Excessive use of antibiotics in the community associated with delayed admission and masked diagnosis of infectious diseases

Resistance to antimicrobial drugs is becoming more serious throughout the world, and is a major problem in Taiwan. The selective pressure of antibiotic use makes some degree of antibiotic resistance inevitable, but extraordinarily high rates of resistance suggest excessive use. This report reviews collaborative studies undertaken in the southern city of Kaohsiung to better define the use of antibiotics in the community and to determine whether recent use of antibiotics results in delayed admission and missed or masked diagnoses of infectious diseases among patients presented at an emergency department. Because of the unreliability in the patients' medical history, antibiotic activity was determined in the urine. These studies demonstrated that (1) detection of antibiotics in the urine offers a simple and inexpensive means to determine antibiotic use when a history of drug use is unreliable; (2) the high frequency of antibiotics use among patients presenting at emergency departments, clinics, and in the community may account for the extraordinarily high rates of antimicrobial drug resistance in Taiwan; and (3) recent use of antimicrobial drugs before visiting an emergency department was associated with a significantly increased risk of delayed and masked or missed diagnoses of infectious diseases, and missed diagnosis of noninfectious diseases. These findings reflect inherent social, economic, and cultural problems and constraints in the medical care system in Taiwan. The issue of inappropriate use of antibiotics in the community, hospitals, and agriculture is now being addressed at a national level.