Some people may feel that it is irresponsible for physicians to prescribe antibiotics for emergency use. They favor withholding these critical medications due to a fear of creating antibiotic resistance if inappropriately used.
Let’s turn to the evidence. Studies over the years have looked at so-called “pocket prescriptions” and their effect on antibiotic use amongst pediatric and adult populations. A “pocket-prescription” is when your health care provider is unsure whether antibiotics are appropriate for your infection, so they write you a “just in case” prescription. They tell you that if the symptoms worsen over the next 24-48 hours, you should fill the prescription and begin taking the prescribed antibiotics. It turns out that this type of care leads to LESS antibiotic use by the patients. This is because they feel empowered to decide the best course of action for their own care. They don’t have to go to the next primary care office, urgent care, or emergency department until they find someone willing to give them antibiotics. Instead, they keep the prescription, knowing that they can fill it if needed—most of the time they don’t.
Antibiotic stewardship is not simply withholding antibiotics from patients. It is also prescribing and using antibiotics when appropriate. It is part of a wholesome physician-patient relationship. One where patient and physician work together to make the best decision on behalf of the patients’ wellbeing. It is also why anyone seeking a prescription through Jase Medical is first evaluated to ensure they are appropriate candidates. In addition, they can contact us any time to follow up with their prescribing physician should they have any questions about the use of the medications prescribed.
A few of the studies referenced above:
Martin Edwards, M. E. (2003). Patients’ responses to delayed antibiotic prescription for acute upper respiratory tract infections. British Journal of General Practice, Nov(53(496)), 845–850. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314726/
Del Mar CB. Delayed prescription reduced antibiotic use in the common cold. ACP J Club. 2002 Nov-Dec;137(3):116. PMID: 12418856.
American Family Physician POEM. (2014). Delayed Prescription Strategies Decrease Antibiotic Use. American Family Physician. Published. https://www.aafp.org/afp/2014/0715/p110.html
According to many scientists and clinicians, antimicrobial resistance is one of the greatest threats to human health worldwide. However, without a clear understanding of the vital role of antimicrobials, and more specifically, antibiotics in modern life, a statement like ‘antimicrobial resistance is the greatest threat to human health worldwide’ may seem like hyperbole.
The discovery of antibiotics in the 1930s fundamentally transformed the way physicians care for patients. Treatment-focused approaches based on antibiotic use allowed physicians to save countless lives.
Since then, we have seen the top causes of mortality in humans change from things like kidney disease, gastrointestinal infections, and pneumonia to cancer and heart disease. More than eight decades later, the medical advances enabled by antibiotics are now threatened by rising antibiotic resistance. Without effective medications to treat infections, many fields of medicine will be hindered. Care of the critically ill, surgery, transplant medicine, neonatology, and the treatment of cancer patients, among others. Our ability to respond to national security threats like bioterrorism or pandemics will also be affected.
The causes of antimicrobial resistance are multifactorial and complicated. Chief among them is the lack of antibiotic stewardship. According to the Centers for Disease Control and Prevention (CDC), antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance.
The CDC lists four primary efforts to address antibiotic stewardship in an outpatient setting. They are: 1 – a means to measure antibiotic prescribing, 2 – improve antibiotic prescribing by clinicians and use by patients so that antibiotics are prescribed and used when needed, 3- minimize misdiagnoses or delayed diagnoses leading to underuse of antibiotics, and 4- ensure that the right drug, dose, and duration are selected when antibiotics are needed.
Over the last 10-20 years, the medical community and general public in developed nations worldwide have made considerable gains in the implementation of antibiotic stewardship. For example, there has been a concerted effort to increase awareness about the inappropriateness of prescribing and using antibiotics to treat viral infections. At JASE, we strive to continue this trend while empowering our patients to care for themselves when access to appropriate and timely medical treatment may not be available.
The effectiveness of antibiotics is a limited resource, and we must treat them as such. Nevertheless, they are crucial to our health and well-being, and we should respect them as powerful medications that save lives but can cause significant harm when misused.
Trying to find a silver lining to the cloud of the coronavirus pandemic can be challenging. However, one such silver lining is how the pandemic highlighted our fragile supply chain here in the United States, if not the world’s global supply chain. The world’s supply chain issues existed before the pandemic, and they have only grown worse since. There doesn’t seem to be an industry that isn’t affected in one way or another.
Before the pandemic, our health care industry was experiencing shortages regularly of basic medical supplies, including pharmaceuticals. The problem is now even more severe.
The FDA’s Center for Drug Evaluation and Research director said, “Historically, the production of medicines for the U.S. population has been domestically based. However, in recent decades, drug manufacturing has gradually moved out of the United States.” Now nearly 3/4ths of the active ingredients used in medicines sold in the United States are produced overseas. Today, the majority of pharmaceutical production takes place in China and India.
In an interview Senator Chris Coons, D-Del said, “If we have another global pandemic that leads to the world to close borders and leads global supply chains to shatter or to break down, we are distinctly vulnerable because we are now dependent upon globally integrated supply chains.”
