Bacterial Resistance

With the vast over-use of antibiotics in the last few decades in this country, many bacteria are evolving to become resistant to most of the known antibiotics. In a few years we may be heading for a new era in medicine, the so-called Post-Antibiotic Era. It is predicted that bacteria will become resistant to all antibiotics in the next few decades, or sooner if the current trend of over-use continues. This means that common infections like strep throat or pneumonia will very commonly result in death, just as they did in the Pre-Antibiotic Era.

Amazingly, a recent survey (2006) showed that 58% of adults are totally unaware that over-using antibiotics poses a danger to themselves and to their community.




Here are some scary recent developments:

1. Bacteria have learned to "use the net". Not on computers, but by passing their DNA back and forth even different species of bacteria can get the DNA code for antibiotic resistance, just as easily as we get information off the internet.

For example, normal bacteria in your intestines get exposed to all the antibiotics that you have taken over time. The ones that evolved to become resistant survive, while the others are killed off by the antibiotics. Then you get a few pneumococci in your lungs for a mild case of pneumonia. Ordinarily a short course of penicillin would cure you. But your intestinal bacteria have shared DNA with these pneumococci so they now have become resistant to most of the known antibiotics! Now you are in trouble. If you are lucky enough to get a good culture and sensitivity test, you might find a drug that will work, but that may mean a long stay in the hospital and weeks of IV therapy with more dangerous drugs.

Your own common germs can become resistant to antibiotics, then pass that resistance to dangerous germs that you might catch in the future.

2. Bacteria learn to get resistant quicker to related drugs. Once resistant to one drug, it is easier for your bacteria to get resistant to other antibiotics that are similar. For example, many bacteria that are resistant to penicillin are very quick to become resistant to the cephalosporins (synthetetic penicillins). These used to be the main "back-up" when bugs got resistant to penicillin.

3. Doctors are accelerating this process by prescribing antibiotics when they are not necessary. Conditions like colds, flu, viral sore throats, bronchitis and viral pneumonia are all caused by virus infections. Antibiotics have no effect whatsoever against viruses. Not even a very slight effect. They don’t help you get better a day sooner, or an hour sooner or even one second sooner! They have zero effect. Antibiotics should never be used for these conditions.

Every time you use an antibiotic for these conditions you are accomplishing only one thing: you are making the bacteria in your environment more resistant to antibiotics. Sadly, the vast majority of prescriptions for antibiotics fall into this category.

4. Even though we know that using less antibiotics will reverse the resistance problem, doctors refuse to stop over-prescribing. Recent studies have shown that there are several factors influencing doctors to over-prescribe. These include fear of being rejected by their patients if they don’t order enough medicine, fear of being sued (because they think it will make their patients angry if they don’t prescribe enough), ignorance of the problem of bacterial resistance, complacency (feeling that new antibiotics will save the day), ignorance about the fact that very few new antibiotics are being developed, fear that managed care systems will not pay them enough if they don’t over-prescribe.

5. The recent trend toward "managed care" forces doctors to over-prescibe antibiotics. Instead of practicing “high quality” medicine, doctors are forced to practice "high efficiency" medicine. This means handing out prescriptions for antibiotics (two minutes) is much more efficient than explaining to a patient why an antibiotic should not be used (ten to twenty minutes). Managed care also rewards doctors who get high approval ratings from their patients. Doctors feel that if they explain the danger of antibiotic over-use to their patients, it may make sense to some, but others will be dissatisfied, and even a minority of dissatisfied patients might ruin their approval ratings.

Even if you never take antibiotics, you could catch a resistant germ from your neighbor who abused antibiotics!

6. The really bad thing about bacterial resistance, is you can’t stop it by practicing good habits in your own family. You might never take antibiotics, ever, then get a bad infection that needs treating with an antibiotic. Guess what? It’s resistant to all known antibiotics! Why? Because you caught it from your neighbor who took antibiotics every time he got a cold or bronchitis. This is definitely a "community" problem. To some extent, you will be much better off than your neighbor who over-used antibiotics. He will get more infections and more resistant ones, but you are still at risk of getting what he has.

Day care centers have more resistant bacteria!

7. Day care centers are breeding some of the worst resistant bugs, such as MRSA. This is Multiply Resistant Staph Aureus. Formerly only found in hospitals with high antibiotic use, it is now commonly found in day care centers where so many kids are inappropriately treated with antibiotics for their many viral colds. This germ is very deadly if it gets into your lungs or bloodstream.

8. Government rules force doctors to over-prescribe antibiotics. In the last 10 years, CLIA (Clinical Laboratory "Inhibitory" Act) has severely limited the use of lab testing in doctors’ offices. Many doctors have stopped doing labs altogether, so they are unable do simple tests such as a throat culture. Instead, they just treat every sore throat with antibiotics, just in case it might be strep throat. Since only 10% of sore throats are due to strep, this means 90% of sore throats are being treated unnecessarily, greatly adding to our risk from resistant bacteria!

9. About half of the antibiotics used in the US are given to animals. This has important implications, since many human infections are caught from animals. We have heard a lot about Salmonella infections from poorly cooked poultry. In the past these infections could be treated with common antibiotics. Now, with the high use of antibiotics given almost indiscriminately to poultry and other animals, a high proportion of Salmonella is resistant to most antibiotics. In 1996, 34% of Salmonella were resistant to everything!

10. A recent report in the journalClinical Infectious Diseasespoints out that antibiotics are not benign medications! Adverse reactions to antibiotics account for 25% of all ER visits for drug reactions, or about 142,000 reactions per year in the United States. A severe reaction such as anaphylaxis (a type of allergic reaction) can result in death.

What can be done to reverse this alarming trend?

Parents and patients can have a positive effect by questioning any use of antibiotics recommended by their doctors. Does the doctor have reasonable proof that a bacterial infection is the cause of your illness? Are there any other treatment options?

We also need to pass the word around to other parents (and all your friends). Most parents have a slight idea that some bacteria are becoming resistant to antibiotics, but almost none of them understand how serious the problem is. In order to make any impact on doctors’ prescribing practices, a very large percentage of patients are going to have to start demanding better care from their own doctors.

Good News:You Can Make a Difference! In Finland and Iceland, two different studies have shown that drastically reducing the unnecessary use of antibiotics led to a major reduction in the percentage of resistant bacteria. At first this didn’t make sense to me. Once a bacteria is resistant (a super-bug), why would it go back to being normal again? The answer is that when no antibiotics are in the germs’ environment, a super-bug has no advantage in survival over all the normal germs. The normal ones are allowed to thrive and have lots of germ-babies who are also "normal". The super-bugs just get lost in the crowd, and their numbers drop off.

One last word of warning! If we wait too long to reverse the trend, the super-bugs will be the majority, and THEY will be the "normal" germs, and we will not be able to turn the tables as they have in Iceland and Finland. Time is running out!