Combating Antibiotic Misuse in Healthcare Facilities

Combating Antibiotic Misuse in Healthcare Facilities with Policy Solutions

Antibiotic resistance, identified by the World Health Organization (WHO) as the greatest public health threat of the 21st century, is largely attributable to the misuse and overuse of antibiotics within healthcare institutions. To combat this threat that undermines the foundation of infectious disease treatment, this article diagnoses the current state of antibiotic misuse in healthcare facilities and conducts an in-depth analysis of effective policy solutions, including the introduction of rapid diagnostic technologies, strengthening prescription incentives and penalties, and enhancing healthcare professional education.

The Reality of Antibiotic Resistance Threats and the Need for Policy Intervention

Examining the current status and outlook of antibiotic-resistant bacteria, which are hindering human progress, reveals that while antibiotics have saved countless lives, their excessive and inappropriate use has fueled the paradoxical threat of 'antibiotic resistance.' Healthcare institutions, in particular, have become breeding grounds for the emergence and spread of resistant bacteria due to concentrated antibiotic use and the presence of vulnerable patients. The WHO has warned that antibiotic resistance could lead to 10 million deaths annually by 2050, surpassing the combined death toll from cancer and diabetes. Infections caused by these resistant strains not only result in treatment failures but also increase patient suffering and generate substantial socioeconomic costs.

A closer look at the specific forms of antibiotic misuse in healthcare facilities reveals various manifestations that worsen patient conditions and lead to unnecessary medical expenses. Prescribing antibiotics for viral illnesses, which are ineffective against them, is a prime example. While antibiotics have no effect on viral diseases like the common cold or flu, they are frequently prescribed to meet patient demands or alleviate anxiety. Furthermore, inappropriate antibiotic selection, where healthcare providers arbitrarily choose familiar antibiotics based on past experience without considering the patient's condition, test results, or the latest research, leads to reduced treatment efficacy or increased resistance. Extending antibiotic treatment duration based solely on symptom relief, rather than adhering to optimal treatment periods, also heightens the risk of resistance. Additionally, broad-spectrum antibiotics are often prioritized even when narrower-spectrum options are available, citing unclear causative agents or as a precautionary measure for unspecified 'what-ifs.' This practice exacerbates the risk of resistance and increases the potential for antibiotic toxicity and side effects.

Considering the enormous socioeconomic costs hidden behind 'easy prescriptions,' antibiotic misuse in healthcare facilities, while causing short-term patient discomfort, poses a serious long-term public health threat and incurs astronomical costs. Once resistant bacteria emerge, treating them becomes difficult with existing antibiotics, necessitating the use of newer, more expensive, and riskier next-generation antibiotics. This leads to extended hospital stays, increased medical costs, a rise in deaths from resistant infections, and delays in the development of new antibiotics, collectively threatening the global healthcare system. Therefore, 'policy intervention' is not an option but a necessity. Research findings, such as the fact that the antibiotic resistance rates for major pathogens in South Korea remain high or are gradually increasing compared to the OECD average, and that 30-50% of antibiotic prescriptions in outpatient settings are unnecessary, underscore the urgency of policy intervention.

The often-unseen link with the livestock industry is also significant. Excessive antibiotic use in livestock spreads resistant bacteria into the environment, which can then enter the human body through food or direct contact. This highlights the importance of designing national and global policies that encompass not only healthcare institutions but also food production processes. While this article focuses specifically on policy solutions within healthcare facilities, this broader connection must not be overlooked.

Effective Policy Design Through Accurate Diagnosis and Reward Systems

As part of technology-based policies aimed at improving 'accuracy' from diagnosis to prescription, policy support is needed for the adoption of advanced technologies like 'rapid diagnostic kits' to address the prevalent practice of empirical prescribing, a major cause of antibiotic misuse. Rapid diagnostic kits allow for the identification of bacterial infection status and major pathogens within minutes to hours, enabling more informed decisions than relying solely on patient symptoms. This approach minimizes unnecessary antibiotic prescriptions and allows for the selection of appropriate antibiotics targeting the specific causative agent when necessary. Furthermore, it is crucial to establish integrated analysis of antibiotic usage, resistance patterns, and patient data from each healthcare institution, along with building big data-based prescription guidelines and decision support systems to aid healthcare professionals in making rational prescribing choices.

For a balanced approach combining 'prescription incentives' and 'usage restrictions,' policy designs that integrate economic incentives and sanctions are required to improve antibiotic prescribing behavior in healthcare institutions. This could involve metricizing antibiotic usage, resistance rates, and antibiotic appropriateness evaluation results, and considering measures that offer additional payment (e.g., fee increments) to institutions meeting appropriate standards while imposing penalties for those that do not. This can motivate healthcare facilities to voluntarily reduce antibiotic misuse. Moreover, a system must be established to regularly update and strictly manage a list of 'Restricted Antibiotics,' limiting their prescription or allowing use only under specific conditions when overuse is identified.

Finally, continuous education is necessary to enhance healthcare professionals' capabilities and foster 'awareness change.' The key to solving the antibiotic resistance problem lies in changing the perceptions and strengthening the expertise of healthcare professionals who prescribe antibiotics on the front lines. It should be mandatory for healthcare professionals to complete a certain number of hours of education on antibiotic resistance and the operation of Antibiotic Stewardship Teams (ART) as part of their license renewal process. The educational content should include the latest resistance trends, appropriate antibiotic selection methods, and practical case-based learning. Furthermore, the role of ARTs, which manage and improve antibiotic use within hospitals, must be strengthened, with support for securing specialized personnel and operational costs to encourage the establishment of systematic antibiotic management systems in each healthcare institution. ARTs play a pivotal role in contributing to the reduction of antibiotic misuse through various functions such as prescription monitoring, education, and policy development.