Antibiotic use varies widely in the USA, with those in Eastern states more likely to use them than those in the West, according to research out today.
West Virginia had the highest antibiotic use per capita from 1999 to 2007, the period evaluated by scientists from Extending the Cure, a project of the nonprofit Center for Disease Dynamics, Economics & Policy. It is funded by the Robert Wood Johnson Foundation.
From 2006 to 2007, West Virginians got 1,222 prescriptions per 1,000 people. That's more than twice the antibiotic use of Alaska, the lowest, with 546 prescriptions per 1,000 people.
"It's actually quite a significant variation in prescribing patterns," says Ramanan Laxminarayan, director of Extending the Cure.
Much of the excess prescribing is for respiratory infections caused by viruses, against which antibiotics are useless, he says. Misuse of antibiotics for treating viral infections can lead to bacteria that are resistant to them.
"Obviously, less is better," he says, adding that he doesn't want to discourage antibiotics' appropriate use.
Why people in some states are more likely to take antibiotics than in others is unclear, Laxminarayan says. He hopes his map will spur research into the reasons.
"It takes a lot of work as a practice to get your patients to understand you're going to be judicious about antibiotic use," says Kathryn Moffett, a pediatric infectious disease specialist at West Virginia University in Morgantown, who called her state's ranking "really discouraging."
West Virginia is rural, so some residents might have to travel far to see a doctor, she says. When they get there, they expect the doctor to do something.
U.S. antibiotic use has leveled off in recent years, partly because of the availability of vaccines against pneumococcal disease, which is caused by a type of bacteria, Laxminarayan says. Even so, he says, Alaskans still consume more antibiotics than Swedes and those in some other European countries.
Campaigns in Scandinavia, he says, have taught patients it's not OK to demand antibiotics. "They've recognized the problem very early."
U.S. doctors and patients finally appear to be getting the message, says Lauri Hicks of the Centers for Disease Control and Prevention.
"We believe there has been some attitude change," she says, partly because of news reports about MRSA, a strain of staph bacteria that doesn't respond to some common antibiotics. Even so, "we still have a really long way to go."
Many people still think antibiotics are "the cure-all," says Hicks, who presented a similar map of geographical variations in use last year at an infectious diseases meeting. "There's also a this perception that there is no harm in taking antibiotics." But they can also cause allergic reactions and side effects such as severe diarrhea.
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