“This is one of the biggest threats to everyone on earth,” says the attractive doctor with the English accent, “and the problem’s only going to get worse.” Despite the gravity of the subject, his voice is steady and soothing as he goes on to tell us that there’s something we can do about it: Become “Antibiotic Guardians.”
Antibiotic guardianship is a concept that Public Health England, a governmental agency, has come up with to try to convince regular Britons to stop misusing antibiotics. Visitors to the campaign website are asked to pledge not to demand antibiotics from their doctor when they have cold symptoms and—when they do have a prescription—to take antibiotics according to directions. (Don’t stop taking them just because you begin to feel better!)
Why is it such a big deal if people take antibiotics incorrectly? The more often people take antibiotics when they don’t need them, the more chances bacteria have to develop resistance to them. Effectively, antibiotic overuse breeds antibiotic-resistant bacteria. In the long run, this creates dangerous bacteria that are no longer treatable with any drug, making an infection a potential death sentence. The World Health Organization just recently reported an uptick in multidrug-resistant tuberculosis.
The doctor in the YouTube video is not exaggerating when he calls antibiotic resistance one of the biggest threats on earth. But is asking everyone to become an Antibiotic Guardian really going to change anything? After all, it’s doctors who prescribe antibiotics inappropriately—shouldn’t they change their practices? (The Antibiotic Guardian website has a section for physicians, but the project is clearly aimed primarily at the general public.)
According to Ramanan Laxminarayan, the director of the Center for Disease Dynamics, Economics, and Policy, a research group that has studied antibiotic resistance, a campaign like Antibiotic Guardians is a step in the right direction. “It’s not innocuous to get an antibiotic that you don’t really need, and I think people don’t really realize that,” says Laxminarayan. “I think if we got the word out that it’s not just harmless—it actually can be harmful to you to take these powerful drugs when you don’t need them—that could change behavior.”
Doctor-patient negotiations are affected by expectations on both sides, sometimes in subtle ways. Patients who are suffering from painful flu symptoms—or parents whose children are up all night crying in pain from an ear infection—often just want to take anything that might help, even if the effect is mostly placebo. Doctors, meanwhile, have tight schedules to stick to. “They want to get the patient out of their office in two minutes rather than spending 15 minutes explaining why they don’t need an antibiotic,” says Laxminarayan. “The writing of a script is a way of signaling the end of a visit, in many ways.” Doctors also don’t want to lose clients by refusing to give them what they want. If patients didn’t expect antibiotic prescriptions for every single infection—or if, better yet, they treated their symptoms at home with over-the-counter drugs instead of making a doctor’s appointment—fewer antibiotic prescriptions would be written.
And there’s evidence that campaigns like Britain’s “Antibiotic Guardians” work to reduce antibiotic consumption. A French campaign with the tagline Les antibiotiques c’est pas automatique (you can probably work out a rough translation on your own), which was launched in 2002, reduced prescriptions 26.5 percent over five years. A similar but shorter-lived campaign in Belgium, which told people to “Use antibiotics less frequently but better,” also trimmed antibiotic sales. Laxminarayan says antibiotic misuse might eventually fall into the same category as indoor cigarette smoking, littering, and drunk driving: People used to accept these things as normal, but effective campaigns helped change the norm.
Which brings us to the United States, where antibiotic prescription rates are higher than Europe’s. Until recently, political apathy has prevented serious funding for antibiotic education campaigns—the CDC’s current educational program, “Get Smart About Antibiotics” is lackluster. Things may change if President Obama’s “National Strategy for Combating Antibiotic Resistant Bacteria,” which was published last month, is fully funded.
So far, unfortunately, the Antibiotic Guardian campaign is not exactly a runaway hit—only 2,808 people have taken the pledge to curb antibiotic overuse. It seems that the United States and the United Kingdom need an Ice Bucket Challenge-style viral campaign to spread the word about antibiotic overuse. Maybe instead of ice, people could dump yogurt or kimchee over their heads while yelling, “I love bacteria!” Or maybe not. But it’s clear that the danger of antibiotic overuse is a message that needs to spread.
