Curbing the misuse of antibiotics

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.

The question that’s interesting is, why on Earth do doctors insist that antibiotics work only against bacteria?  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 first step would be for physicians to avoid using the word “antibiotics,” opting for the word “antibacterial” instead (the word has been around since 1890s).  Organizations such as the CDC should also switch to “antibacterial.” For example, they could easily convert its “Get Smart About Antibiotics Week” to “Get Smart About Antibacterials Week.” The CDC could also easily replace “antibiotic” with “antibacterial” in the hundreds of brochures and websites it produces.  I have inundated the CDC with this suggestion for years, and everyone is just annoyed with my idea; indeed, they insist that the word “antibiotic” is not a source of confusion.  I’m not sure they are delusional, or simply mired in careers that are immune to change.  Using search/replace is also a highly technical computer skill, so maybe that’s the explanation.

If you are truly concerned with antibacterial resistance, under no circumstances should the name of your organization or committee contain “antibiotics,”  especially if your outreach is to the public.  This naming advice comes too late for dozens of groups, of course.  But if you can change your name, I think it would be worth the hassle, even if you have to refile your tax-exemption papers and change your URL.  You might roll your eyes at this suggestion, but I would roll my eyes right back at your eye-rolling: if you truly care about reducing public confusion about antibacterials, banish “antibiotics” from all your verbiage and your name as soon as possible.

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 antibiotics as a useful term in public health outreach (currently, they are entirely unmotivated, and indeed rather fond of the word).

Diagram of different anti-infective drugsAdmittedly, my suggestion is futile. All the entities fighting antibacterial 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.

If you want to see my other posts on topic, here they are. Please help spread the word by clicking on one of the sharing buttons below.

4 Responses to Curbing the misuse of 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?

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