Prescription for antibiotics

Below is my insanely cheap way to reduce the inappropriate use of antibiotics around the world.

The rise of drug-resistant bacteria is an urgent global health crisis that costs billions of dollars and affects millions of patients each year, thousands of whom die (see this NYT article). One major driver of the evolution of these strains is the inappropriate prescription of antibacterial drugs to patients who have viral infections, largely driven by patient demand based upon ignorance of what antibacterials treat. Indeed, 32% of Americans, 43% of UK citizens, and 60% of Europeans believe (incorrectly) that antibacterials are effective against viruses.

1901 definition of antibioticWhy do so many people think antibiotics kill viruses? To most people, the word “antibiotic” sounds like exactly like the kind of drug that might be effective against all types of organisms, even viruses.  That’s because the word is composed of the roots, “anti” and “biotic“, which together mean, “kills life.” That’s not an accident, of course — once upon a time, that’s exactly what the word meant.  For example, here’s a screenshot of a 1901 book (The American Illustrated Medical Dictionary, by William Alexander Newman Dorland):

Definitions of antibiotic and antibacterialThe above view is mirrored on Google, by the way, which defines antibiotics as able to destroy microorganisms (that includes viruses). Many other print and online definitions suggest broad efficacy of antibiotics (i.e., beyond bacteria).

When and why did the word “antibiotic” change meaning? The answer is that a microbiologist in the 1940s (details) started using “antibiotics” in a new way, one that restricted the efficacy of the compounds to only bacteria.  Biologists and physicians adopted the fad, but the rest of the populace still retains the original definition.

So to curb the misuse of antibacterials, the obvious first step would be for physicians to avoid using the word “antibiotic,” and instead opt for the word “antibacterial” (a word that has been around since 1890s). Organizations such as the CDC should also switch to “antibacterial.” For example, the CDC could easily convert its “Get Smart About Antibiotics Week” to “Get Smart About Antibacterials Week.” And the CDC could also easily replace “antibiotic” with “antibacterial” in the hundreds of brochures and websites it produces. I have suggested this to the CDC, and they are just annoyed; they insist that the word “antibiotic” is not a source of confusion to anyone. If they could make the change, it would be the single most important weapon against resistance they could possibly use. And it would be insanely cheap. It’s just a search/replace problem.

By the way, if you happen to do research on public misconceptions over science, I would be grateful if somebody could conduct a poll that looks at word choice on  respondents’ beliefs. My hypothesis is that if you asked people EITHER, “Are antibacterials effective against virus?” or “Are antibiotics effective against viruses?”, the percentage answering “yes” to the former would be a measurably lower number. It would make for an easy publication and would help motivate others to consider moving away from the word “antibiotics” in public health outreach.

Diagram of different anti-infective drugsAdmittedly, getting people to use “antibacterial” is hard. All the entities fighting resistance are composed of microbiologists, physicians, and other over-educated types who have grown up using the word “antibiotics” for drugs that act only against bacteria. After decades of using it in that sense, they would naturally think my suggestion silly, and would balk at the prospect of changing their educational outreach verbiage even if it only took a day to do so. Ultimately, I don’t think my suggestion will catch on until a Bill Gates, a President, or powerful equivalent tells one of these groups to just do it.

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6 Responses to Prescription for antibiotics

  1. Asem Shehabi says:

    I agree 100% with proper use of antibacterial drugs instead antibiotics which may confuse uneducated person on the correct meaning of antibiotics.

  2. Yerg says:

    Colin, I agree with you. I really like the poster which links common names such as “cold” with infectious agents such as “virus”. What I agree with is asking the public to colude on solving the problem rather than protecting ones own sense of superiority by pretending that one is explaining and perhaps ENJOYING the continued ignorance. Ironically, I would wager that more people would if you were being agreeable about it. Inspiring is a better plan than convincing. Could you try asking doctors to colude with you on changing the misleading name of this set of infection fighting agents rather than trying to get the public to remember not to be misled by the popular name?

  3. Jan Wegner says:

    Unfortunately you’re assuming most people know the difference between bacteria and viruses. They don’t. Just ask them.

    • Oh, believe me, I agree. I’ve met doctors who don’t know the difference, though when pressed they suddenly remember and are embarrassed. Switching to “antibacterial” and “antiviral” in outreach programs and in doctors’ offices would be a better approach to educating the public. Currently the battle is BOTH the confusion about bacteria vs virus AND confusion about what antibiotics actually work on. My proposal is to eliminate the “antibiotic” confusion INSTANTLY, simply by using “antibacterial”, instead.

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