Daily Independent (Ashland, KY)

Editorials

April 23, 2013

Overprescribed?

.Kentucky is 2nd in the nation in treating with antibiotics

ASHLAND — Kentucky ranks right behind neighboring West Virginia in the number of antibiotics prescribed per 1,000 population, with Tennessee ranking third. Thus, it is no wonder the Centers for Disease Control is questioning why so many patients are being treated with antibiotics in the three neighboring states compared to the rest of the nation.

The CDC is concerned the antibiotics are being overprescribed in this region, and if so, they could become less effective in treating ailments.

Antibiotics are not narcotics. Instead, antibiotics like penicillin or streptomicin are produced from organisms such as fungi and bacteria. Unlike the prescription drug epidemic that has plagued Kentucky, West Virginia, Tennessee and other states in Appalachia in recent years and caused thousands of deaths from overdoses, antibiotics when properly prescribed effectively treat people suffering from infections ranging from pneumonia to sexually transmitted diseases.

However, bacteria have increasingly gained the power to shrug off antibiotics, and the more antibiotics are used the less effective they are. If physicians in this region are overusing antibiotics — and the numbers indicate they may be — then those medications are likely to become less effective.

There is no scientific consensus on an appropriate level of antibiotic prescribing. But some experts said the new study’s results are disturbing, and that rates are probably excessive even in the states with the lowest antibiotic prescription levels.

Experts say chances of resistance increase when antibiotics are used too frequently or are taken for the wrong reasons, allowing bacteria to survive and adapt. The CDC is tracking at least 20 strains of resistant bacteria.

CDC researchers conducted the new study, analyzing a national prescription drug database for 2010. Other studies have focused on antibiotic prescriptions for specific groups like Medicare patients. This is the first to look at it for all Americans.

Doctors and other health care providers prescribed 258 million courses of antibiotics in 2010, for a population just shy of 309 million, the researchers found. That translates to 833 antibiotic prescriptions for every 1,000 people, on average.

But rates were much higher in West Virginia, Kentucky and Tennessee, where about 1,200 were written for every 1,000. On the low end were Alaska, Oregon and California, where prescriptions were at or below 600. Earlier studies found similar geographic trends.

Why the difference?

One possibility: Southerners suffer more infections than people in other parts of the country. Southern states have the highest rates of obesity and diabetes, and diabetics tend to have more infections than other people, noted the CDC’s Dr. Lauri Hicks, one of the study’s authors. “So some of that prescribing may be warranted,” she said.

During the swine flu pandemic of 2009 and 2010, the South saw more reports of illness than other parts of the country. Experts at the time said patients with flu-related pneumonia should be treated with both antiviral medicines and antibiotics to prevent all forms of deadly complications.

The South also has higher rates of certain other respiratory infections, including bronchitis, according to a study last year by University of Pittsburgh researchers. The CDC study found the most frequently prescribed antibiotic was azithromycin, which is commonly used for bronchitis symptoms. But that’s a problem. Bronchitis is usually caused by a virus, and antibiotics like azithromycin don’t work against viruses.

Researchers need to do more to find out why antibiotics are prescribed at twice the level in Kentucky, West Virginia and Tennessee than they are in states like Oregon and California. If it is because we tend to become ill more often because of diabetes, obesity, unhealthy eating habits and lack of exercise, then the use of antibiotics is understandable.

But if it is because health care professionals do not know enough about the antibiotics they are prescribing, then more education is needed to prevent misuse.       

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