American College of Physicians: Internal Medicine — Doctors for Adults ®


College launches fight against antibiotic resistance

From the June 2000 ACP-ASIM Observer, copyright 2000 by the American College of Physicians-American Society of Internal Medicine.

By Deborah Gesensway

PHILADELPHIA—At an Annual Session press conference, the College officially kicked off its first-ever clinical theme, which will attempt to staunch the spread of antibiotic-resistant disease. To do so, it turned a spotlight on one part of the problem: inappropriate physician prescribing.

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Studies have concluded that between 25% and 40% of antibiotics are prescribed inappropriately, explained Dale N. Gerding, FACP, who represents the Infectious Diseases Society of America on the College's work group on emerging antibiotic resistance. At the press conference, Dr. Gerding praised the College's upcoming efforts to write practice guidelines and educate internists about what he called "good antibiotic stewardship"prescribing the right drug at the right time in the right dosage and for the right duration.

ACP—ASIM plans to work with other organizations, including the CDC, to address multiple parts of what has become a multifaceted problem. Those areas include inappropriate use of antibiotics in agriculture and for animals, inappropriate use of antibiotics in other nations, and inappropriate demands and expectations of patients.

"Any successful strategy will have to be multifaceted," explained David J. Gullen, MACP, Immediate Past Chair of the College's Board of Regents. "But in the United States, we as physicians prescribe, and we accept responsibility and want to do our share." The alternative, he said, is bleak: "We could see new and re-emerging diseases in our lifetime for which we have no effective antibiotics."

Antibiotic resistance is not new; the first resistant microbes were identified shortly after penicillin came into use. But the problem is now considered a major public health issue. For instance, about 30% of Streptococcus pneumoniae infections in some areas of the country are now resistant to penicillin.

The CDC estimates that the country's office-based doctors provide about 100 million courses of antibiotics each year, 50 million of which are unnecessary and given mostly for colds and other viral infections for which antibiotics offer no benefit.

As part of its clinical theme initiative, the College will expand content on antibiotic resistance in all College education courses. It also plans to develop clinical practice guidelines for treating diseases prone to overtreatment by antibiotics (sinusitis, COPD and dyspepsia) and produce patient education pieces in English and Spanish. The College will also incorporate information about the risks of antibiotic resistance into its national "Doctors for Adults" public education campaign.

Dr. Gerding said he hopes the College's effort will transform the now commonly heard patient demand of "Doc, I need an antibiotic!" to "Doc, is this something we can manage without an antibiotic?"


Deborah Gesensway is a freelance writer in Abington, Pa.

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