How Misaligned Incentives Influence Antibiotic Prescribing and Resistance

Assistant Professor, Center for Advanced Modeling in the Social, Behavioral, and Health Sciences, Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland Fellow, Center for Disease Dynamics, Economics, & Policy, Washington, D.C., United States


Antibiotic resistance is a significant threat to public and patient health. Its emergence has significantly reduced a physician’s ability to treat infections and increases the probability of mortality for patients. It also threatens to reverse significant medical gains, particularly the ability to perform transplants and other surgical procedures that are dependent on antibiotic effectiveness. Drug-resistant infections cause significant morbidity and mortality: Approximately 2 million Americans are infected with hospital-acquired infections annually, the vast majority of which are resistant to antibiotics, resulting in about 99,000 deaths each year. Emergence and spread of antibiotic resistance is engendered by inappropriate use of antibiotics, which occurs largely because of the misalignment of incentives for using and producing antibiotics. Problems with resistant bacteria are compounded by the fact that there are also impediments to the development of new antibiotics that could be effective against these resistant organisms. All these problems are systemic and require interventions at both the consumer and producer level to ensure the long-term efficacy of antibiotics.