If you catch a bacterial infection, chances are your doctor will prescribe antibiotics to clear it up. While antibiotics are effective at clearing up many conditions, concerns about the consequences of overuse, including antibiotic resistant bacteria and potential disruptions in the gut microbiome, are increasing among researchers. And according to a University of Michigan study published in the British Medical Journal, nearly one in four antibiotic prescriptions might actually be unnecessary. This echoes previous findings that antibiotics are important, but overused, as the National Institutes of Health has noted.
Beata Mostafavi for the University of Michigan Health blog wrote that researchers found that one in seven children and non-elderly adults were prescribed potentially unnecessary antibiotics in 2016. According to a recent press release on the research, of the 19.2 million privately insured U.S. adults and children studied, ages 18-64, 23 percent of outpatient antibiotic prescriptions were medically unnecessary, and 28 percent were issued without any recorded diagnosis. Researchers found that only 36 percent of participants received antibiotic prescriptions that may have been medically useful. According to the study’s authors in the paper, unnecessary antibiotic prescriptions contribute to the development of antibiotic resistance — or antibiotic resistant bacterial strains — which is “one of the greatest threats to public health worldwide.”
“Antibiotic overuse is still rampant and affects an enormous number of patients,” said lead study author Kao-Ping Chua, MD, PhD, a researcher and pediatrician at University of Michigan C.S. Mott Children's Hospital and the University of Michigan Institute for Healthcare Policy and Innovation, according to the press release. "Despite decades of quality improvement and educational initiatives, providers are still writing antibiotic prescriptions for illnesses that would get better on their own."
Katelyn Newman for U.S. News & World Report wrote that, according to the study, researchers say that, despite over 30 years of efforts to curb antibiotic overuse, results “show the widespread nature of inappropriate outpatient antibiotic prescribing at the level of both prescription fill and population.”
Not only does antibiotic overuse contribute to antibiotic resistance, according to the study’s authors, a 2018 study published in the Yonsei Medical Journal also found that antibiotics can disrupt the delicate ecosystem of the gut microbiome. The study’s authors write that “Recent studies have provided information on how antibiotics can alter the intestinal environment, how harmful bacteria and beneficial bacteria react, and how pathogenic bacteria use these environments. Pathogens exploit the sugars, radicals, and oxygen occurring as a result of disruption of intestinal microbiota and the host inflammatory response.” The researchers further suggest that the therapeutic use of probiotic supplements and probiotics foods might be an important component to restoring the gut microbiome disrupted by antibiotic use.
Additionally, University of Michigan researchers say that, given the potential health risks associated with antibiotic overuse, “Providers urgently need to eliminate prescribing that isn't needed, both for the sake of their patients and society,” according to the press release.
Scott Hensley wrote for NPR that, if a trip to your doctor results in a talk about an antibiotic prescription, it might not be a bad idea to discuss your options. If you have a sinus or bacterial infection, you have choices, Hensley wrote. "A lot of times what people really want is treatment, but treatment doesn't necessarily mean antibiotics," John Cullen, a family doctor in Valdez, Alaska told NPR. Some over-the-counter remedies can also help, and Cullen often recommends old-fashioned honey for coughs, wrote Hensley.
It's important to note that this research does not mean that antibiotic prescriptions are always unnecessary — in fact, they are life-saving treatments in many cases. If you are prescribed antibiotics, it's important to follow best practices for taking them according to your doctor to help prevent the spread of antibiotic resistance, which includes finishing out the full course.