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New guidelines tackle misuse of antibiotics amid rise of superbugs

by Tomoko Otake

Staff Writer

Public health officials have begun tackling the misuse and overuse of antibiotics, as the prevalence of superbugs, or bacteria resistant to antibiotics, reaches alarming levels worldwide.

A panel of experts under the Health, Labor and Welfare Ministry on Monday adopted draft guidelines on when doctors should refrain from using antibiotics. These guidelines, soon to be finalized and distributed to clinics and hospitals across the nation, explicitly discourage prescribing antibiotics to treat common colds or acute diarrhea.

For years, doctors have dispensed antibiotics for minor ailments, such as a sore throat or fever, even though the drugs, which are meant to kill or inhibit the growth of bacteria in the body, have little effect on colds or other viral illnesses.

Overuse and misuse of antibiotics and other antimicrobial drugs in medicine and agriculture has led to the emergence of powerful drug-resistant pathogens.

Common infections, such as pneumonia, gonorrhea and postoperative infections are becoming harder to treat as a result of antimicrobial resistance, experts say.

Drug-resistant superbugs cause about 700,000 deaths each year worldwide, according to the Organisation for Economic Co-operation and Development. If no measures are taken, superbugs could kill 10 million people by 2050, according to a 2014 report commissioned by the British government. That would surpass the 8.2 million cancer-related deaths recorded globally in 2012.

The ministry move comes as Japan faces pressure to follow through with its international commitment to reduce antibiotic use by 2020. In 2015, the World Health Assembly issued a global action plan to address antimicrobial resistance, urging member states to commit to national versions of the program by 2017.

Japan’s government adopted the National Action Plan on Antimicrobial Resistance in April last year, setting measurable targets to curb domestic consumption of antibiotics, including cutting total usage by 33 percent by 2020 from 2013 levels.

In 2013, the country’s human antibiotic use came in at 15.8 defined daily doses (DDD) per 1,000 patients per day, a statistical measure that means 15.8 out of 1,000 people were prescribed antibiotics on any given day.

Japan’s overall figure is relatively low compared with usage in other developed countries, such as France, Italy and Spain, where DDD logged in at 20 or higher in 2013. But the consumption of particular classes of oral antibiotics that are effective against a wide range of bacteria has been extremely high in Japan.

According to a 2016 report funded by the health ministry, domestic use of cephalosporins, quinolones and macrolides in 2013 — tallying respectively at 4.59, 2.79 and 4.88 DDD per 1,000 people per day, — was more than twice as high as many European countries.

The government aims to halve the consumption of these three classes of antibiotics from 2013 levels by 2020.

The new guidelines are geared toward primary care physicians treating outpatients with no major illnesses. The rules will discourage doctors from dispensing antibiotics to treat mild sinus infections, a sore throat or acute bronchitis. Other misuse of the drugs would include early-stage acute diarrhea, which is typically caused by food poisoning or viral infections.

Proper use of the antibacterial drugs may include treatment for an acute sore throat caused by Group A Strep, and for suspected whooping cough or 100-day cough, a highly contagious bacterial disease, according to the guidelines.

The new policy is expected to have a widespread impact on medical practices, but patients may fear that withholding antibiotics could compromise their health.

To address this concern, the guidelines offer examples of how physicians should explain the use and nonuse of the medicines.

For example, to patients seeking medication for a cold, doctors should refrain from prescribing antibiotics, recommend plenty of rest and explain that the symptoms should subside in seven to 10 days. Physicians should also inform patients that early symptoms of serious diseases may resemble colds and patients should come back if their condition persists or worsens after more than three days.

Dr. Yosuke Aoki, an infectious diseases expert at Saga University who was called in as an expert observer at Monday’s meeting, told the panel that the detailed examples of doctor-patient communication will be useful for physicians on the front line.

“The guidelines’ major task is to let doctors thoroughly explain to patients that the unnecessary use of antibiotics can only do harm and no good,” he said. “So it’s good that they contain advice on how to communicate that message to the patients.”

Some members of the panel, however, pointed out that the guidelines need to be updated in the future, since they do not address what doctors other than primary care physicians should do. Some otolaryngologists have reported that children with middle-ear infections are becoming harder to treat due to the spread of drug-resistant bacteria.

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