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 Nearly a third of antibiotics prescribed in doctors' offices, emergency rooms and hospital-based clinics in the United States are not needed, according to the most in-depth study yet to examine the use and misuse of these life-saving drugs. 
 
 The finding, which has implications for antibiotics' diminished efficacy, translates to about 47 million unnecessary prescriptions given out each year across the country to children and adults. Most of these are for conditions that don't respond to antibiotics, such as colds, sore throats, bronchitis, flu and other viral illnesses. 
 
 Although health officials have been warning for decades about the overuse of antibiotics and its contribution to the development of drug-resistant bacteria, the research from the Centers for Disease Control and Prevention and the Pew Charitable Trust is the first to quantify the depth of the problem. 
 
 "We've all been hearing, 'This is a problem, this is problem,' and we all understood the general concept that there is a lot of antibiotic use," said David Hyun, a senior officer with Pew's antibiotic resistance project and one of the authors of the report published Tuesday in JAMA. Pew also published a companion report using the same data. 
 
 "Why this study is so important: It actually provides concrete numbers," Hyun said. 
 
 [CDC warns that Americans may be overmedicating young children with ADHD] 
 
 The study analyzed data for all antibiotic use in the three settings as collected from two major CDC surveys from 2010 to 2011. Antibiotic prescriptions written there represent the majority of dollars spent on antibiotics in this country. 
 
 “Antibiotics are life-saving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said CDC Director Tom Frieden. “Losing these antibiotics would undermine our ability to treat patients with deadly infections [and] cancer, provide organ transplants and save victims of burns and trauma.” 
 
 [‘Looming catastrophe’: These 7 emergency surgeries account for 80 percent of deaths and costs] 
 
 Among the key findings: 
 
 • About 13 percent of all outpatient visits in the United States -- about 154 million visits annually -- result in an antibiotic prescription. 
 
 • More than four in 10 (44 percent) of antibiotic prescriptions are written to treat patients with acute respiratory conditions, such as sinus infections, middle ear infections, sore throats, colds, bronchitis, asthma, allergies, flu, and pneumonia. 
 
 • Half of these prescriptions are unnecessary because many are for viral illnesses. 
 
 Doctors often wind up prescribing antibiotics because of pressure from patients or parents, said Katherine Fleming-Dutra, a CDC medical epidemiologist and report's lead author. 
 
 "Clinicians are concerned about patient satisfaction and the patient demand for antibiotics," she said. But the majority of individuals do trust their doctors to make the right diagnosis, and better communication by doctors about the dangers of antibiotic overuse can lead to more appropriate prescribing, she said. 
 
 An accompanying editorial in JAMA noted that the numbers provided in the report likely are an undercount because they don't include the times antibiotics are given when patients talk to doctors' offices over the telephone, or when patients seek medical care at urgent care clinics, retail pharmacies and dentists' offices. 
 
 Also not included are prescriptions written by nurse practitioners and physician assistants. 
 
 But even relatively simple steps, such as displaying a poster in patient waiting rooms can cut down on antibiotic prescribing, the editorial said. 
 
 The overuse of antibiotics has led to the frightening rise of drug-resistant superbugs in recent years. The CDC has warned that "nightmare bacteria" are increasingly resistant to even the strongest antibiotics, posing a growing threat to hospitals and nursing homes nationwide. 
 
 Last year, the White House announced an aggressive plan to combat antibiotic-resistant bacteria, which already cause an estimated 2 million illnesses and 23,000 deaths every year just in the United States. The administration set a target of reducing inappropriate antibiotic use in outpatient settings by half by 2020. 
 
 Based on the new report, this goal would be reached by cutting outpatient antibiotic use by 15 percent overall, which would result in approximately 23 million fewer antibiotics prescribed annually by 2020. 
 
