Free offers of antibiotics raise concern for some in public health: Resistance feared ===================================================================================== * Teddi Dineley Johnson With American wallets getting tighter, loosening the price tag on prescription drugs commonly used by consumers is becoming a growing trend among U.S. pharmacies and stores — including new offers for free antibiotics at grocery stores. But with antibiotic-resistant infections on the rise, public health experts warn that “free” can come at a dangerously high price. In January, several major grocery store chains announced plans to give free generic antibiotics to customers with valid prescriptions. Through March, shoppers can present prescriptions to receive free, 14-day supplies of commonly prescribed antibiotics such as amoxicillin, penicillin and tetracycline. But while the promise of free antibiotics may entice cost-cutting consumers, it is raising alarm bells for many in public health, especially those who have been working to combat misuse of antibiotics. Promoting free antibiotics at a time when the nation faces a growing crisis of antibiotic resistance “does not make good public health sense,” according to the Infectious Diseases Society of America, which criticized the giveaways. “Most doctors know better than to prescribe antibiotics when they are not needed,” said Anne Gershon, MD, president of the Infectious Diseases Society of America. “But many find it hard to say ‘no’ to sick patients who think antibiotics will make them feel better. We are concerned that these pharmacy marketing efforts will encourage patients to ask for antibiotics prescriptions.” Antibiotic resistance is “one of the key microbial threats to health in the United States,” according to the Institute of Medicine, which has recommended curbing the inappropriate use of antibiotics — such as using them for illnesses they do not treat, like colds or the flu, or using them to enhance growth among livestock. Unfortunately, antibiotic resistance has been growing in recent decades, making it harder to treat infectious diseases such as tuberculosis and methicillin-resistant *Staphylococcus aureus*, or MRSA. According to the Centers for Disease Control and Prevention, MRSA caused more than 94,000 life-threatening infections in the United States in 2005. Multidrug-resistant TB is a growing threat around the world, and recent reports have documented drug resistance among *Clostridium difficile*, a bacteria that can cause serious intestinal conditions. Compounding the issue is that few new antibiotics are being developed to replace those that are losing effectiveness. The free antibiotic offers are dangerous because they could lead consumers to stockpile the drugs, John Santa, MD, MPH, director of the *Consumer Reports* Health Rating Center, told *The Nation’s Health*. Consumers could meet with more than one doctor, get multiple prescriptions and save the antibiotics for later “and that is not a trend we want to encourage or facilitate these days,” Santa said. ![Figure1](http://www.thenationshealth.org/https://www.thenationshealth.org/content/nathealth/39/2/1.2/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/39/2/1.2/F1) Another concern is that when antibiotics are free, patients want them even more, Santa said, noting that during more than 20 years as a primary care internist, situations involving patients demanding antibiotics were one of the most challenging for him. “It is frustrating for practicing physicians to see that major chains are reinforcing that behavior rather than discouraging it,” he said. In some cases, advertisements being used to hype the free antiobiotic campaigns are misleading, said Ed Septimus, MD, a member of the board of directors of the Infectious Diseases Society of America, who noted that some of the ads tout the free antibiotics as coming just in time for winter colds and flu. “These conditions are primarily viral, so they are giving the wrong message to the public that somehow flu and cold and cough should be treated with antibiotics,” Septimus told *The Nation’s Health*. “There is significant literature that suggests that the majority of these prescriptions are inappropriate for upper respiratory infections, most of them being viral. So our concern regarding a program like this is that we don’t want to put any additional pressure, both on consumers and prescribers, to prescribe unnecessary antibiotics.” Public health organizations and advocates have been actively working in past decades to educate both consumers and physicians on the safe use of antibiotics and have been making inroads. CDC’s “Get Smart: Know When Antibiotics Work” campaign teaches how to reduce resistance brought on by overuse and overprescribing of antibiotics. The program’s goal is to build consumers’ and health care providers’ awareness about appropriate antibiotic use, said the campaign’s director, Lauri Hicks, DO. Studies have shown that such efforts can be effective. To combat the message that may be conveyed by the grocery store freebies, Hicks said CDC and the Infectious Diseases Society of America will ask retailers that offer free antibiotics to partner with the Get Smart program and distribute materials to their customers on inappropriate antibiotic use. “We don’t want to limit access to people that actually do need them,” she said. “We want to make sure that when they are being used, they are being used appropriately.” Jamie Miller, spokesman for Maryland-based Giant Food, which is one of the grocery stores offering the free antibiotics, told *The Nation’s Health* that the company is “open to listening to what constituents and government agencies may want to talk to us about.” Giant’s free antibiotic program is designed for customers who have been prescribed antibiotics by their physicians, “who have an obligation to look out for the safety and well-being of their customers,” he said. Providing free medicine may get customers into stores, said Septimus, of the Infectious Diseases Society of America. But a more responsible marketing effort would be to offer free flu shots, he said. “If you can prevent an infection like influenza, which we know is associated with significant mortality and morbidity, it would be much more beneficial to the community to offer free flu vaccines than offering free antibiotics,” Septimus said. For more information, visit [www.cdc.gov/drugresistance/community](http://www.cdc.gov/drugresistance/community). ## FDA reverses decision to ban use of cephalosporin in animals Responding to pressure from the U.S. agricultural industry, the Food and Drug Administration in December reversed its July decision banning the use of cephalosporin antimicrobial drugs in veterinary practice, setting aside concerns that using the drugs for diseases other than those for which they are officially approved is a risk to public health. According to the advocacy organization Keep Antibiotics Working, cephalosporins are the antibiotic treatment of choice for serious salmonella infections in humans, which cause 1.3 million illnesses each year in the United States. But studies link the widespread preventive use of cephalosporins in poultry to increasing resistance to the drugs in both humans and farm animals. APHA supports a ban on cephalosporins for use in animals. Last year, the Association urged FDA to reject the drug for use in cattle, citing increased human resistance to cephalosporins, which are also used to treat people with pneumonia. “We are hoping that the new administration and the new FDA will support legislation that would review all the existing approvals for antibiotics for animal use and determine which ones may be contributing to resistance in humans,” said APHA member John M. Balbus, MD, MPH, chief health scientist for Environmental Defense Fund. “People would be surprised that herds of animals can get advanced antibiotics without anybody writing a prescription.” For more information, visit [www.keepantibioticsworking.com/new/index.cfm](http://www.keepantibioticsworking.com/new/index.cfm). * Copyright The Nation’s Health, American Public Health Association