resistance include: ( 1) overuse through over-prescription, ( 2) misuse through
failure to complete course of treatment, ( 3) failure to contain antibiotic-resistant infections in healthcare settings, ( 4) factory farming and
subtherapeutic use in meat products, and ( 5) barriers to pharmaceutical
innovation given the current patent system and the price/volume business
model on which the industry currently operates. 26 Each factor must be
considered to develop an effective response to antibiotic resistance.
1. Overuse Through Over-Prescription
Antibiotic resistance is perpetuated by the excessive use of antibiotics in
humans. 27 The CDC estimates that approximately fifty percent of all the
antibiotics prescribed for patients in the United States are unnecessary or not
optimally prescribed. 28 In addition, many physicians erroneously recommend
antibiotics for viral infections. 29 This is due in part to the appearance of a
tangible medical intervention, as compared to the indirect relief of symptoms
or a mere “wait it out” approach. 30 Many patients insist on receiving novel
antibiotics when other approaches may be equally, or in some cases more,
efficient. 31 This phenomenon demonstrates that physicians may be
“acquiescing to their patients’ demands in order to deliver a positive
treatment outcome and retain the patients’ business.” 32 Physicians must keep
these concerns about overuse in mind and prescribe antibiotics prudently to
preserve the limited amount of effective medications. 33
Antibiotic cycling is one antibiotic utilization strategy that may slow the
development of antibiotic resistance. Antibiotic cycling occurs when
different classes of antibiotics are deliberately alternated and rotated in a
given population for a period of time. 34 As early as the 1980s, the
Minneapolis Veterans’ Affairs Medical Center’s cycling efforts of the
antibiotics gentamicin, tobramycin, and amikacin effectively reduced
gentamicin resistance. 35 However, cycling policies are difficult to enforce
26. See Ventola, supra note 4, at 277–283.
27. See ANTIBIOTIC RESISTANCE THREATS, supra note 2, at 11.
29. See Cory Fox, Resisting Antibiotic Resistance: Legal Strategies to Maintain Man’s
Dominion Over Microbes, 12 HOUS. J. HEALTH L. & POL’Y 35, 42 (2011).
30. Richard S. Saver, In Tepid Defense of Population Health: Physicians and Antibiotic
Resistance, 34 AM. J. L. & MED. 431, 471 (2008).
31. Fox, supra note 29, at 41–42.
32. Id. at 42.
33. See Saver, supra note 30, at 435.
34. See Erwin M. Brown & Dilip Nathwani, Antibiotic Cycling or Rotation: A Systematic
Review of the Evidence of Efficacy, 55 J. ANTIMICROBIAL CHEMOTHERERAPY 6, 6 (2005).
35. Joseph F. John, Jr., Editorial, Antibiotic Cycling: Is It Ready For Prime Time?,
21. 1 INFECTION CONTROL & HOSP. EPIDEMIOLOG Y 9, 9–10 (2000) (explaining that gentamicin,