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The Curse of the Antibiotics- Resistance

You probably think of antibiotics as a magic bullet against many deadly bacterial diseases. But because of persistent overuse, we have actually encouraged the growth of difficult-to-treat bacteria that are resistant to antibiotics.

“My pediatrician’s great,” a mother boasts. “When my daughter gets a cold, I call him for an antibiotic and he phones in the prescription right away.”

Actually, the pediatrician may not be doing this mom any favors. Her daughter’s cold is probably a viral infection—not bacterial—so an antibiotic will have no effect. What’s more, the antibiotic will kill off substantial amounts of normal, friendly bacteria in the little girl’s body, encouraging the growth of antibiotic-resistant bacteria that may wreak havoc later.

Bacteria-enemy or friends, read How Microbes Defend and Define Us in NEW YORK TIMES

Twentieth century lifesavers are wearing out

In the 1940’s, penicillin—the first widely used antibiotic—began saving countless lives from bacterial diseases. Antibiotics have enabled physicians to treat many of the scourges of humanity, including tuberculosis, pneumonia, meningitis, tetanus, syphilis and gonorrhea.

But we overdid it. We used antibiotics too casually—confident we’d always have another one to try if the first didn’t work. We were heedless that bacteria naturally mutate and eventually become drug-resistant in direct relationship to their exposure to antibiotics.

“Between 20% and 50% of all antibiotics prescribed for human use each year are unnecessary” according to the Centers for Disease Control and Prevention (CDC). Patients are demanding antibiotics for conditions that do not require an antibiotic, such as the common cold, and physicians feel pressured to write prescriptions. This is a waste of money, and is also lessening the effectiveness of the antibiotics for the times we really need them.

A worldwide problem

Huge amounts of antibiotics are used in the dairy, poultry and livestock industries, allowing drug-resistant bacteria to find their way into our kitchens. In developing countries, antibiotics are available over-the-counter, increasing the likelihood that they will be used without proper supervision. And jet plane travel makes it possible for resistant bacteria to travel from continent to continent with ease.

“Just give me something to make me feel better”

In the United States, we like to be proactive. We like a quick fix for our illnesses. So we’re likely to ask the doctor for antibiotics to treat viral infections like colds, the flu and bronchitis.

But viruses and bacteria are different. Antibiotics have no effect on the common cold or flu, which usually resolve without treatment in a matter of days. The table below shows viral infections that can be mistaken for those caused by bacteria. Of course, your doctor should make the actual diagnosis.

Viral infection
(antibiotic probably not needed)

Bacterial infection
(treatable with antibiotic)
Sore throat

Strep throat
Cold, flu Sinusitis
Cough, bronchitis Pneumonia

Physicians often write a prescription for an antibiotic even when they believe the patient’s condition doesn’t warrant it. At a recent seminar, Dr. Stuart B. Levy of Tufts University School of Medicine in Boston, Massachusetts reported that “more than 80% of the physicians present admitted to having written antibiotic prescriptions on demand against their better judgment.” Time constraints imposed by the current health care system make it easier for physicians to take 30 seconds to write a prescription than to spend 10-15 minutes explaining to a patient why an antibiotic isn’t needed.

The price of antibiotic overuse: tougher bacteria

The human body normally is home to millions of bacteria. These “friendly” bacteria found on the skin, in the mouth, lining the digestive tract—virtually all over our bodies—are harmless and many are necessary for the normal functioning of the body.

Use of antibiotics disrupts the ecology of your body. Whether an antibiotic is taken appropriately for a bacterial infection or taken inappropriately for a viral infection, antibiotics kill off thousands of friendly bacteria. With less competition from the harmless, “friendly” bacteria, the newly mutated, antibiotic-resistant “super germs” can proliferate more freely. These organisms could make you ill or hang around to bother you later.

The consumer group, Center for Science in the Public Interest, estimates that 20% of the U.S. population is at risk for infections because of weakened immune-defense systems. This population group includes children, the elderly, people on cortisol-like medications, cancer patients and people with AIDS. A person infected with an antibiotic resistant super germ will need a stronger antibiotic that may have unpleasant side effects and may need to be administered intravenously. In extreme cases, there are no effective antibiotics. You can also pass these super germs on to classmates and coworkers. No wonder drug-resistant bacteria have become a major public health concern!

Birth DefectsSome of the antibiotics used to treat urinary tract infections during pregnancy may increase the risk of several birth defects if a woman uses them early in pregnancy, a new study in the Archives of Pediatrics & Adolescent Medicine shows. Researchers found an increased risk for two classes of antibiotics: sulfonamide (example: Bactrim) and nitrofurantoins (example: Macrobid). But the antibiotics pregnant women are most likely to be prescribed, the penicillins and erythromycins, appeared to be safe.

What you can do

Be smart with antibiotics
When you or your child is sick, tell the doctor that you are not expecting to receive an antibiotic unless it’s necessary. Surveys show that doctors often prescribe antibiotics because they assume you will be disappointed if you don’t get one. Surveys also show that most patients don’t want unneeded antibiotics and welcome a simple explanation.

Take antibiotics exactly as prescribed
If you do need a prescription, take all the pills as directed. Even if you feel better, continue to take the full prescribed dose.

Don’t self-prescribe
Don’t take leftover antibiotics and don’t borrow antibiotics or give antibiotics to another person.

Manage without antibiotics
Your doctor can suggest ways to help manage a viral infection and its symptoms. In most cases, a viral infection resolves on its own. Of course, always contact your physician if the illness seems to worsen or has the usual characteristics of a bacterial infection.

Here are some suggestions from Breaking the Antibiotic Habit: A Parent’s Guide to Coughs, Colds, Ear Infections and Sore Throats:

Colds

  • saltwater nose drops
  • elevate head while sleeping
  • drink adequate fluids
  • rest
  • blow nose as needed
  • vitamin C
  • zinc
  • chicken soup
  • echinacea

Coughs

  • moist air (humidified)
  • adequate fluids
  • rest
  • warm liquids (soup, tea)
  • cough drops

Sore throats

  • saltwater gargles
  • cold drinks
  • popsicles and ice chips
  • medicated throat lozenges
  • honey served in warm tea
  • analgesics or analgesic spray

Use common sense around food
Reduce the chances of picking up illnesses through food. Avoid drug-resistant bacteria and residues of antibiotics on food by following these steps:

  • Wash hands, utensils and surfaces with hot, soapy water before and after food preparation.
  • Wash raw fruits and vegetables thoroughly before eating.
  • Separate raw meat, poultry, eggs and seafood from ready-to-eat foods.
  • Cook food completely. Cook eggs until both the yolk and white are firm.
  • Refrigerate or freeze perishables and leftovers within two hours.

Outlook for antibiotics

World Health Organization warns that "the gap between [microbes'] ability to mutate into drug-resistant strains and man's ability to counter them is widening fast." Pharmaceutical companies continue to search for newer antibiotics that will overcome resistance. Scientists are also trying to modify existing antibiotics, like penicillin, to make them more effective.

Take care of yourself and your family. Treat antibiotics as a precious resource to be used only when needed.

Resources

What is Antibiotic Resistance and Why Is It a Problem?
Alliance for the Prudent Use of Antibiotics
  

Get Smart about Antibiotics

Resistance to Antibiotics
American College of Physicians

Centers for Disease Control and Prevention
www.cdc.gov/drugresistance/  

More Info on Antibiotic use and Abuse