Restricting Use of Antibiotic Drugs

Restricting Use of Antibiotic Drugs in Response to a Viral Pathogen
Submitted by: Jacqueline Pauk BIOL 252 003
It’s flu season, yet again. A child complains to his mother, “Mommy, I don’t feel so good”. Like every good mother, she takes her child to the doctor’s office to get something, anything, to make her child feel better, quicker. The doctor the child is presented to is aware it is flu season, and that the child more than likely had caught the flu at school. However, to make the mother and the child feel secure and get out of the office content and quiet, the physician prescribes Amoxicillin, a common, considerably mild antibiotic.
Antibiotic resistance is on the rise. Bacteria are more and more able to grow in the presence of chemicals that once were lethal to them, yet not harmful to humans. There are many contributing factors to this alarming development; such as antibiotics, homologous to antibiotics safe for humans, being used at sub-therapeutic levels to prevent disease in cattle (Alexander). However, the before mentioned scenario, and other cases where antibiotics are overly prescribed, is the main contributing factor to the ever rising public health concern of antibiotic resistance (Sabuncu). For years, Physicians have been prescribing antibiotics in response to viral infections. This is helping evolution, “the natural selection [that is] acting on variant phenotypes” (Adam), favor bacteria which express various antibiotic resistant phenotypes, physical manifestations of genes. These phenotypes are encoded for in many sources that bacteria can exploit, such as: conjugative plasmids, transposable elements, and integron systems (Bennett). Many times, bacteria are making use of more than one of these systems (Bennett) which program the cell to express a certain protein or enzyme, so as to be resistant to a specific antibiotic.
What is most worrisome is that once a bacterium possesses and expresses a certain swatch of genetic material that lends a hand to antibiotic resistance, those swatches of genes can be transferred to other bacteria. It doesn’t have to be the same species bacteria (Bennett)! For example: If an antibiotic resistant form of Salmonella (obtained from eating raw or undercooked poultry) were ingested by a person, during its inhabitance of the individual’s, gut a transfer of the gene sequence possessed by that strain of Salmonella could occur to the normal, non-pathogenic, E. coli flora of the gut; leading to the E. coli being resistant to the same antibiotics that strain of Salmonella was.
Attempting to combat and slow the evolution of antibiotic resistant bacteria, some states and countries have educated the public and physicians on the harm overuse of antibiotics can do. For instance, in Colorado, the campaign “Be S.M.A.R.T. about Antibiotics” was launched from 2000 to 2001. In this program, the public and Physicians were educated that most acute respiratory tract infections were of viral etiology, and that antibiotics would not help get rid of the illness any sooner. Also, Physicians were given set targets to have certain measurements fall into (Gonzales). During this campaign, prescription antibiotic use dropped significantly. This drop is hoped to slow the progression and emergence of new antibiotic resistant bacteria. Associated Benefits Corporation wishes to implement a policy similar to the “Be S.M.A.R.T. about Antibiotics” program, due to the success seen in the program.
Policy- Proposed on behalf of Associated Benefits Corporation
To prevent the superfluous prescription of antibiotic drugs in response to a viral infection, common, first line group antibiotics (Amoxicillin, Ampicillin, Bacampicillin, Carbenicillin Indayl, Mezlocillin, Piperacillin, and Ticarcillin) will no longer be covered under insurance; unless proper documentation a bacterial infection is submitted. Proper documentation includes: cultures, samples, or slides of suspected pathogen. Once proper documentation is submitted and approved, patients prescribed the first-line group of antibiotics will be reimbursed. This policy will only apply to private practices, nurse practitioner clinics and doctors’ clinics. Hospitals are not included because most clients only go to hospital settings to obtain emergency care.
The costs of culturing, acquiring samples, and/or producing slides will be covered by the amount of money saved from not filling un-necessary antibiotics. This will cause a shift in yearly limits. The yearly limit for prescriptions shall be reduced. However, yearly limits for lab work shall be increased in proportion to the reduction of yearly limits on prescription. Premiums and co-pay rates will not change in response to this change in policy.
Clients may have many questions and concerns about the new policy. The two most common questions are addressed below.
What about prescriptions for chronic diseases?
The coverage of prescriptions for chronic diseases will not be limited by this policy. This policy is targeted at first-line group antibiotics, which bacteria are most commonly resistant to.
What about sever, emergency infections where there isn’t time to do a culture or submit a sample?
Since this policy is targeted at common antibiotics, which are used to treat mild infections that cause minor inconveniences, such a case would not be affected by this policy.
Antibiotic resistance is occurring at an alarming rate. Bacteria are overly exposed to antibiotics and this is accelerating the evolution of bacteria which are resistant to one or more antibiotics. If this pattern continues, soon antibiotics will be completely ineffective at treating illnesses caused by pathogenic bacteria. Although it cannot be stopped, it is hoped the emergence of antibiotic resistant bacteria will be slowed by the implementation of this policy.
Adam, Mike; Murali, Bhuvana; O Glenn, Nicole and Potter, S Steven. Epigenetic inheritance based evolution of antibiotic resistance in bacteria. BMC Evolutionary Biology. 8:52. 2008.
Alexander, T.W.; Yankye L.J.; Topp, E. et al. Effect of subtherapeutic administration of antibiotics on prevalence of antibiotic-resistant Escheriachia coli bacteria in feedlot cattle. Applied and Environmental Microbiology. 74:14. 2008. 4405-4416.
Bennett, PM. Plasmid encoded antibiotic resistance: acquisition and transfer of antibiotic resistance genes in bacteria. British Journal of Pharmacology. 153. 2008. 347-357.
Gonzales, Ralph; Corbett, Kitty K.; Leeman-Castillo, Bonnie A.; et al. The “Minimizing antibiotic resistance in Colorado” Project: Impact of patient education in improving antibiotic use in private office practices. Health Services Research. 40:1 2005. 101-116.
Sabuncu, Elifsu; David, Julie; Bernede-Bauduin, Claire; et al. Significant reduction of antibiotic use in the community after a nationwide campaign in France, 2002-2007. PLoS Medicine. 6:6. 2009.

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