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Behaviors
Associated with the Misuse of Antibiotics Samantha
Magnus Resubmitted
to Dale Sullivan, October 3, 2010 Abstract The
inappropriate use of antibiotics is an important issue around the world. Not
only can the use of antibiotics for viral infections or over use of antibiotics
promote antibiotic resistance but it can also increase the likelihood of
preventable drug-related adverse events. Inappropriate use of antibiotics can
be linked to two main sources; the prescriber (the physician) and the user (the
patient). The proposed literature review examines a handful of articles
discussing the behaviors associated with the prescription of antibiotics
amongst physicians and the behaviors associated with the patients seeking
antibiotics. A short description of background information on misuse of
antibiotics is included to incorporate already identified information. The
methods, parameters, and time frame for this project are outlined within the
following paragraphs. Introduction The
misuse of antibiotics is not just limited to the United State, it occurs around
the world and at an alarmingly frequent rate. Sometimes misuse is due to the
physician, who prescribes antibiotic when they are not needed or prescribes
them incorrectly and sometimes the misuse is due to the patient who does not
take the antibiotics as prescribed, or takes them when they are not needed. As
an attempt to help the general population understand the affects of the misuse
of antibiotics and to understand why antibiotics are misused, I am proposing to
write a literature review for our English 324 class in response to our class
assignment. The literature review will discuss the behaviors associated with
misuse of antibiotics amongst physicians as well as patients and will also
address the effects of this misuse along with adjust behavior to avoid misuse
of antibiotics. This proposal will be comprised of four distinct sections;
background information, a brief project description, methods, and a schedule. Background In
1928, Alexander Fleming is credited with finding our first true antibiotic:
penicillin. Named after the mold from which it comes from, Penicillium, penicillin proved to kill one of the deadly and common
bacterium of the time, Staphylococcus
aureus. Although Fleming discovered penicillin in 1928, it was not used as
a therapeutic agent to treat infections in humans until the 1940Õs. In the
1930Õs Howard Florey and Ernst Chain collaborated, and together they were able
to extract enough penicillin and keep it stable to test on animals and humans,
a problem which would impede Fleming from making any further advances . They
found that even small doses of penicillin could turn the fate of a patient on
their ÔdeathbedÕ around and cure them. At first penicillin was scarce and only
available to treat a small number of patients, mostly military with a few
civilians. However in 1944, penicillin became available to the general public.
This is when misconceptions about antibiotics began to occur. Even with our
vast knowledge about antibiotics now, we can still find passages from the
1940Õs which state penicillin was a cure all and had cured cancer and viral
infections; something which we now know penicillin cannot do. The first
instance we see antibiotic resistance become a problem is with Streptomycin
which was made in 1943. Streptomycin proved effective to fight off infections
such as urinary track infections and meningitis; however it also proved to
fight off tuberculosis. The problem with streptomycin is that during therapy
become resistant to the killing effect of streptomycin at a frequency which
actually compromises the therapy. Because of this scientists quickly focused
their energies on creating a replacement antibiotic for streptomycin, and the
created neomycin which was not as prone to creating antibiotic resistant
bacteria (Levy 2001). Since then we have created multiple other antibiotics
which have proven to help fight off numerous bacteria and saved numerous lives. The
problem created when antibiotics became easily accessible to the public, for
example when penicillin entered the market in the 1940Õs, was the image created
by the public of antibiotics. The public treated antibiotics as if they were
miracle, cure-all drugs. Because of the ideas the public held of these drugs,
the public formed their own idea of how to use these drugs which created the
trend of misuse of antibiotics. The more educated the public is about
antibiotics the easier it is to stop behavior which can lead to the misuse of
antibiotics; however this is not always true. Physicians also play a hand in
the misuse of antibiotics. Often time physicians prescribe antibiotics when
they are not needed or in a dosage that is too much or too little. This
contributes to the misuse of antibiotics and can have extremely harmful effects
such as the creation of an antibiotic resistant bacterium. The four leading
hypotheses as to why physicians contribute to the misuse of antibiotics is:
there is a lack of physician knowledge, time in practice is responsible for the
differences in prescribing, the physician training environment is responsible
for the difference, and inappropriate prescribing is the result of avoidance of
patient education (Cadieux, Tamblyn, Dauphinee, and Libman 2007). However
misuse of antibiotics is not always due to the physicians. There are many
occasions where the patients misuse the antibiotics given to them by not