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 ‘Looming catastrophe’: These 7 emergency surgeries account for 80 percent of deaths and costs ||||| MAY 02, 2016 
 
 Allison Gilchrist, Associate Editor 
 
 About 30% of all outpatient oral antibiotic prescriptions written in the United States are inappropriate, a new CDC study suggests.CDC researchers used data from the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to determine the rates of outpatient oral antibiotic prescribing by patient age and diagnosis, as well as the estimated amount of antibiotic use that could be considered inappropriate.Of the 184,032 outpatient visits included in the data, 12.6% resulted in an antibiotic prescription. The researchers estimated that 353 of the 506 antibiotic prescriptions written annually per 1000 population were appropriate.Broken down further, the data revealed that sinusitis diagnoses resulted in the most antibiotic prescriptions per 1000 population (56), followed by ear infections (47), and pharyngitis (43).“Half of antibiotic prescriptions for acute respiratory conditions may have been unnecessary, representing 34 million antibiotic prescriptions annually,” the researchers wrote. “Collectively across all conditions, an estimated 30% of outpatient oral antibiotic prescriptions may have been inappropriate.”Last fall, the President signed an Executive Order on “detecting, preventing, and controlling antibiotic-resistant microbes” as part of the White House’s 5-year National Action Plan for Combating Antibiotic-Resistant Bacteria, which aims to reduce inappropriate antibiotic use in outpatient settings by 50% by 2020. Based on the current study results, a 15% reduction in overall antibiotic use would be necessary in order to meet that goal, the researchers noted.Because antibiotic overprescribing contributes to drug resistance, curbing the practice is a major public health care priority. Failure to do so could have grim consequences, as the CDC already estimates that 2 million individuals are infected with antibiotic-resistant bacteria each year in the United States, and 23,000 of them die from these infections annually.In one of the more notorious examples , UCLA Health indicated that 179 patients might have been infected with “ superbug ” carbapenem-resistant Enterobacteriaceae at the Ronald Reagan UCLA Medical Center during “complex endoscopic procedures that took place between October 2014 and January 2015.”“Health professionals generally know when antibiotics are and are not needed,” lead study author Katherine Fleming-Dutra, MD, a medical epidemiologist with the CDC’s Office of Antibiotic Stewardship, explained to Pharmacy Times. “Often, clinicians are worried about patient satisfaction. They think that a patient wants antibiotics…sometimes leading them to prescribe when they shouldn’t.”Pharmacists can help prevent this by providing patients with information about the potential consequences of unnecessary antibiotic use.“Pharmacists are the last health professional to see a patient when an antibiotic is prescribed,” Dr. Fleming-Dutra said. “When dispensing antibiotics, pharmacists can educate patients about properly taking antibiotics and about potential harms from antibiotics such as allergies, adverse events, and antibiotic resistance.”Beyond treating infections, other studies have found that as many as 1 in 10 health care providers prescribe antibiotics for almost every patient they see with a cold or bronchitis, despite the fact that antibiotics aren’t effective against viral infections.“It is important for all health professionals in all regions seeing patients of all ages to only prescribe antibiotics when they are needed, and if needed, select the right antibiotic at the right dose for the right duration,” Dr. Fleming-Dutra advised.The current study results appeared in the May 3, 2016, edition of JAMA. ||||| WASHINGTON—The Pew Charitable Trusts and the Centers for Disease Control and Prevention (CDC) released today a first-of-its kind analysis of antibiotic use in doctors’ offices, emergency rooms, and hospital-based clinics in the United States. The analysis, conducted in partnership with a panel of leading antibiotic use experts, identifies acute respiratory conditions as key drivers of antibiotic overuse in human health care and establishes data-driven targets for eliminating the approximately 47 million unnecessary antibiotic prescriptions issued in outpatient facilities across the country every year. 
 
 The findings are outlined in two documents released today: Pew’s report “Antibiotic Use in Outpatient Settings” and “Prevalence of Inappropriate Antibiotic Prescriptions Among U.S. Ambulatory Care Visits, 2010-2011,” an article authored by experts from Pew, CDC, and members of the panel, appearing in the current issue of the Journal of the American Medical Association. They outline the baseline analysis and condition-specific targets, as well as practical strategies to improve prescribing. 
 
 “This report provides the most in-depth picture to date of outpatient antibiotic prescriptions in the U.S. and will serve as a benchmark in measuring progress moving forward,” said David Hyun, M.D., a senior officer with Pew’s antibiotic resistance project, who focuses on research and policy development pertaining to the stewardship of antibiotics in health care settings. “While our estimates of unnecessary antibiotic use are conservative, it is clear that a small number of health conditions constitute the lion’s share of unwarranted antibiotic prescriptions in this country. These detailed data will help health care providers target stewardship efforts where they can do the most good.” 
 
