Misuse of Antibiotics Is Killing Us

[Guest guest]

Misuse of Antibiotics Is Killing Us

Antibiotics are no longer the " wonder

drugs " that cure all that ails us. In fact, this very notion spurred

what is now a major public health concern -- antibiotic resistance.

Virtually all important bacterial infections in the US and throughout the

world are becoming resistant to the drugs created to eradicate them. As a

result, new strains of resistant bacteria such as mycobacterium

tuberculosis, E. coli and methicillin-resistant Staphylococcus

aureus (MRSA) have emerged, with the potential to infect healthy

people of all ages. While the issue of antibiotic overuse has been in the

news off and on for years, significant change has not yet occurred, so

it's time to bring the issue to light again. What can be done about this

problem, and how can we protect ourselves?

A MAJOR PUBLIC HEALTH CONCERN

Antibiotic resistance is taxing our heath care system and threatening our

well-being. According to statistics from the Centers for Disease Control

and Prevention (CDC), more than 70% of bacteria that caused

hospital-acquired infections (where patients become ill after being

exposed to the organism in the hospital) are now resistant to at least

one of the antibiotics commonly used to treat them. Infections from

drug-resistant organisms can cause longer hospital stays and often

require treatment with drugs that may be less effective, more toxic

and/or more expensive.

The problem extends to common bacterial infections that were once easily

treatable with antibiotics, such as pneumonia, ear infections, diarrhea,

urinary tract infections and skin infections, such as cellulitis and

boils. New strains of bacteria can quickly spread in the community among

people in close physical contact, such as family members, schoolmates and

co-workers.

ANTIBIOTIC RESISTANCE: A PROBLEM OF NATURE AND NURTURE

What causes antibiotic resistance? The answer is part nature, part

nurture. Bacteria spread and replicate quickly and are able to adapt to

their environment via a genetic mutation that can arise to help them

survive in the presence of an antibiotic drug. Although the drug will

inhibit the growth and survival of susceptible bacteria, some resistant

ones may survive, which will then quickly become the dominant bacteria.

 

We humans have no control over the natural adaptability of bacteria, but

widespread and sometimes inappropriate use of antibiotics has amplified

antibiotic resistance. We've been using them too much, and often when

there's no confirmation of a bacterial infection. According to N. Kent

Peters, PhD, program officer for Antibacterial Resistance Program in the

Division of Microbiology and Infectious Diseases at the National

Institute of Allergy and Infectious Diseases (NIAID), part of the

National Institutes of Health (NIH), " any time we use an

antimicrobial, we create an opportunity for resistant

organisms. "

There are many examples of how physicians and patients inappropriately

use antibiotics. For instance, patients often ask for, and physicians

often prescribe, antibiotics to treat non-bacterial illnesses for which

they are completely ineffective, such as the common cold, most sore

throats, most ear infections and the flu. Although antibiotics are widely

prescribed to treat sinus infections, a study published in Journal of

the American Medical Association in the December 5, 2007, issue found

that they were not effective in treating them. In the study, 240 acute

sinus infection sufferers were assigned to one of four groups for

different treatments -- a full antibiotic (amoxicillin) course for one

week combined with steroid spray for 10 days... just the spray and a

placebo " antibiotic " ... just the amoxicillin and a placebo

spray... or placebo for both. Neither the antibiotic or steroid, alone or

in combination, proved effective in treating sinus infection. (It is,

however, important to recognize that despite these results, sometimes

antibiotics are necessary -- meningitis is a rare but real risk from

acute sinusitis.)

In other instances, doctors prescribe antibiotics even though they have

incomplete diagnostic information, either because they feel pressure from

their patients to do so or because they want to play it safe. Four years

ago, the American Academy of Pediatrics and the American Academy of

Family Physicians issued guidelines for treating acute otitis media (ear

infections) that recommend a " wait and see " approach for

children over the age of two whose ear infections are not severe. A

recent study published in Pediatrics in August 2007 found that

while over 80% of physicians considered the guidelines reasonable, only

15% actually adhered to them. Physicians cited parental reluctance as the

top barrier, as well as cost and difficulty in following up, so they

continue to prescribe antibiotics prophylactically.