following the prescription directions or by taking old prescriptions without
proper advisement by a medical practitioner. Sometimes patients even go into
their physicians requesting an antibiotic when they donÕt know why they are
sick or for that matter even need an antibiotic. There are a handful of reasons
as to why both the physician and the patient contribute to antibiotic misuse
and many have to do with the perceptions of antibiotics, perceptions which have
not entirely changed since the first true antibiotic, penicillin, came onto the
market. Project The
purpose of this project is to gain a more thorough understanding of how the
misuse of antibiotics has occurred. To achieve this, this project will review a
handful of articles outlining the misuse of antibiotic amongst physicians and
patients. First, this project will review four hypotheses on why physicians
inappropriately describe antibiotics amongst their patients. Then, this project
will review the behaviors of patients seeking antibiotics. As a psychology
major, I plan to focus on the reason why each group of individuals has learned
the set of behaviors they display when it comes to antibiotics. Also as a
college student I plan to focus more on college students as patients and how
this affects misuse of antibiotics. The target audience of this project will be
the general public, more specifically college aged individuals(young adults) as
this is the best time to implement an intervention strategy to prevent misuse
of antibiotics (Haltiwanger, Hayden, Weber, Evens, and Possner 2001). By the
end of this literature review I hope to have provided a well-rounded view of
the inappropriate use of antibiotics by both physicians and patients and to provide
enough information to help cease behaviors which lead to the misuse of
antibiotics. Method The
methods which will be used to create this specific literature review will not
be difficult but will be time consuming. First I plan to use our library to its
fullest extent and accumulate the proper references for this particular
literature review. Currently IÕm planning on focusing more on psychology
references for the behaviors associated with antibiotic misuse because as a
psychology major I am more interested in the psychological aspect of this
specific problem. However whilst IÕm looking for references I plan broaden my
search to the medical side too because there are many studies and theories as
to why the placebo effect works both in the medical field and psychology. All
of the references I will choose will focus more on the behaviors which lead to
the misuse of antibiotics along with the outcome of these behaviors and how to
prevent these behaviors. After I
have found all of my references I will begin to incorporate the necessary
information from each reference to form my literature review. Having multiple
references will allow me to have a more well-versed literature review and will
also give the future readers more accurate information. Although our library
and NDSU is great source for obtaining materials, there is the possibility that
I do not have access to all of the most current information pertaining to my
topic and therefore I will try to compensate for this by using other sources
such as professors, this is one limitation that I can see occurring with this literature
review. Schedule The
project will begin September 27th 2010 and will conclude on December
3rd 2010. The first week of the project will be spent searching for
references to be used within the popular science article. The following weeks
will consist of combing through the references and focusing on pertinent
information which can be used for the article. By October 29th, 2010
all references will be finalized along with the information which will be used
from each reference. Also on the 29th the annotated bibliography
will be finished for the project. After the first few weeks of the project, the
information that is pulled from the articles will begin to be arranged into a
rough draft of the popular science article. The first draft of the article will
be finished by November 24th, 2010. Finally the project will
conclude on the 3rd of December, 2010 when the final version of the
article will be submitted. Conclusion The
misuse of antibiotics has lead to some major problems within the recent years,
specifically the increasing prevalent aggravation of antibiotic resistant
bacteria. The behaviors of both physicians and patients have seriously
contributed to this growing problem, which is why it is extremely important
that the public be properly informed about the consequences of these behaviors.
The problem in fixing these behaviors is finding how the behaviors originate in
both physicians and in patients. This proposed project, a literature review,
will allow for the general public to become more knowledgeable about antibiotic
misuse and could help assist individuals in changing their behaviors to help
prevent the misuse of antibiotics. Cadieux, G., Tamblyn, R.,
Dauphinee, D., & Libman, M. (2007). Predictors of inappropriate antibiotic
prescribing among primary care physicians. Canadian Medical Association Journal,
177(8), 877-883. doi:10.1503/cmaj.070151. Haltiwanger, K., Hayden,
G., Weber, T., Evans, B., & Possner, A. (2001). Antibiotic-seeking behavior
in college students: What do they really expect?. Journal of American College Health,
50(1), 9-13. doi:10.1080/07448480109595705. Levy, S. B. (2001). The
Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative
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