 At least 30 percent of antibiotics prescribed in outpatient settings in the United States are unnecessary, according to the report. The majority are prescribed for acute respiratory conditions such as colds, sore throats, bronchitis, flu, and other viral illnesses that do not respond to antibiotics. 
 
 “The more antibiotics are used, the less effective they become. Reducing the needless use of antibiotics will slow the emergence of antibiotic-resistant microbes, so-called superbugs, which are among the most urgent public health threats of our time,” said Kathy Talkington, director of Pew’s antibiotic resistance project. “Patients and health care providers must work together to understand when antibiotics will help and when they won’t, and help preserve these lifesaving drugs for patients who really need them.” 
 
 Antibiotic use in outpatient settings represents the majority of dollars spent on antibiotics for human health care in the United States, and outpatient providers are often the first place patients go for health care when suffering from a cold, flu, sore throat, or other common condition for which antibiotics are often unnecessarily prescribed. 
 
 The analysis concludes that: 
 
 Approximately 13 percent of all outpatient office visits in the United States, or about 154 million visits annually, result in an antibiotic prescription; about 30 percent of these prescriptions are unnecessary. 
 
 Forty-four percent of outpatient antibiotic prescriptions are written to treat patients with acute respiratory conditions, such as sinus infections, middle ear infections, pharyngitis, viral upper respiratory infections (i.e., the common cold), bronchitis, bronchiolitis, asthma, allergies, influenza, and pneumonia. Half of these prescriptions are unnecessary. 
 
 In 2015, the White House released a national action plan for combating antibiotic resistance, which included the goal of reducing inappropriate outpatient antibiotic use by 50 percent by 2020. Based on the panel’s estimate of unnecessary prescribing, this goal would be reached by reducing outpatient antibiotic use by 15 percent overall, which would result in approximately 23 million fewer antibiotics prescribed annually by 2020. 
 
 The panel outlined actions that health care providers, patients, and the health care industry as a whole can take to reach the targets, including: 
 
 Individual outpatient health care providers can evaluate their own prescribing habits as well as implement stewardship activities in their practices. 
 
 Health systems can provide expertise and resources to offices within their network to aid in stewardship implementation. 
 
 Health plans can assist in data collection and analysis—evaluating the antibiotic prescribing habits of their providers and providing feedback that highlights potential areas for improvement. 
 
 State and local health agencies can help provide outpatient facilities with information on best practices for implementing antibiotic stewardship programs, and help develop regional partnerships between various health care stakeholders, such as providers, health plans, and health systems, in order to better coordinate stewardship activities. 
 
 Federal agencies can track antibiotic prescribing at the national level, identifying areas for further improvement and providing technical assistance to stakeholders interested in implementing stewardship efforts of their own. 
 
 Organizations such as the National Committee for Quality Assurance that develop standards to assess the quality of health care services can establish metrics to assess the antibiotic prescribing habits of health care providers. 
 
 Health care professional societies can provide expert guidance to their members on appropriate antibiotic prescribing and incorporating diagnostics to aid in prescribing decision-making. 
 
 “Prescribing unnecessary antibiotics is just one element of inappropriate use of antibiotics,” said Lauri Hicks, D.O., director of the CDC’s Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases. “Health care providers can also prescribe antibiotics at the wrong dose or for the wrong duration, amplifying the extent of inappropriate use. Setting a national target to reduce unnecessary antibiotic use is the first step, and we must work together across the health care continuum to reach this goal.” 
 
 Pew, CDC, and the expert panel are preparing a similar report on inpatient antibiotic prescribing. It will set national targets for reducing unnecessary use in hospitals and will be released in 2017. 
 
 The Pew Charitable Trusts is driven by the power of knowledge to solve today’s most challenging problems. Learn more at www.pewtrusts.org. ||||| CHICAGO Antibiotic-resistant gonorrhea, a diarrhea-causing superbug and a class of fast-growing killer bacteria dubbed a "nightmare" were classified as urgent public-health threats in the United States on Monday. 
 
 According to a new report by the U.S. Centers for Disease Control and Prevention (CDC), at least 2 million people in the United States develop serious bacterial infections that are resistant to one or more types of antibiotics each year, and at least 23,000 die from the infections. 
 
 "For organism after organism, we're seeing this steady increase in resistance rates," Dr Thomas Frieden, director of the CDC, said in a telephone interview. "We don't have new drugs about to come out of the pipeline. If and when we get new drugs, unless we do a better job of protecting them, we'll lose those, also." 
 