Many will remember donning their mask and venturing out into the eerily quiet streets to visit an essential business such as the grocery store only to see bare shelves. We have lived through supply chain shortages caused by a global pandemic, but many other potential causes may disrupt our fragile supply chain. Other causes include local disasters in the countries or cities of pharmaceuticals factories or a terror attack on infrastructure anywhere along the supply chain.
At JASE Medical, we are on a mission to help our community prepare for the worst. We want to empower our neighbors to be self-sufficient and not have to rely on others when it comes to their well-being. We are starting that mission with emergency use antibiotics.
Over the years many lists have been published in an effort to rank the most “revolutionary inventions or discoveries in history”, or the “greatest breakthroughs of all time”. Invariably these lists include “penicillin” or “antibiotics”. In fact, a list published by The Atlantic in 2013 listed the discovery of penicillin in 1928 as number three in their article of “The 50 Greatest Breakthroughs Since the Wheel”.
The discovery of penicillin by Alexander Fleming in St. Mary’s Hospital, London ushered in the modern age of medicine. He is credited with the following quote, “One sometimes finds what one is not looking for. When I woke up just after dawn on Sept. 28, 1928, I certainly didn’t plan to revolutionize all medicine by discovering the world’s first antibiotic, or bacteria killer. But I guess that was exactly what I did.”
So why, exactly, was Fleming’s discovery so revolutionary? Prior to the beginning of the 20th century, bacterial infections accounted for the top causes of death in the world. The average life expectancy was just 47 years. Diseases like cholera, pneumonia, tuberculosis were rampant. The antibiotic era revolutionized the treatment of infectious diseases. The average life expectancy rose to 79 years. Antibiotics and other factors like improved sanitation, vaccinations, public health measures, and education are the reasons developed nations such as the United States have seen such a dramatic increase in overall life expectancy and quality of life.
With such impactful consequences to humankind it is easy to see how the discovery of penicillin warrants a top 3 placement in “The 50 Greatest Breakthroughs Since the Wheel”. We have grown so accustomed to the use of antibiotics that it is hard to imagine a world where once again infectious disease becomes a top killer. By preparing for the worst and hoping for the best, we at JASE Medical are on a mission to provide everyone the opportunity to ensure themselves and their families piece of mind should, one day, a world where antibiotics are in short supply or impossible to obtain becomes a reality.
Consumer Notice: A note on expiration dates. This article discusses published research on drug stability, including the FDA and Department of Defense Shelf Life Extension Program (SLEP). SLEP applies to federal stockpiles held under controlled, monitored storage and tested lot by lot. It does not apply to medications stored at home, and its findings do not extend the expiration date of any medication you own. FDA’s guidance to consumers is that expired medications should not be used. Jase Medical follows the manufacturer’s printed expiration date on every medication we dispense and recommends replacing medications when they expire. Nothing in this article is a recommendation to use expired medication.
Clinician Notice: A note on expiration dates. This article discusses published research on drug stability, including the FDA and Department of Defense Shelf Life Extension Program (SLEP). SLEP applies to federal stockpiles held under controlled, monitored storage and tested lot by lot. It does not apply to medications stored at home, and its findings do not extend the expiration date of any medication you own. FDA’s guidance to consumers is that expired medications should not be used. This article is written for licensed healthcare professionals to support patient counseling. Jase Medical follows the manufacturer’s printed expiration date on every medication we dispense, and we recommend counseling patients to replace medications at the labeled date and dispose of expired supply following FDA guidance.
Your antibiotics carry an expiration date, and that date is when to replace them. You may see two different dates on what you receive. Here is which one applies.
The pharmacy label date. When a pharmacy dispenses a medication, it prints a date on the prescription label, marked “discard after” or “use by.” This is a beyond-use date. State pharmacy rules set it, commonly at one year from the fill date or the manufacturer’s expiration date, whichever comes first.
The manufacturer’s expiration date. The manufacturer prints an expiration date on the original package, marked “EXP.” Federal rules have required it since 1979. It is the date through which the manufacturer guarantees full potency and safety when the product is stored as labeled in its original container.
Which date applies. If your medication came in the manufacturer’s original sealed packaging, the EXP date on that packaging applies. If your pharmacy repackaged it into a vial or bottle, the date on the pharmacy label applies. Replace the medication on or before the date that applies to you.
What the research shows, and why it doesn’t change your date. The FDA and Department of Defense Shelf Life Extension Program tests medications in federal stockpiles held under controlled, monitored storage. FDA scientists who analyzed the program’s results found that stability varied widely between drugs, and between different lots of the same drug. That variation is why the findings apply only to the specific stockpiled lots tested. Nobody can tell from a bottle at home which group it falls in. The labeled date is the reliable answer.
Storing your antibiotics until their date. Tablets and capsules hold up better than liquids and suspensions. Keep every antibiotic capped in its original container, in a cool, dry, dark place. Avoid bathrooms, vehicles, and anywhere with heat or humidity.
Closing Notice: When a medication reaches its expiration date, replace it. Dispose of the expired supply following FDA’s guidance on expired medicines.
Sources: FDA, Don’t Be Tempted to Use Expired Medicines · FDA, Expiration Dates Questions and Answers · Lyon RC et al., “Stability profiles of drug products extended beyond labeled expiration dates,” J Pharm Sci, 2006.
