While it's hard to believe, hospitals have become one of the riskiest places for picking up a deadly infection. Now a new study suggests an equally surprising solution: Doctors should stop giving hospital patients so many antibiotics.
Research published in The Lancet, a British medical journal, shows that when doctors in U.K. hospitals cut back on prescribing Cipro, Levaquin, and other so-called fluoroquinolone antibiotics, the rate of deadly infections from the bacteria known as C. diff dropped a whopping 80 percent.
The overuse of antibiotics—particularly "broad-spectrum" drugs like Cipro—increases the risk of hospital infections because they kill a wide variety of bacteria, including those that actually prevent infections, explains Arjun Srinivasan, M.D., who oversees the Centers for Disease Control and Prevention's (CDC) efforts to prevent hospital-acquired infections.
"We depend on these drugs to treat serious illnesses, but they can cause potentially life-threatening side effects such as C. diff infections," he says. "This study is an important reminder that we have to be smart about how we use these vital drugs."
How Antibiotics Cause Infections
C. diff bacterial infections—which attack the intestines—sicken almost half a million Americans each year and contribute to the deaths of another 29,000, according to the CDC.
Researchers estimate that about two-thirds of those who get sick from C. diff are exposed to it in the hospital or another healthcare facility.
According to Srinivasan, doctors frequently start patients on a broad-spectrum drug while waiting for test results to find out exactly what type of bacteria is making them sick. The idea is that they can then switch to a more targeted antibiotic once test results reveal what type of infection a patient has.
The trouble with prescribing Cipro, Levaquin, and similar drugs is that while essential for treating some serious infections, they may also kill protective bacteria that aggressively defend you against disease-causing invaders such as C. diff. So people treated with Cipro or similar antibiotics are more vulnerable to C. diff infections.
C. diff spreads easily in hospitals, says Srinivasan, where sick and vulnerable people are in close quarters—and are often cared for by the same healthcare workers using some of the same equipment.
More narrowly targeted drugs such as amoxicillin kill fewer "good" bacteria and so are less likely to lead to C. diff infections.
In an effort to reduce C. diff and other hospital infections, the U.K. instituted strict guidelines for hospitals regarding antibiotic use a decade ago, according to the Lancet study. Part of those guidelines called for doctors to cut back on prescribing broad-spectrum drugs such as fluoroquinolones, using them only when a more narrowly targeted antibiotic doesn't work.
Choose an 'Antibiotic-Smart Hospital'
Despite the growing awareness of the risks, broad-spectrum drugs continue to be prescribed in many U.S. hospitals when they are not necessary, says Srinivasan.
However, Consumer Reports' hospital ratings show that some U.S. healthcare facilities do a much better job than others at protecting people against C. diff and other hospital infections.
Says Srinivasan, "One thing that good hospitals do is keep close tabs on antibiotic prescribing, checking to make sure that patients get the right drug for their infection, in the right dose, and as quickly as possible."
While programs monitoring antibiotic use in hospitals are mandatory in Britain, the U.S. is playing catchup. The Joint Commission, an independent nonprofit organization that accredits healthcare facilities, just started requiring hospitals to report on their programs in January.
"That's a start, but information about whether hospitals comply with Joint Commission standards is not public," says Lisa McGiffert, director of Consumer Reports' Safe Patient Project. "What we really need are national policies requiring hospitals not only to have stewardship programs, but also to inform the public about how well their doctors are following established guidelines for appropriate antibiotic use."
Ask About Antibiotics in the Hospital
Consumer Reports' medical director Orly Avitzur recommends that, whether you're a hospital patient or at your doctor's office, you ask which antibiotic is being prescribed and why.
Questioning your doctor might feel "awkward," says Avitzur. "But it's an opportunity to discuss your care," she says. "It also serves as a reminder to doctors that patients are concerned about antibiotic use and encourages more thoughtful prescribing."
Here are four questions to ask:
- What is this drug for? If your doctor suspects a bacterial infection, ask whether you can be tested for it; results can confirm the infection and determine the type of bug, which can dictate the type of antibiotic that works best.
- What type is it? If a narrower-spectrum drug such as penicillin will work against your infection, that's usually a better choice than a broad-spectrum drug.
- How long should I take it? Ask your doctor to prescribe the drug for the shortest time possible. (But be sure you take it for that full duration.) Ask for the type and dose to be re-evaluated when test results are in. One common mistake that doctors make, says Avitzur, is not switching from a broad-spectrum drug to a more narrowly targeted antibiotic once the bug causing the infection has been identified.
- What about side effects? Most antibiotics are well tolerated; but in addition to C. diff, antibiotics can trigger allergic reactions and other serious side effects. For example, while fluoroquinolones are essential for treating some serious infections, they can, though rarely, cause disabling and potentially permanent side effects that affect the tendons, muscles, joints, nerves, and central nervous system.
Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
