Thesis:With the advent of antibiotics in 1929 Fleming said, "The time may come when penicillin can be bought by anyone in the shops.Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant."With the overuse of antibiotics today we have seen this very idea come to be.Over usage is caused most prevalently by a lack of education on the part of the patient.Thus stated, the way to overcome such a circumstance is to educate, not only the patient but also the physician.
 

I.Introduction

II.History – Present (Statistics)

a.History of Antibiotics

b.Current Over Prescription Rates

III.Causes of Overuse

a.Diagnostic Uncertainty

b.Patient Expectations

c.Lack of Education (patient)

d.Malpractice Litigation

IV.Reasons for wanting to stop overuse

a.Drug Resistant Strains Developing

b.Extensive Cost for fighting Resistant Strains

V.Solutions for Controlling Overuse

a.Education (patient)

b.Education (physician)

c.Guidelines for Prescribing

Many causes can be blamed for the overuse of antibiotics.Mostly the blame can be put on the consumer or patient and their overall lack of education.This is more than just a higher level of learning this would an education that is specific to the needs of prescribing and the overall use of antibiotics.This cause, though the most prevalent, is not the only cause.Diagnostic uncertainty, patient expectations, and malpractice litigation are other causes that ideally have played into the overuse of antibiotics.

While most blame can be put onto the patient the physician is also at fault in some cases.With the demanding scheduling in a doctor's office, the physician is usually on a time intensive table.He or she must rush in and out of patient rooms seeing many different types of symptoms.Thus with a hurried schedule physicians would rather err on the side of prescribing too much rather than too little, or even at all.^[8]In the same breath it is said that it is easier and takes less time to prescribe an antibiotic than it does to tell the patient why you are not prescribing one.The use of testing devices to gain knowledge about an illness is the only way in which the correct, if any, antibiotic is needed.Physicians tend to skip these defining tests to save time and money in the office.It is also reported that physicians tend to not perceive the amount of patient satisfaction in giving antibiotics, meaning that some patients don't really want the antibiotics.^[9]

Insurance companies could also have the blame pointed in their direction.The multiple changes and pressures that insurance companies cause doctors to undergo can be shown to increase the amount of antibiotics that are given.For instance, an insurance company would gladly pay for a prescription rather than a follow up visit.Meaning that the physician feels pressured into giving antibiotics because the authority that brings him/her patients is holding this proposition over there head.Thus, the physicians are more likely to prescribe to appease the insurance company.With the often changes of a primary provider, perhaps as often as six to twelve months, the doctor feels that the patient isn't really trusting him/her, because they are new to seeing the physician, therefore the doctor feels that he/she must do everything possible to make the patient feel comfortable and more importantly to gain the trust of the patient.Thus, the doctor is more likely to over prescribe because he/she wants to convey to the patient that he/she is competent in treating illnesses.^[9]

The main blame for the over usage of antibiotics is due the lack of education of the public.The general public doesn't have a grasp for the difference between that of a virus and a microbial infection.With this simple bit of knowledge, much of the overuse would be eliminated, because after all, antibiotics cannot treat a virus.Patient's expectations play into what the mindset of the patient is when he/she steps into the doctor's office.For instance, say a patient is experiencing symptoms similar to his or her spouse was feeling a week ago, and the spouse had been treated with an antibiotic and now is feeling better.Now the patient goes to the doctor with one item on his/her agenda, to get that same antibiotic.The doctor sees the patient and decides that it is a virus, but before the doctor has time to tell the patient this, the patient goes into the spiel and his/her spouse felt the same and that the doctor prescribed an antibiotic and they felt better.So now the doctor is in a predicament and most likely chooses to just prescribe.This of course, being a hypothetical example, is most likely played out in a doctor's office on a daily basis.After getting and taking this antibiotic the person then feels better after a week or so, because that is the normal life span of a virus.This problem is quite evident in a family setting, because both antibiotics and viruses are shared.Prior experience plays into the equation most prevalently when it is the previous experience of that patient.Patients of a lower income level are also more likely to demand antibiotics for illnesses.^[10]Patients that come from disadvantaged situations are more likely to want a quick fix, they do not want to know about why they are sick, and all that they care about is that they want to get better and back to work.

In a world that is so time and money oriented it is easy to see how patients want to get in and out of the doctors office, after all time is money.This not only goes for the work force, but also for the children.Educators and daycare personnel most often require that student or toddler must have had antibiotics to be able to continue to be at school or the daycare.^[9]Therefore if the physician does not prescribe an antibiotic than a parent will have to stay at home with the child until he/she is better.This causes problems for the parents because of working schedules and cash flow.With the direction that the world is going these days this problem will only increase.Larger corporations usually means less family oriented and therefore fewer sick leaves are allowed, especially in the case of children.

In the past the over prescribing of antibiotics for upper respiratory illnesses (URI) has created a supply and demand system.^[11]Early in the history of antibiotics some properties of the antibiotics and the microbes that they were being used on were still being discovered.Since that time many new discoveries and breakthroughs have been made and now we know much more than when antibiotics were first discovered, or invented.Only history and the lack of knowledge can be blamed for this, however the reoccurrence of this now is due to lack of education.

