Antibiotic overuse making common urinary tract infections harder to treat

By Deborah Kotz, Globe Staff

As public health officials roll out their annual awareness campaign about antibiotic overuse -- including this quiz to test your smarts on when the drugs should be prescribed -- they’re publicizing some scary news along with a little optimism.

First, the bit of good news: The rate of antibiotic prescriptions has dropped by about 17 percent nationwide in recent years. In 2010, doctors wrote antibiotic prescriptions for 80 out of every 100 Americans compared with 96 out of 100 a decade earlier.

(Massachusetts falls right near the national average, whereas Vermont, New Hampshire, and Maine all have rates that are significantly lower, according to a new state data map released on Tuesday by the nonprofit Center for Disease Dynamics, Economics & Policy.)

Clearly, patients and doctors are beginning to get the message that antibiotic use needs to be curtailed and that the medications shouldn’t be prescribed in the absence of a confirmed bacterial infection -- just to be on the safe side -- to treat a sore throat, sinusitis, or a mild ear infection.

Unfortunately, we’re still not doing enough to ensure that we’ve got a strong arsenal of drugs to fight life-threatening infections in the future. For instance, the livestock that we eat still get fed antibiotics, and experts believe this has contributed to a rise in drug-resistant bacteria. And doctors in certain areas of the country can still write far fewer prescriptions: Some Southern states have double the prescribing rates of states with the lowest rates such as California and Oregon.

“There are patients in hospitals that we cannot treat with any antibiotics that we have available to us. These cases are rare, but they exist,” Dr. Arjun Srinivasan, an infection prevention specialist at the federal Centers for Disease Control and Prevention said in a press briefing. “We are now in a post-antibiotic era.”

While Congress considers passing legislation to provide more incentives for drug companies to develop new antibiotics, a coalition of experts that includes infectious disease specialists, pediatricians, and veterinarians contend that at the moment, the arsenal is lacking.

“We all agree that new drug development hasn’t kept up with resistance development,” said Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics, & Policy, who also participated in the press briefing.

As a result, patients who develop some of the most common infections sometimes need to be admitted to the hospital and treated with intravenous antibiotics because they have bacterial strains that are resistant to antibiotics in pill form.

Urinary tract infections -- the second most common type of infection, which half of women will have at some point during their lifetime -- are becoming less treatable with antibiotic pills including cephalosporins, and the percentage of antibiotic resistant infections has risen by over 30 percent from 1999 to 2010.

“On a weekly basis, we see a few women admitted to the hospital from our emergency room with a drug-resistant urinary tract infection, where in the past we would have been able to give them oral antibiotics and sent them home,” said Dr. Sara Cosgrove, an internist and epidemiologist at Johns Hopkins Hospital in Baltimore.