Beyond the misuse of antibiotics, an assortment of other factors have

also contributed to the antibiotic resistance problem...

 

Scientists believe the addition of antibiotics to agricultural feed

promotes drug resistance. Hospitals provide fertile environments for antibiotic-resistant germs

because close contact among sick patients and extensive use of

antibiotics in these settings cultivate resistant bacteria. Our longevity puts us at risk. Living longer and undergoing more

invasive procedures make us vulnerable to infections.

Invasive and elective surgery, intensive care units and a variety of

catheters and other medical insertions are all avenues for infection.

 

As a result of all of these factors, several drug-resistant bacterial

infections have emerged in recent years, including tuberculosis,

gonorrhea and MRSA. The community associated MRSA (CA-MRSA) has made

headlines lately. " While MRSA is a great concern because of its

prevalence, we still have a few tools left to treat it, such as

Vancomycin, which must be given intravenously, daptomycin, another IV

drug, and Linezolid, which is given orally, " said Dr.

Peters.

 

SCIENTISTS SEARCH FOR NEW STRATEGIES

The NIAID is exploring new diagnostic techniques that would provide

physicians with more precise information about diseases sooner, so

antibiotics could be prescribed more effectively, said Dr. Peters. This

should reduce the inclination to prescribe broad-spectrum antibiotics or

prescribe an antibiotic " just in case " there is a bacterial

infection. NIAID researchers are also exploring ways to maximize the use

of antibiotics that are currently on the market and are still effective,

perhaps by prescribing them for a shorter duration when the infection is

known to respond more quickly to treatment.

A CALL TO ACTION: WHAT CONSUMERS CAN DO

To learn more about what consumers can do about antibiotic resistance, I

spoke with Stuart B. Levy, MD, professor of medicine, molecular biology

and microbiology at Tufts University School of Medicine in Boston,

Massachusetts, and author of

 

The Antibiotic Paradox. He shares Dr. Peters' concern about

the situation. " We're seeing new resistances popping up to new

drugs; bacteria acquiring more resistances in addition to the ones they

already have; and the spread of resistant bacteria among different

populations, especially in hospitals. In terms of general use, people are

still relying on them for viral illnesses, for which they have no

effect. " He said he's seen evidence of positive change in

pediatrics, though: " There's a little less immediate use of

antibiotics for pediatric ear aches, and more of a wait-and-see at least

24 hours approach. "

According to Dr. Levy, the first critical step in combating antibiotic

resistance is understanding when antibiotics are useful and when they are

not. Most importantly: Infections caused by viruses, such as colds

and flu, should not be treated with antibiotics. Other tips:

 

If you are sick, ask your doctor whether an antibiotic is likely to

help your illness. Do not demand antibiotics from your doctor if he/she

says it's not necessary.

Take antibiotics exactly as the doctor tells you. Complete the

prescribed course of treatment, even if you are feeling better. Do not save some of your antibiotic for the next time you get sick.

Discard any leftover medication, if you have to discontinue the drug. Do

not keep it to take at some point in the future.

Do not take an antibiotic that is prescribed for someone else.

 

Personal hygiene goes far to avoid catching an antibiotic-resistant

infection. " Cleanliness is key, " said Dr. Levy. " Wash your

hands frequently and before you eat. " Plain old soap and water are

best... alcohol-based sanitizers are a good second choice.

Dr. Levy's final words of wisdom: " Respect antibiotics. They exist

for specific purposes, and they are not here to be

misused. "

Source(s):

N. Kent Peters, PhD, is program officer for the Antibacterial Resistance

Program in the Division of Microbiology and Infectious Diseases at the

National Institute of Allergy and Infectious Diseases (NIAID), a

component of the National Institutes of Health.

Stuart B. Levy, MD, is professor of medicine, molecular biology and

microbiology, as well as director of the Center for Adaptation Genetics

and Drug Resistance at Tufts University School of Medicine in Boston,

Massachusetts. Dr. Levy has published over 300 articles in the areas of

antibiotic resistance and infectious diseases. He is author of The

Antibiotic Paradox, now in its second edition and translated into

five languages. Dr. Levy is President of the Alliance for the Prudent Use

of Antibiotics and co-founder and Chief Scientific Officer of Paratek

Pharmaceuticals Inc.