The need for the reduction or stoppage of antibiotic overuse is made apparent by the recent increase of antibiotic resistant strains of bacteria and the cost of fighting these "super bugs".This has also become an issue in the recent past with the advent of the bio-terrorism using anthrax in postal mailings.In four recent newspaper articles and one online news headline experts are warning that with the used of Cipro to treat anthrax we are causing a much larger problem in risking the loss of a crucial class of antibiotics.^{[12],[13],[14],[15],[16]} Even with the continuous advent of new and more powerful drugs by breakthrough medical technologies the bacteria are still finding ways to become resistant.In a September 7 news report on CNN.com Stenger concluded that "the United States must spend between $30 billion and $50 billion a year"^[17] to fight these super bugs.With figures of that magnitude, it is hard not to see that there is a problem.Where would money like that come from, certainly not from selling the antiquated antibiotics.

With a grandiose problem ahead of mankind one would expect a grandiose solution to remedy the problem.However a much simpler and down to earth ideal is one that should prevail.Education is perhaps the strongest tool to influence a group of people, for bad or good.Giving knowledge in an easy and foolproof way of interpretation and is among the simplest way of showing someone the right way in which to carry out a task.So why not then use the simple tool of education to enlighten others as to solution of the problem at hand.

Educating the general public is an idea that the Center for Disease Control and Prevention (CDC) has set out to do.In July of 2000, the CDC added seven states, to make a total of twelve, "to the campaign to reduce the number of unnecessary antibiotic prescriptions."The CDC's campaign is one in which billboards, TV and radio spots, bus stops, and newspapers will be used as the vector to reach the general public.The messages will most likely be ones of simple nature, so that the general public, for example ones that have no biological background, will be able to read and comprehend.^[2]This is a first step in the education process.By putting this information out into the hands of the public it will create it's own sense of awareness.Colorado is one such state in which the CDC is starting their campaign.Coloradoans are very keen on the idea; one mother says, "They [doctors] push antibiotics way too much."^[18]Colorado will be allotted two million dollars of federal funds for this ad campaign.This form of education is a general one, one in which the public will be able to gain a general knowledge of the subject.This is advantageous to get the ball rolling, so to speak.With this groundwork laid, many patients own curiosity will get the better of them and then the physicians will be primed to supplement the learning process.

Giving patients information through education during the visit is a crucial way of education.This is the time in which the patients can put their newfound knowledge to work.The knowledge is applicable and relevant at the time, which aids in the learning process.If educational material is introduced at this time in the patient-physician relationship it is more likely to be viewed as authoritative, reports say.^[8]Verbal instruction is not necessarily the easiest way for everyone to learn therefore pamphlets and patient education sheets should be prepared and given out at that time as well, so that the patient will be given the opportunity to learn more about their situation.The doctor would most likely make pamphlets and patient education sheets or an organization well versed in the subject.These supplemental education tools could be written with greater detail because the patient for one will be with the doctor when he or she receives the sheet and also the groundwork of CDC's ad campaign mentioned above will have been laid.Having this form of education tailored to each patient would be an ideal but highly improbable way of going about it; however having narrower spectrum educational sheets would be sufficient.Possibly with these information sheets some long-term and short-term affects of reducing antibiotic overuse should be stated.Some long-term affects being mainly the decrease in the numbers of antibiotic resistant bacterial strains.Short-term effects include changing the amount of office visits and the type of therapy used, ei. diet, herbs, lifestyle changes, etc.^[8]

Education at the level of elementary children would also be merited.Talking with children at young ages, though not in a ground-shaking manner, could introduce the idea and difference between viruses and bacterial infections.This along with handing out information at places such as community organizations, childcare centers, and pharmacies would be beneficial.Again the whole idea behind this education is to repeat and reinforce, therefore the more that the public sees and is made aware of the problem of antibiotic overuse the more likely it is to stick with them.

The physician must also gain education.Possibly what the patient needs and/or wants is not always to have pills to take care of their problem.Physicians should be enlightened as to the newer and more foolproof testing methods to insure the amount and correct antibiotic is administered.More time should be taken with a patient, as alluded to before.By taking the time in the office to explain and educate the patient as to the illness that they are facing, and clearly laying out treatment options is more advantageous to the patient and to the well being of the antibiotics.

Along with education national guidelines for judicious antibiotic use would need to be drawn up and then more importantly followed.Having these guidelines set on a national level could cause predicaments and physicians would be less likely to use those guidelines.^[19]Most commonly these guidelines are not followed because of there is a lack of clinical applicability seen by the practicing physician.A solution is to set very general guidelines at the national level and then allow for a more local refinement of these general guidelines, therefore the physicians would be more likely to follow guidelines that they had set out.^[20]Overall the bureaucracy of these guidelines should not be so tight as to limit the decision making process of the physician.

Upon the advent of antibiotics Alexander Fleming warned that these antibiotics, if misused could lead to grave problems, this warning was not heeded and now the warning has come to pass.With more and more bacterial strains gaining antibiotic resistance something must be done.In a society based around time and money it puts undesirable strains on doctors and physicians to be rushed into prescribing medicine.This in turn causes a gross over usage of antibiotics.Constant overuse of antibiotics has been shown to lead to antibiotic resistant strains of bacterial.Lack of education is the leading causation in this problem.Therefore, by educating the public as to reasoning behind prescribing is the way to reduce the overuse of antibiotics.