Antibiotics are one of the greatest advancements in modern medical history. When penicillin was discovered in 1928, it changed everything. Infections that had once been lethal were now curable. As time went on and more antibiotics were discovered, health improved. In 1967 the U.S. Surgeon General claimed the end of the war on germs was near. However, that same year, the first descriptions of the “superbug” MRSA (methicillin-resistant Staphylococcus aureus) were made public. Since that time, resistance by germs to antibiotics has continued to rise, putting these revolutionary medicines in peril of no longer being able to cure illnesses.
Resistance appears as the germs encounter antibiotics. If the type of antibiotic chosen and the dose is incorrect, it exposes the patient without having the desired effect. This will afford the germs a preview, allowing them to mutate and become resistant. Later, when a patient has a bacterial infection, the kind that requires antibiotics to get better, the response will be poor or nonexistent. As the resistant bacteria grow in number, infections become harder and harder to treat, threatening to put our future right back in the past to an age when we couldn’t cure these illnesses and people died.
Why has this happened? Simple: antibiotic overuse. And while that explanation is only two words, the reason why so many antibiotics are used worldwide is pretty complicated. There are many factors, including over-the-counter access to them in many parts of the world; people becoming colonized with resistant germs by visiting hospitals and long-term care facilities to see loved ones; travel to distant areas of the globe; and frequent use of antibiotics in the animal agricultural world to maintain production. However, the harsh truth is: The issue is mostly due to inappropriate antibiotic use in U.S. medical settings.
Research has shown that half of all antibiotic prescriptions in the U.S. are unnecessary. This includes in outpatient settings, as well as in hospitals. In fact, about 50 million prescriptions a year written in the outpatient setting, such as doctor’s offices and clinics, are unnecessary. The reason? Most of these encounters are for vial illnesses (think colds and flu). Viral illnesses are cleared by the body’s immune system over time and are not killed by antibiotics. They are the most common infections that we see but there is generally no effective treatment and they definitely will not be cured by antibiotics. The impact of all these unnecessary prescriptions is worrisome: two million resistant infections per year that result in long hospital stays, more complications and nearly 25,000 unanticipated deaths.
There are additional problems with using antibiotics unnecessarily. The medication may wash out the good germs that generally reside in the gut and keep the body balanced. This allows resistant germs or other microbes to fill that space, resulting in additional infections, such as Clostridium difficile, which can cause severe diarrhea and even death. In addition, antibiotics aren’t without side effects. About 1 out of every 5 emergency department visits is due to adverse drug events, and these reactions are the most common cause of ED visits in children under 18.
So why do we prescribe antibiotics unnecessarily? Truthfully, it can be very hard to know if an illness is bacterial or viral. There may be clues on examination or found in some lab tests, but overwhelmingly in otherwise healthy children, the odds are good that they have common viruses. However, that doesn’t mean they don’t feel poorly, or have fevers and rashes; and that certainly doesn’t mean they aren’t contagious. These things generally get people to the doctor, especially when it comes to children who are not yet talking and cannot say what is hurting them. The uncertainty of diagnosis paired with parental or caregiver concern frequently results in a prescription being written. Within a few days, people feel better as the virus naturally begins to resolve, and they attribute the improvement to the antibiotic rather than nature’s course. Then, the next time they contract one of the more than 2 million viruses that inhabit the Earth, they will want an antibiotic and the cycle continues.
All over the country, people are working on improving the use of antibiotics through efforts known as antimicrobial stewardship. These are doctors and pharmacists who are employing their knowledge to make sure people get antibiotics only when the drugs will be helpful, and at the right dose, with the right drug and for the appropriate duration. While many hospitals already have these teams, the federal government, realizing the impending disaster of germs that cannot be treated, is mandating these programs across the country.
There are several ways patients and families can help control the overuse of antibiotics and prevent continued development of superbugs. The first is to discuss the need for antibiotics with care providers. By not insisting on a prescription or a stronger antibiotic and exploring alternate therapies, many of the 50 million unnecessary prescriptions and their side effects can be avoided.
When a bacterial infection is present and an antibiotic is necessary, it should be taken exactly as prescribed, at the right time and for the right number of doses and days. Unused medication that remains after an illness should be discarded immediately and never saved for use at a later date, when it may not be as effective and might promote resistance. Medication should not be used by anyone except the patient for whom it was prescribed. Failure to improve on therapy should be determined by a repeat doctor visit so that unnecessary medication changes do not add to the possible development of resistant germs.
In addition to medication, patience is truly needed during a febrile illness. Viruses have a natural course of evolution and can take a days to show improvement and even weeks to totally clear. This is expected, even if it is annoying. By being proactive, like getting vaccinated for many of the viral illnesses that are part of the required immunizations, we can prevent illnesses with serious complications and avoid suffering long bouts of symptoms.
In addition, the remedies many adults remember their grandmothers employing still have a place in modern medicine. Consuming fluids, using cool mist vaporizers, gargling, eating Popsicles and suctioning the nose can all help relieve symptoms without bringing the dangers of unnecessary medication into play. And when non-antibiotic medications are used, such as fever reducers and decongestants, they should be used according to age specifications for best results and limited side effects.
While there are fewer and fewer new antibiotics in the drug pipeline, protection of the ones we currently have in our germ-fighting arsenal is critical. The government and Centers for Disease Control and Prevention will continue to roll out initiatives and programs to assist us to ” Get Smart about Antibiotics.”
Along the way, we should listen to our grandmothers and stick to feeding a fever and starving a cold — without putting antibiotics on the menu.
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Antibiotics Are Losing Their Effectiveness: What You Can Do originally appeared on usnews.com
