Reflection on Antibiotic Use and Misuse

During my clinical rotations, I saw just how common antibiotics are in medicine, which makes my head spin thinking about how only 20% of antibiotics are used in people while the remaining 80% is used in livestock, according to the data in this chapter. I’d like to paint a picture of antibiotic use in healthcare to demonstrate how pervasive antibiotics are to classmates who are less familiar clinical care to highlight how absurd that four times as many antibiotics are used in livestock.

Antibiotics are the mostly commonly prescribed class of medications in hospitals worldwide; between 1 in 2 to 1 in 3 hospitalized patients are prescribed antibiotics. My experience at Stony Brook corroborates this statistic as I have seen antibiotics in virtually all types of patients from the preemies in the NICU to the elderly in the ICU. In many cases, these patients are on more than one antibiotic over the course of a hospital stay, which may include multiple simultaneously. Antibiotics are common in the outpatient setting too, where they are also sometimes given as prophylaxis to patients who do not already have an infection (such as prophylaxis for UTIs). I think it would be hard to find a person in our community who has never taken an antibiotic and I’m sure that many have been prescribed more than they are even aware of. From what I’ve seen, it is hard for me to wrap my head around imagining how antibiotic use in livestock is scaled up four times this.

As antibiotic resistance is a growing concern that is “responsible for more than 2 million infections and 23,000 deaths each year in the United States, at a direct cost of $20 billion,” physicians are being warned to only use antibiotics when clinically indicated. While I agree that it is important to consider decreasing antibiotic use in this way, it makes me wonder if this should be the main target. Shouldn’t there be greater concern for limiting antibiotic use in livestock when it is used commonly just to increase growth? Is blaming physicians for overuse of antibiotics justified and will curtailing use in the medical setting actually lead to less resistance if most antibiotic use occurs in animals?