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US Ebola Case: An Example of the Misuse of Antibiotics and a Reminder for Better Stewardship

      To the Editor:
      The December 2014 issue of Mayo Clinic Proceedings contained 2 informative articles on Ebola. In the first, Tosh and Sampathkumar
      • Tosh P.K.
      • Sampathkumar P.
      What clinicians should know about the 2014 Ebola outbreak.
      provided an overview of the 2014 Ebola outbreak. In the other, Butler
      • Butler Y.S.
      Ebola virus: exposing the inadequacies of public health in Liberia.
      described the harm to baseline health services in Liberia as a result of the diversion of efforts and resources to accommodate the Ebola outbreak. Of note, both articles ended with an editor’s note, from Associate Editor Thomas Beckman on the article by Tosh and Sampathkumar and from Editor-in-Chief William Lanier on the article by Butler, notifying readers that these articles address “a rapidly evolving field, and we will provide updates in the electronic and print versions of the journal as appropriate.”
      • Tosh P.K.
      • Sampathkumar P.
      What clinicians should know about the 2014 Ebola outbreak.
      • Butler Y.S.
      Ebola virus: exposing the inadequacies of public health in Liberia.
      I commend the Journal for taking this approach to inform readers.
      Although it is widely recognized that our understanding of Ebola is rapidly changing, there is one aspect of the disease that is not changing: it is caused by a virus, and the therapies for Ebola should be directed toward a viral pathogen (ie, not a bacterial, fungal, or some other type pathogen). Despite these facts, several apparent “breakdowns in the system” were, and continue to be, widely covered by the television and print media regarding the management of a US patient infected with Ebola virus. However, a very important area in need of improvement not mentioned in previous media reports was the apparent misuse of antibiotics. According to information released by a hospital, the patient was diagnosed as having a viral infection and was given antibiotics: “Ultimately, the man, who had come to the hospital with a fever and some abdominal pain, was diagnosed with a ‘low-grade, common viral disease’ and sent home, Lester [Mark C. Lester, executive vice-president of the health care system] said. [The patient’s] sister told the Associated Press that he was given antibiotics.”
      • Berman M.
      • Nutt A.E.
      Ebola patient was allowed to leave Dallas hospital last week.
      Whether this episode was reported correctly in the media or not, it is important to remind ourselves that escalating antibiotic resistance and the lack of countermeasures is arguably a more urgent and imminent threat than Ebola for patients everywhere.

      World Health Organization. Antimicrobial Resistance: Global Report on Surveillance 2014. http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf?ua=1. Accessed November 4, 2014.

      • Boucher H.W.
      • Talbot G.H.
      • Bradley J.S.
      • et al.
      Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America.
      • Bartlett J.G.
      • Gilbert D.N.
      • Spellberg B.
      Seven ways to preserve the miracle of antibiotics.

      Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013. Centers for Disease Control and Prevention website. http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf. Accessed November 4, 2014.

      Health care professionals can, and should, do better than to inappropriately prescribe antibiotics for viral diagnoses.

      References

        • Tosh P.K.
        • Sampathkumar P.
        What clinicians should know about the 2014 Ebola outbreak.
        Mayo Clin Proc. 2014; 89: 1710-1717
        • Butler Y.S.
        Ebola virus: exposing the inadequacies of public health in Liberia.
        Mayo Clin Proc. 2014; 89: 1596-1598
        • Berman M.
        • Nutt A.E.
        Ebola patient was allowed to leave Dallas hospital last week.
        Washington Post. October 2, 2014; (. http://www.washingtonpost.com/national/health-science/ebola-patient-was-allowed-to-leave-the-dallas-hospital-last-week/2014/10/01/778f1276-49b4-11e4-891d-713f052086a0_story.html. Accessed December 2, 2014.)
      1. World Health Organization. Antimicrobial Resistance: Global Report on Surveillance 2014. http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf?ua=1. Accessed November 4, 2014.

        • Boucher H.W.
        • Talbot G.H.
        • Bradley J.S.
        • et al.
        Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America.
        Clin Infect Dis. 2009; 48: 1-12
        • Bartlett J.G.
        • Gilbert D.N.
        • Spellberg B.
        Seven ways to preserve the miracle of antibiotics.
        Clin Infect Dis. 2013; 56: 1445-1450
      2. Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013. Centers for Disease Control and Prevention website. http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf. Accessed November 4, 2014.

      Linked Article

      • What Clinicians Should Know About the 2014 Ebola Outbreak
        Mayo Clinic ProceedingsVol. 89Issue 12
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          The ongoing Ebola outbreak that began in Guinea in February 2014 has spread to Liberia, Sierra Leone, Nigeria, Senegal, Spain, and the United States and has become the largest Ebola outbreak in recorded history. It is important for frontline medical providers to understand key aspects of Ebola virus disease (EVD) to quickly recognize an imported case, provide appropriate medical care, and prevent transmission. Furthermore, an understanding of the clinical presentation, clinical course, transmission, and prevention of EVD can help reduce anxiety about the disease and allow health care providers to calmly and confidently provide medical care to patients suspected of having EVD.
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