Antibiotic Resistance, and How To Prevent It

What is the greatest threat to human health?

The answer may differ depending on who you ask, but some medical experts from Britain say that antibiotic-resistant bacteria pose a dangerous threat to human health. And our own Centers for Disease Control and Prevention (CDC) agree with them.

Although many bacteria are not dangerous to humans and many actually help humans (think about all the wonderful bacteria who live in your gut and help you digest your food), some bacteria can be life-threatening. To this point in history, we have been able to kill or control these bacteria with powerful chemicals called antibiotics.

But bacteria are not a stationary target: since they are living creatures, they can adapt to their environment and surroundings. Sometimes bacteria are not killed by antibiotics. These wounded bacteria, having been exposed to the powerful chemicals, go about learning how to survive another such attack.

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And we now know that bacteria share this information with each other.

So, the more bacteria are exposed to antibiotics, the faster they are able to adapt to them. This means that we have to be more and more careful about how we use antibiotics. Here are two ways: 1) Doctors have often prescribed antibiotics for conditions in which antibiotics cannot help, such as viral infections. For most viral infections, such as ear infections or colds or flus, the best course is to "wait and see", drink plenty of fluids, and look to chiropractic care for help maintaining proper nervous and immune system functions. 2) When a doctor prescribes a course of antibiotics, it is very important to take the proper dosage each day for the full number of days. If you stop taking the antibiotics too soon, it is likely that the full population of harmful bacteria will not have been eliminated. Just because you feel better does not mean that the course of treatment is completed.

Here are some comments made by England's chief medical officer, courtesy of the BBC:

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The chief medical officer, Prof Dame Sally Davies, said: "Antibiotics are losing their effectiveness at a rate that is both alarming and irreversible - similar to global warming.

"I urge patients and prescribers to think about the drugs they are requesting and dispensing. Bacteria are adapting and finding ways to survive the effects of antibiotics, ultimately becoming resistant so they no longer work. The more you use an antibiotic, the more bacteria become resistant to it."

To reinforce her message, Dame Sally has issued a list of "dos and don'ts".

These include:

• Do remember antibiotics should be taken only when prescribed by a health professional.
• Do complete the prescribed course even if you feel better, as not taking the full course encourages the emergence of resistance.
• Don't share antibiotics with anyone else.
• Do remember that antibiotics cannot help you recover from infections caused by viruses, such as colds or flu.

The HPA [England's Health Protection Agency] said the last point was one of the common misconceptions among the public.

Dr Cliodna McNulty from the HPA said: "We all seem to forget just how awful you can feel with a bad cold, let alone flu, and this maybe makes us think that we are more poorly than we really are and that we need antibiotics to get better.

"But this isn't the case and using your favourite over-the-counter medicines that can help to ease headaches, aching muscles and stop your nose running will make you feel a lot better."

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Our own CDC believes that this is no laughing matter, either. The CDC website lists factsheets on the dangers and prevention of antibiotic resistance, a link to guidelines on antibiotic stewardship, expert commentary on safe prescriptions of antibiotics, and much, much more.

The CDC also states that antibiotics are overprescribed for children. That is, children are given antibiotics even when the antibiotics will not help them. This is a very significant problem, because we know that there are serious consequences of antibiotic use in infants. The CDC's Morbidity and Mortality Weekly Report from September 2, 2011, summarizes these problems in the United States:

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What is already known on this topic?

Inappropriate antibiotic use contributes to antimicrobial resistance, a major health threat in the United States. Children frequently are prescribed antibiotics in U.S. physician offices and most typically for acute respiratory infections (ARIs), even though most ARI episodes do not require antibiotic treatment.

What is added by this report?

The antibiotic prescribing rate for persons aged ≤14 years in U.S. physician offices decreased 24%, from 300 antibiotic courses per 1,000 office visits in 1993–1994 to 229 antibiotic courses per 1,000 office visits in 2007–2008. However, in 2007–2008 ARIs still accounted for 58% of all office-based antibiotic prescribing, and prescribing rates for otitis media, sinusitis, and bronchitis had not changed significantly.

What are the implications for public health practice?

Antibiotic prescribing for persons aged ≤14 years in the United States remains inappropriately high. Further intervention is needed to decrease inappropriate antibiotic prescribing for this population.

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The CDC particularly noted that antibiotic prescription rates have not changed (but need to be reduced) for ear infections, bronchitis, and sinusitis. The CDC notes that antibiotic prescription rates have slightly reduced, but not far enough, for pharyngitis and the common cold. Remember, the common cold is caused by a virus, and antibiotics have no effect on viruses.

The CDC notes that physicians are often under pressure from their patients to prescribe antibiotics, even when the physician knows that the antibiotics won't help. If we are to prevent antibiotic resistance from becoming a rampant threat to human health, we all need to be educated about the problem and responsible in our antibiotic use.