Competition and Antibiotic Resistance

At a recent conference I attended (pdf file), one speaker (Dominique Monnet) presented a very interesting observation about the relationship between the number of different antibiotics available and the amount of antibiotics prescribed.

Quite simply, as the number of potential competiting drugs increases, the amount of drugs prescribed increases:

(from here; the y-axis is the number of daily doses per 1000 residents)

There are at least two reasons for this pattern:

1) Advertising aimed at doctors and hospitals is more likely to increase use simply because doctors will be influenced to use antibiotics.

2) Countries that tightly regulate the distribution of antibiotics--and thus have fewer drugs in their drug formulary--have better awareness of the overuse problem, and consequently practioners are less likely to prescribe needlessly. In addition, these countries might have better control over who actually gets to prescribe (i.e., no prescriptions in most cases without an ID consult).

Those are the explanations I could think of, but I'm open to other suggestions. These data do stress the importance of making antibiotics a separate class of drugs.

an aside: there seems to have been some confusion about this post. I'm not saying antibiotics should be outlawed, as most narcotics are, but only that they need to be treated as a different regulatory class, so specific guidelines, training, and perhaps personnel are involved in their distribution.