A new study by researchers at Intermountain Health and Stanford University found that overprescribing and inappropriate prescribing of antibiotics is not only leading to antibiotic resistance, but also causing significant patient harm.

Dr. Harris Carmichael, lead investigator of the study and a hospitalist at Intermountain Health, said the study, published in the Journal of Internal Medicine, followed 51 million patients over a 15-year period, focusing on upper respiratory infections for which antibiotics were known to be overprescribed 50% of the time. Some of the most potent and dangerous antibiotics used were rarely needed, according to the study, leading to 1 in 300 patients experiencing side effects serious enough to require hospitalization or follow up visits with their physician.

“Having these kinds of side effects for one in a few hundred, or even a thousand patients might not seem like a lot, but when you look at this problem on a population health level, we’re talking about hundreds and thousands of adverse events severe enough that these patient needed additional care from a doctor,” Carmichael said.

One of the most serious side effects, he said, is clostridium difficile, or C. diff, which causes serious diarrhea and inflammation in the colon and can be life threatening.

“These findings underscore that inappropriately giving patients antibiotics is causing real and widespread harm,” Carmichael said. “With millions of visits for upper respiratory infections in the United States each year, the extent of these severe adverse events is significant.”

Researchers found that the antibiotic Cefdinir was the fourth-most prescribed antibiotic for these patients, despite it rarely being recommended by prescription guidelines as an appropriate treatment for simple upper respiratory infections.

Cefdinir also had the second-highest chance of leading to serious side effects. That means patients are being prescribed a medication that is either not needed at all or unlikely to be the most appropriate medication for their condition and is routinely causing harm, Carmichael said.

Antibiotics are also increasingly causing resistant infections.

Tariq Mosleh, an antimicrobial stewardship pharmacist at the Department of Health and Human Services, said it used to take 20 to 30 years for an antibiotic to build up resistance. He said a friend of his who is a pharmacist was recently excited about a new antibiotic only to discover it only took two years for it to build up resistance.

“It’s happening at a much faster rate now, and it’s not just bacterial infections. It’s fungal infections as well,” he said. “People go to the doctor and push for these antibiotics for a common cold or an ear or sinus infection when it’s not needed and it’s causing all kinds of problems.”

Mosleh said not only are people taking antibiotics when they aren’t needed, they are also taking needed antibiotics and not finishing them, which is another reason they are becoming resistant to bacterial and fungal infections.

“They will take the medicine and start to feel better, so they’ll just stop taking it, but what they don’t realize is the medicine likely killed 80% to 90% of the infection, but there’s still some there,” he said. “So that remaining infection has a chance to get stronger and get around the antibiotic. When a person gets an infection that’s resistant to antibiotics, there’s not a lot of choices left and sometimes they end up on IV antibiotics in the hospital.”

The Centers for Disease Control and Prevention estimates more than 2.8 million people suffer from antibiotic resistant infections every year. More than 35,000 die as a result, 12,800 of those from C diff.

“There are a lot of different infections that are drug resistant,” Mosleh said. “MRSA is one of those and it can spread quickly. Antibiotics are great medications, but we’re losing the battle with bacteria. Bacteria are intelligent.”

Mosleh said he is trying to create awareness of antibiotic overuse and misuse, not only with the general public, but in nursing homes and long-term facilities as well.

The message here, said Mosleh and Carmichael, is for patients to stop demanding antibiotics when they’re not needed and to finish antibiotics when they are needed. In addition, they said it’s important not to share these powerful medications with friends or family.

“Patients don’t get upset when they don’t get antibiotics, as long as we take the time to explain their condition and that we’re treating them in the way that is best for them,” Carmichael said. “Our first role is to do no harm.”

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