 Overprescribing of antibiotics is a chief cause of antibiotic resistance, affording pathogens the opportunity to outwit the drugs used to treat them. Only a handful of new antibiotics have been developed and brought to market in the past few decades, and only a few companies are working on drugs to replace them. 
 
 In addition to resistant gonorrhea, the others now seen as urgent threats, according to the first-of-its-kind report released on Monday, are C. difficile and the killer class known as carbapenem-resistant Enterobacteriaceae, or CRE. 
 
 The report was conceived to bring together as much information as possible about drug-resistant superbugs and how to slow their spread, with a hope of preserving the remaining drugs that still work, Frieden said. 
 
 The United States is not alone in raising the alarm over antibiotic drug resistance. Last March the chief medical officer for England said antibiotic resistance poses a "catastrophic health threat". That followed a report last year from the World Health Organization that found a "superbug" strain of gonorrhea had spread to several European countries. 
 
 The CDC report ranks the threat of drug-resistant superbugs into three categories - urgent, severe and concerning - based on factors such as their health and economic impacts, the total number of cases, the ease with which they are transmitted and the availability of effective antibiotics. 
 
 Among the top three threats deemed "urgent" is CRE, which Frieden last March called a "nightmare bacteria" because even the strongest antibiotics are not effective against it. 
 
 According to the report, CRE accounts for 9,300 healthcare-associated infections. The two most common types of CRE - carbapenem-resistant Klebsiella spp. and carbapenem-resistant E. coli - account for some 600 deaths each year. 
 
 "For CRE, we're seeing increases from 1 state to 38 states in the last decade," Frieden said. 
 
 HOSPITAL THREAT 
 
 C. difficile, the most common hospital-based infection in the United States, made the list of urgent threats both because it has begun to resist antibiotics and because it preys on the overuse of antibiotics. 
 
 C. difficile, which causes life-threatening diarrhea, spreads from person to person on contaminated equipment and on the hands of healthcare workers and visitors. It is especially stubborn in hospitals because of the widespread use of antibiotics, which kill protective bacteria in the gut for months, allowing invaders such as C. difficile to flourish. 
 
 According to the report, C. difficile causes 250,000 infections and kills 14,000 people in the United States each year, adding $1 billion annually in excess medical costs. Deaths from C. difficile rose 400 percent from 2000 to 2007 due to the emergence of a drug-resistant strain of the bacteria. 
 
 The third "urgent" threat in the report is drug-resistant Neisseria gonorrhoeae, which causes 246,000 U.S. cases of the sexually transmitted disease gonorrhea each year. Gonorrhea is increasingly becoming resistant to tetracycline, cefixime, ceftriaxone and azithromycin - formerly the most successful treatments for the disease. 
 
 Gonorrhea is especially troublesome because it is easily spread, and infections are easily missed. In the United States, there are approximately 300,000 reported cases, but because infected people often have no symptoms the CDC estimates the actual number of cases is closer to 820,000. 
 
 If left untreated, gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy, stillbirths, severe eye infections in babies and infertility in men and women. 
 
 "The three organisms that have been chosen as urgent are all increasing at an alarming rate to which therapies are limited," said Dr Edward Septimus, an infectious disease expert at HCA Healthcare System in Houston, Texas, and a member of the Infectious Diseases Society of America's Antimicrobial Resistance Workgroup. 
 
 Septimus, who was not involved with the CDC report, said the pathogens in the urgent and serious categories - which include Methicillin-resistant Staphylococcus aureus, or MRSA, and drug-resistant tuberculosis - are "certainly worthy of immediate response. I do believe it's a looming public-health crisis," he said. 
 
 In addition to ranking the threat of superbugs, the report outlines a four-point plan to help fight the spread of antibiotic resistance. 
 
 Not surprisingly, it underscores the need for new antibiotics, citing ever-slowing development efforts by pharmaceutical companies due to the high cost of such programs and relatively low profit margins of the drugs. 
 
 It also stresses the need for hospitals to prevent infections from occurring and to contain the spread of resistant infections; carefully tracking the spread of resistant bacteria; and ensuring that antibiotics are prescribed only to patients who need them. 
 
