Lauri Hicks, DO: Stories of Antibiotic Use and Resistance

During my training in infectious diseases, I encountered several situations where patients did poorly because they were infected with antibiotic-resistant bacteria. I also realized that in many situations there were opportunities to improve antibiotic prescribing that could benefit patients and improve their outcomes. When I rejoined CDC in 2007, I advocated for expansion of our activities to improve how antibiotics are used.

There isn’t a day that goes by that I don’t think about the problem of antibiotic resistance and what I can do to improve how we use antibiotics. I recognize that improving antibiotics is one piece of the puzzle to address antibiotic resistance, in addition to infection prevention, vaccines, and new drug and diagnostic test development.

I lead CDC’s Office of Antibiotic Stewardship. Our office works across the spectrum of human health care (doctor’s offices, hospitals, nursing homes, etc.) to improve how antibiotics are used. We measure antibiotic use so that we know where we need to target our efforts. Additionally, we work with partners to implement programs and practices and educate the general public and healthcare providers.

The biggest challenge with improving antibiotic use is that it involves changing behavior, and changing behavior is notoriously difficult. For example, nearly 80% of visits for uncomplicated bronchitis, a condition that doesn’t warrant antibiotic use, lead to an antibiotic prescription. For many years, patients have received antibiotics for bronchitis, so understandably many patients expect antibiotics when they have a routine case of bronchitis. Doctors report that patient satisfaction influences their decision to prescribe. There is also a widespread perception that antibiotics are harmless drugs, but taking antibiotics when they are not needed can be dangerous and lead to unintended consequences, such as the sometimes deadly Clostridium difficile diarrhea.

I especially worry about whether my son will have antibiotic options for treatment of infections in the future. I worry about my aging parents and their increasing need for health care and whether they will be exposed to antibiotic-resistant bacteria. I worry about whether existing or new “nightmare bacteria” (antibiotic-resistant bacteria that are resistant to virtually all available antibiotics) will escape our infection prevention efforts and become more widespread in hospitals and the community.

There is so much to learn, and we still need to better understand the impact of improving antibiotic use on antibiotic resistance. While we know a large proportion of antibiotic use is unnecessary or inappropriate, how much do we need to reduce antibiotic use to see meaningful changes in antibiotic-resistant infections?