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ODs can help reduce antibiotic resistance
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Google “antibiotic resistance” and in a fraction of a second you will find more than 10 million results. Seriously. Everyone from the U.S. Centers for Disease Control and Prevention to the World Health Organization to the evening news has something to say about antibiotic resistance. While you might expect a tremendous diversity of opinion on the subject, quite frankly there is really very little controversy. The message is clear: bugs are becoming more resistant, our antibiotics less effective and we just cannot seem to ebb the tide. Seriously.
The challenge of antibiotic resistance is not a new one. Since medicine first waged its war on bacteria with the introduction of penicillin, we have witnessed a litany of new antibiotics countered by more resistance. The problem has become much more widespread, involving all categories of anti-infectives. The urgency is that it is becoming increasingly difficult for pharmaceutical companies to win this battle – technically and practically.
For starters, developing an anti-infective agent is no easy task. Factor in an onerous and cost-prohibitive U.S. Food and Drug Administration approval process and the tremendous pressure from government and insurers to curtail drug costs, and it becomes prohibitive for pharmaceutical companies to bring an innovative agent to the market. They simply cannot justify the time and expense given the short duration of treatment associated with anti-infective drugs. While we continue to eke out small victories – as evidenced by our latest-generation fluoroquinolones – the sad fact is they are derived from a quinolone backbone developed more than 4 decades ago. Seriously.
The real problem is that antibiotics are everywhere, often at suboptimal dosing levels – for sure the perfect storm for microbial resistance. While certain countries have banned antibiotic use for disease prevention and growth acceleration in farm animals, it remains a robust practice in the U.S., often leading to the “farm to fork” phenomenon associated with resistance. While it is easy to blame chickens and cows, humans must also accept some responsibility. Americans make up just under 5% of the world’s population, yet we consume almost 50% of the world’s antibiotics. And antibiotic overuse leads to greater bacterial resistance.
Given most anti-infective overuse and resistance occurs in hospitals, with catheter administration, and as a result of community-wide over prescribing, what does this have to do with optometry? After all, most of our anti-infective prescriptions are topical, and rarely do we prescribe orally for any significant duration. While it is true we might not be a big part of the problem, we should, nonetheless, be part of the solution.
It goes without saying that all prescribers, including optometrists, must avoid prescribing anti-infective agents indiscriminately or inappropriately. In addition, we should always dose – amount, frequency and duration – for optimal efficacy.
These issues aside, perhaps our greatest role is one of education. In countries where there are fewer resistant strains and nosocomial methicillin-resistant Staphylococcus aureus infections, it is the result of a clear and consistent message. Whether from a public service advertisement, insurer, prescriber or pharmacist, the public understands one certainty. If we are to win the battle of anti-infective drug resistance, physicians must prescribe the appropriate agent only when it is truly indicated, and patients must comply.
As optometrists, we have the opportunity to communicate this message every day. Whether it is a viral conjunctivitis or ocular symptoms associated with sinusitis, it is critical that we echo these sentiments as well. It may be the only chance society has to reverse this crisis. Seriously.