Kentucky has one of the nation's worst drug problems, but not the kind of drugs you might think.
Kentucky and other southeastern states continue to overuse antibiotics, contributing to a dangerous decline in the effectiveness of the drugs, according to a study released Tuesday by a group affiliated with the federal Centers for Disease Control and Prevention.
Kentucky and West Virginia residents take about twice as many antibiotics per capita as people living in Alaska and Hawaii.
"We're running out of antibiotics that work, period," said Nikolay Braykov, a senior research analyst at Extending the Cure, a part of the Center for Disease Dynamics.
He said the difference might be one of state-by-state culture, and he urged patients and physicians to be judicious in the use of antibiotics during cold and flu season. A key prevention element for avoiding antibiotics is simple, Braykov said: Get a flu shot.
Not only does that increase resistance to the flu virus, but it helps patients avoid the bacterial complications that can arrive during the course of the flu.
The Center for Disease Dynamics, along with the CDC in Atlanta, announced Tuesday a new project aimed at fighting antibiotic resistance. The project involves more than a dozen high-profile organizations, among them Consumers Union and groups representing public hospitals, pediatrics practitioners and public health professionals.
The Center for Disease Dynamics and its Extend the Cure project say that in 2010, the five states with the highest antibiotic use were Kentucky, West Virginia, Tennessee, Mississippi and Louisiana. The five states with the least antibiotic use were Alaska, Hawaii, California, Oregon and Washington.
It's unclear what influences put Kentucky at the top in antibiotic use. Craig Martin, a infectious disease clinical pharmacist at the University of Kentucky, said that a 2009 study of Medicaid data in the state suggested that some pockets of Eastern Kentucky had higher rates of antibiotic use than the bluegrass or some parts of western Kentucky.
Dr. Robert Salley, KentuckyOne Health executive director of cardiovascular services in the Lexington market, said the overuse of antibiotics might reflect the state's problem with prescription pain pills.
Many Kentuckians are used to "that culture of availability, that culture of not making appropriate use of the physician-patient relationship," he said.
People should be careful about their antibiotic use, but they also should pay attention to the antibiotics being used on animals in the food supply, he said.
"These get into the food supply, and these also lead to drug-resistant bacteria that get into the general population," Salley said. "We cannot be just focused on the human population. We have to be focused on all populations."
Antibiotics in animals, he said "are leading to these reservoirs of antibiotic-resistant bacteria that are going to bleed into the general population."
States that have lower rates of antibiotic use have poured resources into education campaigns, he said. Kentucky has not done that.
"Health literacy rates are not great," Martin said.
Anecdotally, there have been some cases of diseases that land patients in hospitals with conditions that cannot be treated by any antibiotic, and some urinary tract infections that are antibiotic-resistant are being treated in hospitals rather than at home.
Between 1999 and 2010, the available drugs used to treat urinary tract infections, the second most common infection, were losing their overall effectiveness, and resistant bacteria increased by more than 30 percent.
"It's just a disturbing trend," said Braykov of Extending the Cure. "We could reach a point where they're not easy to treat at all."
He attributed over-prescribing of antibiotics to "patients wanting that fix" and putting pressure on physicians. Children's illnesses "are most of the time viral and should not be treated with antibiotics," Braykov said.
A poll released Tuesday by the Pew Charitable Trust indicates that most Americans know how to properly take antibiotics, including taking all the prescribed medicine. But in private focus groups, consumers admitted that they don't always adhere to such practices.