at the same greater level that we have seen elsewhere.”
Despite such concerns, the spread of drug-resistant bacteria is not an immediate threat, according to Ghussin.
“It’s not going to happen overnight,” he said. “The bacteria slowly over the generations of the bacterial strain remember the chemical composition of each antibiotic that led to their death, and over time, they build resistance. It’s an evolution. It may take years. But slowly over time each strain adds a little more resistance to certain antibiotics, and the problem is only going to get worse until we stop over-prescribing antibiotics.”