Partners in fighting antibiotic resistance

Published October 19, 2017

Nearly 30 percent of all antibiotics prescribed in doctors’ offices and in hospitals may be unnecessary, according to a recent report from the Centers for Disease Control and Prevention (CDC). And here’s why this matters to all of us: overprescribing of antibiotics can contribute to antibiotic resistance. How? Antibiotics kill lots of germs, but a few survive. The survivors pass that ability to resist a particular antibiotic on to other bacteria – and, potentially, on to other people you encounter. The CDC considers antibiotic resistance a serious threat to public health. Several kinds of bacterial illnesses, like gonorrhea and Clostridium difficile (C. difficile), are already known to be resistant to all but a few last-resort antibiotics.

The good news is that lots of groups – including patients– are playing a part in fighting antibiotic resistance. Their goal isn’t to take antibiotics away from people who need them, but to be better stewards of the life-saving power of these drugs. Insurers, doctors and the CDC are helping to raise awareness about antibiotic resistance. And it might be working. According to a recent Blue Cross Blue Shield Association Health of America report, antibiotic prescribing has decreased among certain groups. That’s a sign of progress. But there’s more work to do.

Antibiotic prescription rates are declining

Key findings from an August 2017 report from the Blue Cross Blue Shield Association include:

  • The fill rate of outpatient antibiotic prescriptions declined 9 percent among commercially insured Americans from 2010 to 2016.
  • Broad-spectrum antibiotic fill rates dropped the most at 13 percent. Broad-spectrum antibiotics are the type most likely to facilitate the creation of antibiotic-resistant bacteria.
  • The drop in antibiotic fill rates was significantly greater in children (16 percent) when compared to adults (6 percent), with infants experiencing the steepest decline (22 percent).

Insurers help boost awareness, use data to fight overuse

Excellus BlueCross BlueShield in New York has taken an active role in promoting antibiotic stewardship. The insurer recently launched a public awareness campaign about how to use antibiotics wisely. But Excellus Corporate Medical Director Martin Lustick, M.D., says doctors have to be included in the awareness-raising effort. He says physicians can sometimes feel pressured to prescribe an antibiotic, even when one isn’t necessary.

Imagine, says Lustick, that you have a child with an ear infection. “And you don’t know whether it’s a viral infection or bacterial infection. You can watch it for a few days to see if they get better without antibiotics,” says Lustick.

Or you could start the child on antibiotics just in case bacteria are causing the infection, and the child will get better sooner. The child feels better and the parent avoids a second doctor’s visit. But if the infection is viral, using that antibiotic could contribute to creating more resistance to that drug.

Lustick says the CDC has issued clear guidelines on when to prescribe antibiotics. When doctors prescribe outside those guidelines, insurers can track that activity and work with a doctor to address any issues. “We can see real-time pharmacy claims and can communicate with doctors about overuse,” says Lustick. Unfortunately, he says, “We know from our data that there’s a lot of inappropriate use.”

Gregory Daniel, Ph.D, is deputy director of the Duke-Robert J. Margolis, MD, Center for Health Policy and a clinical professor at Duke’s Fuqua School of Business. He’s studied the impact insurers can have on preserving the effectiveness of antibiotics.

Daniel agrees that insurers can dive into their data to find trends in antibiotic use. “We need more evidence and data out there,” about how antibiotics are used, says Daniel. Insurers can match prescriptions with laboratory results, to make sure antibiotics are prescribed for the right illnesses. They can also help assess whether there are geographic pockets of higher resistance.

Most importantly, Daniel says insurers can help educate their members about the concept of antibiotic resistance and how to be good stewards of antibacterial drugs.

More resistance on the horizon

Lustick says several types of infections are becoming increasingly antibiotic-resistant. And some of those infections can be deadly.

Lustick worries in particular about MRSA, or Methicillan-resistant Staphylococcus aureas. It’s an infection that begins on your skin and can make its way into the bloodstream. Methicillan is a form of penicillin designed to treat that bacteria. “But now,” says Lustick,” staph organisms are not responding to methicillan or even to new antibiotics.”

But Daniel says there’s a problem when it comes to new antibiotics. There aren’t enough in the pipeline. “It takes 10 years to get a drug to market,” he says. “It costs almost $2 billion dollars.” Included in those are the costs of researching, developing and marketing that drug – and drug companies are nervous about recouping their investment. What’s more, new antibacterial drugs are only allowed to be used for our most severe infections, limiting the volume drug makers can sell.

So Daniel and colleagues have proposed some novel economic incentives to entice pharmaceutical companies back into the antibiotic development game.

How you can join the fight against antibiotic resistance

As a patient, you can fight antibiotic resistance in a few ways.

  • Take a look at this helpful guide from Excellus.
  • Start a conversation with your doctor about whether an antibiotic is right for you.
  • Make sure you get the recommended vaccinations and a flu shot.
  • And curb the spread of disease by washing your hands well and staying home when you’re sick.