This very study has revealed the non-benign nature of antibiotics and the often overlooked culture of overprescribing antibiotics in the healthcare setting.
"Too often, clinicians prescribe antibiotics even if they have a low suspicion for a bacterial infection, thinking that even if antibiotics may not be necessary, they are probably not harmful," says Pranita Tamma, assistant professor of paediatrics at The Johns Hopkins Hospital.
"But that is not always the case. Antibiotics have the potential to cause real harm to patients. Each time we think to prescribe an antibiotic, we need to pause and ask ourselves, Does this patient really need an antibiotic?" she adds.
As antibiotic resistance starts to grow and the number of viable choices dwindling, it is a question we need to start asking ourselves once more.
Antibiotics cause side effects in a substantial number of patients
Antibiotics are able to elicit an adverse reaction in up to 20% of the patients who take them and this is not just limited to the data obtained from The John Hopkins Hospital. For all patients who suffered from antibiotics side effects, the onset of the effects all came within the first month of treatment with the side effects becoming gradually worst the longer the treatment continued.
The most common side effects experienced affected the digestive system (42%), kidney (24%) and blood (15%). On the more serious side of the spectrum, 4% suffered from Clostridium difficile infection and 6% developed multi-drug resistant infections.
As a result of these side effects, all the patients required a suite of management ranging from prolonged hospital admissions and additional investigations to repeat hospital visits. Making matters worse, in 20% of the patients treated for the side effects, antibiotics were not even deemed necessary in the first place.
Adverse side effects can be life changing for some patients
While there were no deaths associated with antibiotic side effects reported, these adverse reactions can often have life-changing effects. As seen in Philadelphia resident, Michael Schumacher, a 33-year-old gentleman who now suffers from muscle atrophy as a result of Fluoroquinolone toxicity.
The condition has caused damage to his tendons and his muscles to waste as he is no longer able to sit or stand for more than a few minutes at a time. After having been prescribed antibiotics for a pain in his groin, Mr. Schumacher’s did not resolve but, instead worsened and even spread to his legs.
“I Googled the medication and uncovered a lot of horrific information about this drug and how it can damage tendons. I immediately stopped taking the medication,” Schumacher said.
But by then, the damage had been done and Mr. Schumacher was powerless in taking any legal action against the drug companies, as the side effects were included as part of the warning label for the antibiotic.
Despite having such devastating side effects, the drug’s manufacturer, Bayer, continues to stand by the antibiotics with a spokeswoman reaffirming that they “are well-tolerated and effective in all approved indications when used in accordance with current product labeling. Both medicines have a favorable benefit-risk profile in all approved indications.”
Doctors continue to overprescribe antibiotics
Despite all their side effects and the recommendation of clinical guidelines against such practice, clinicians continue to overprescribe antibiotics. In a study carried out on Australian hospitals, it was discovered that approximately 40% of patients receive antibiotics but only half of the receiving population actually required the treatment.
This judicious prescription of antibiotics can be chalked up to various reasons but, they all find their roots in the hospital culture. Doctors often prioritise the short-term goal of treating the problem in front of them rather than considering the long-term side effects.
Meanwhile, junior staff often prescribe antibiotics as a clear safety measure especially in the night shift where they would rather not risk waking a senior doctor and asking for help.
Nevertheless, doctors may not be all there is to blame as patients too can play a defining factor in the prescription of antibiotics. A study from the United Kingdom found that doctors were more likely to prescribe antibiotics at the request of patients or as a means of reassurance.
According to lead researcher, Miroslav Sirota, “Rather, we want to point out that the overprescribing of antibiotics is a serious systemic issue: we should all work together — from patients having more realistic expectations about antibiotic effectiveness to physicians managing patients’ expectations when contradicting clinical guidelines — to tackle its multiple facets.”
Antibiotics associated with long-term behavioural changes
Over-prescription of antibiotics due to misinterpretations between doctors and patients
The emergence of superbugs