 "It's not too late," Frieden said. "There are things we can do that can stop the spread of drug resistance. We need to scale up the implementation of those strategies." 
 
 (Reporting by Julie Steenhuysen; Editing by Bill Berkrot and Douglas Royalty) ||||| Superbug Suit: Judge Orders FDA to Act on Antibiotic Use in Livestock 
 
 A federal court ruled Thursday that government regulators must, at long last, conclude whether feeding antibiotics to healthy livestock -- a widespread practice in factory farming designed to promote animal growth and prevent disease -- could pose a threat to human health. And if so, they must end the practice. 
 
 
 
 The U.S. Food and Drug Administration has failed to act for more than three decades on scientific evidence, including some of its own findings, showing that the indiscriminate use of antibiotics in animal feed can lead to the growth and spread of drug-resistant bacteria capable of infecting people. 
 
 
 
 Such infections, known as “superbugs,” kill 70,000 Americans in U.S. hospitals each year. (See “You Want Superbugs With That?”) 
 
 
 
 Ruling on a lawsuit brought last year by the Natural Resources Defense Council (which publishes OnEarth) and several partners, U.S. District Court Judge Theodore Katz said the FDA can no longer delay acting on its own 1977 safety findings and must determine whether there is a need to ban what’s known as the subtherapeutic use of antibiotics in livestock. 
 
 
 
 The FDA had previously approved use of the antibiotics in the 1950s, then started proceedings to withdraw that approval after its 1977 findings. But the agency failed to finalize the order due to pressure from drug companies, agribusiness, and their allies in Congress. 
 
 
 
 The judge stopped short of ordering the FDA to ban the practice Thursday and said drug sponsors should still have an opportunity to demonstrate that the subtherapeutic use of penicillin and tetracyclines is safe. He ordered the FDA commissioner to set a hearing on the issue. 
 
 
 
 As OnEarth has previously reported, fully 80 percent of the antibiotics used in the U.S. are given to livestock, and the vast majority are administered to promote growth and stave off potential infections, not to treat illness. Bacteria in the guts of farm animals can evolve to resist those antibiotics, then spread from livestock to the humans who tend them. Drug-resistant bacteria can then be passed on to people who have never been anywhere near a chicken house or hog barn. 
 
 
 
 Yet even as evidence of the practice’s negative impact on human health has grown, more drugs are being administered to livestock than ever before -- from 17.8 million pounds per year in 1999 to 29.8 million pounds in 2009. 
 
 
 
 Read OnEarth’s previous coverage of the antibiotics case from award-winning food writer Barry Estabrook, and look for more about this story soon on our Food, Health & Home channel. 
 
 Image: fras1977/Flickr
– Scientists have been concerned for some time about "Phantom Menace"-type superbugs that aren't fazed by meds. The latest CDC data finds that 2 million people a year in the US are infected with bacteria resistant to antibiotics, and at least 23,000 die directly from those infections. And a new report from the CDC and the Pew Charitable Trusts—the first research to quantify this issue, per the Washington Post—isn't encouraging. A study published Tuesday in JAMA finds nearly one in three antibiotic prescriptions (around 47 million per year) are given needlessly to people with viruses such as bronchitis and the common cold, as well as for ear and sinus infections and sore throats not caused by bacterial infections—meaning the Rx not only won't vanquish their illness, but can potentially build up antibiotic resistance, the St. Louis Post-Dispatch reports. Besides the drug resistance, overuse can up the risk for drug allergies and even an unpleasant-sounding diarrhea that can be fatal. The researchers analyzed 184,032 outpatient visits to ERs and medical clinics in 2010 and 2011 and found that 12.6% walked out with an antibiotic script, per the Pharmacy Times. Out of an estimated annual antibiotic-prescription rate of 506 per every 1,000 people, only about 353 of those who received prescriptions should likely have received them. The Times notes President Obama's initiative to cut down on unnecessary outpatient antibiotic use by 50% by 2020; researchers say that, based on this study, we'll need to slash overall antibiotic use by 15% to meet that. "If we continue down the road of inappropriate use we'll lose the most powerful tool we have to fight life-threatening infections," CDC Director Tom Frieden says. "Losing these antibiotics would undermine our ability to treat patients with deadly infections [and] cancer, provide organ transplants, and save victims of burns and trauma." (Here's hoping teixobactin can help us out with superbugs.)