There is no doubt that over the past 80 years, antibiotics have saved millions of lives—a true ‘miracle’ of modern medicine.

But when an individual patient is given an unnecessary or incorrect antibiotic, he or she may suffer a side effect of that agent, such as an allergic reaction, or a secondary complication such as a potentially life-threatening intestinal infection with C. difficile.

Wider implications

Communally, of course, we all suffer when antibiotic over-use leads to the development of ‘resistant’ organisms, less responsive to standard treatments. The Centers for Disease Control (CDC) has estimated that 2 million illnesses, and over 20,000 deaths, occur in the U.S. annually due to resistant bacteria. Recognizing this, President Obama issued an Executive Order in September 2014, culminating in the release in March 2015 of the “National Action Plan for Combating Antibiotic-Resistant Bacteria.”

In response, the CDC has committed over $250M in FY2016 to its “Antibiotic Resistance Solutions Initiative.” They explicitly state that antibiotic stewardship, defined as using antibiotics only when needed, and using the right agent, the right way, is “perhaps the single most important action needed” in this effort.

Locating threats

H pylori is a bacterial infection of the human stomach that causes gastritis, abdominal pain, gastric ulcers and in some patients, stomach cancer. It is a common infection worldwide, and infects perhaps 30 percent of the U.S. population. When identified as causing a problem, we prescribe antibiotics, implying extensive testing and treating of this large population.

Unfortunately, however, there’s fairly good evidence that we’re not practicing very good antibiotic stewardship with respect to this infection, with data reporting that many U.S. clinicians are treating without confirming the infection with an appropriate test (an example of unnecessary antibiotics), or treating with the wrong drugs (incorrect antibiotics).

"Two million illnesses, and over 20,000 deaths, occur in the U.S. annually due to resistant bacteria."

This clearly has an economic cost (wasting valuable health care dollars) but also contributes to resistance of this bacteria, which has been climbing consistently over the past decades, with now nearly 50 percent of strains showing some form of resistance. While a routine course of antibiotics used to cure nearly 90 percent of infections, we’re now closer to 70 percent (and falling).

As discussed in a general sense above, antibiotic stewardship is important here too. Using the wrong test, or the wrong drug regimen, is harmful to patients, increases costs and fosters resistance. Health care providers clearly need to stay on top of best-practice strategies for testing and treating this problematic infection.