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The threatening rise of antibiotic resistant bacteria

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The overprescribing and misuse of antibiotics is a driving factor behind the development of antibiotic resistant bacteria, known as “superbugs.”

Aetna is working to educate doctors and clinicians across the country on guidelines for antibiotic use so they’re confidently prescribing the appropriate treatment for their patients after a diagnosis. Equally important, Aetna plans on collaborating with providers so they feel confident not prescribing antibiotics for conditions that do not require antibiotics.

“Antibiotic resistant bacteria pose an increasing risk to individuals’ health. Although the development of new medications is important, it is vital that we preserve the efficacy of our current antibiotics through appropriate prescribing and use,” said Harold L. Paz, M.D., M.S., Aetna’s chief medical officer. “We are working with physicians to help them educate themselves and their patients about when antibiotics are necessary and the importance of taking them exactly as prescribed. Responsible stewardship of antibiotics will help keep all of our families healthier.”

These efforts are meant to help patients receive the proper treatment, which will in turn reduce the development of superbugs.

“Antibiotics have revolutionized how we take care of patients over the past century. They are the cornerstone of managing bacterial infections,” said Dr.  Daniel Knecht, head of Clinical Strategy for Health & Clinical Services at Aetna. “Unfortunately, physicians have been overprescribing this very important class of drugs, since they are generally very effective and inexpensive.”

“Resistant bacteria threaten our ability to treat infections such as pneumonia, cellulitis and urinary tract infections. Without being able to use a first line antibiotic, doctors have to use drugs that are less effective or more toxic to patients and may cause more severe adverse side effects.”

The creation of antibiotic resistant bacteria

Antibiotics are prescribed to patients to treat bacterial infections. While the goal is to kill all bacteria, some acquire mutations that enable these “bugs” to survive and reproduce. Strains can then be spread throughout hospitals or other health care settings, especially if doctors, nurses and visitors fail to wash their hands and observe proper precautions.

An infographic by the World Health Organization detailing how antibiotic resistant bacteria spread. Courtesy: World Health Organization

Bacteria resistant to multiple types of antibiotics also develop within animals that are administered antibiotics to treat illnesses or promote growth. Giving animals antibiotics is accelerating the development of superbugs, according to the World Health Organization (WHO). Humans are exposed to superbugs through direct contact with the animal, through food made from the animal or through the environment, according to WHO.

At least 2 million people become infected with antibiotic resistant bacteria each year in the United States, according to the Centers for Disease Control and Prevention. Of those infected, at least 23,000 die from difficult to treat infections. It’s estimated that antibiotic resistant bacteria has cost the U.S. $20 billion in health care costs and $35 billion a year in lost productivity each year.

In February 2016, the WHO released a list of 12 antibiotic resistant bacteria that are the greatest threat to humans if left unaddressed.

The most critical group includes multidrug resistant bacteria that pose a threat in hospitals, nursing homes and among patients who use ventilators and blood catheters. Antibiotic resistant bacteria can pass genetic mutations that extend resistance to nearby bacteria – allowing for the spread of resistant properties.

The overuse of antibiotics is also accelerating the creation and spread of resistant bacteria. Of the estimated 154 million prescriptions for antibiotics written in an outpatient care setting in the U.S. from 2010 to 2011, over 30 percent were prescribed unnecessarily, according to a study published in the Journal of the American Medical Association (JAMA).

Using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, the researchers found nearly three-quarters of adults diagnosed with pharyngitis, or sore throat, from 2010 to 2011 were prescribed antibiotics, even though it was unnecessary.

Pharyngitis should be treated with antibiotics if it is caused by streptococcus bacteria, according to national guidelines. Physicians can conduct a rapid strep test to determine if the sore throat is caused by a bacterial infection.

More resistance = harder to treat

Superbugs are a growing issue for clinicians and society at large. As types of bacteria become more resistant, certain conditions, such as pneumonia, tuberculosis and gonorrhea, become harder to treat.

When bacteria can’t be killed with typical antibiotics, patients may have to go through a longer course of treatment that may have worse side effects. A rare situation, Knecht said, involves superbugs that aren’t susceptible to any antibiotics.

“It’s a nightmare scenario when some bacteria don’t even respond to the latter-line therapies because it’s completely resistant to antibiotics,” Knecht said. “Patients die because doctors are unable to effectively treat them.”

While rare, there has been at least one documented case where a person was infected by bacteria completely resistant to antibiotics. A woman died in Nevada in 2016 after doctors discovered she was infected by bacteria resistant to all 26 antibiotics available in the U.S.

Appropriate prescriptions, proper treatment

The dangers of antibiotic resistant bacteria led to the White House’s announcement of the National Action Plan for Combating Antibiotic-Resistant Bacteria in March 2015. The plan sets a goal of reducing inappropriate antibiotic use in an outpatient setting by 50 percent by 2020.

The WHO also calls for the research and development of new antibiotics that are effective against known resistant bacteria. And with the number of antibiotics being prescribed unnecessarily, researchers in the JAMA study believe there is a need for establishing outpatient antibiotic stewardship.

People can also play a part in reducing the development of superbugs by only using antibiotics when prescribed, taking the complete prescription, never using leftover antibiotics, never sharing antibiotics, and preventing infections by practicing good hygiene.

Working with doctors and clinicians across the country, Aetna is providing health care professionals with information to help diagnose and properly treat patients.

“We want to empower providers and physicians and support so they not only know when it’s appropriate to prescribe antibiotics but also when it may not be needed for treatment. Ultimately we all want them to make the best decision for their patients,” Knecht said.

“We have to change our society’s perception of antibiotics and view them as a precious resource before it’s too late. Antibiotics are one of the few therapies available that can also immediately save a life… we cannot afford to lose the effectiveness of this class of drugs.”