Hospitals were making progress on antibiotic stewardship…then COVID-19 arrived

Antibiotics are powerful tools against bacterial infection, but are far less effective when used for other afflictions. Physicians and prescribers have a unique responsibility to only use antibiotics when medically indicated to avoid antimicrobial resistance, which develops when germs evolve beyond the treatment capabilities of our medication arsenal.

The Centers for Disease Control and Prevention (CDC) released a special report on COVID-19 and its impact on antimicrobial resistance in the United States, emphasizing the importance of antibiotic stewardship due to alarming increases in resistance infections. Not only are these resistant infections endangering people’s lives, they are also estimated to cost the healthcare system approximately $4.6 billion dollars. How did we get here?

COVID and antibiotics reversed our progress

For a while, the U.S. was on a downward trend in deaths due to drug-resistant infections, falling by nearly 30% in hospitals from 2013 to 2017. This latest CDC report marks a complete flip in that trend, with the rate of deaths due to drug-resistant infections increasing by 15%.

But unfortunately, Covid-19 disrupted this pattern. During the initial chaos of COVID-19, 30% of outpatient and nearly 80% of patients hospitalized with COVID-19 received an antibiotic. While these were likely prescribed with the good intention of preventing potential secondary infections, these antibiotics were ultimately useless in treating this virus. This becomes concerning on a macro-level when considering the evolution of the germs that make us sick. As we throw more and more of our best infection-preventing weapons at these germs, they evolve and become harder to fight.

When a patient (human or animal) receives an antibiotic they do not need, not only does the patient get no benefit, but they are also put at risk for side effects (e.g., allergic reactions, toxicity that affects organ function, C. diff). Evidence suggests that 1 in 5 hospitalized patients who receive an antibiotic has an adverse drug event. – CDC 2022 SPECIAL REPORT

CDC 2022 Special Report, U.S. Impact on Antimicrobial Resistance

Overprescription is overuse

Similar to other types of overuse, overprescription can be harmful in both the short and long term. From antibiotics to benzodiazepines to high blood pressure medications, there is a systemic miscalculation happening when it comes to the need for prescription medications. This problem is particularly bad in the older population, where the combination of these drugs in their bloodstream can lead to adverse drug events resulting in hospitalization. 

Overprescription is endangering public health on various levels, from increasing antibiotic resistance to medication overload. COVID-19 highlighted exactly how important it is that we protect public health and prevent as many unnecessary harms as possible. The CDC recommends a multifaceted, upstream approach involving more robust data tracking, infection prevention, and vaccine development. We have policy options – it’s time we use them.