| To the average person, antibiotic resistance may
not sound like that big of a problem, at least not one that can't
be easily solved. But there is no "quick fix." And many
medical researchers believe that a rapidly increasing resistance
to antibiotics is one of the world's most pressing health problems.
Since the 1940s, when the first antibiotic, Penicillin, became
available to the public, it and other similar "miracle"
drugs have been used over and over through the years to fight infectious
disease. Unfortunately, this has lead to the mind set that for every
infection, there's an antibiotic that can treat it.
And this public perception, along with the widespread availability
of these medications, is slowly creating a host of infections that
don't respond to antibiotics. Simply put ... the more they're
used to fight infection, the more resistant the infection becomes.
Recent Resistance Alarming
According to an annual World Health Organization (WHO) report,
about 14,000 people are infected and die each year as a result of
drug-resistant microbes picked up in U.S. hospitals. More
than 2 million Americans are infected each year and more than half
of these infections resist at least one antibiotic.
From 1975 to 1991, the incidence of methicillin-resistant Staphylococcus
aureus (MRSA) in U.S. hospitals increased from 2.4 percent to 29
percent. Staph bacteria can cause skin, heart valve, blood, and
bone infections that can lead to septic shock and death are showing
an alarming resistance to the methicillin class of drugs.
As MRSA spreads, the only choice left to doctors is the use of
Vancomycin, often called the drug of last resort for infectious
diseases. But there are already at least two documented cases in
the U.S. just in the last year in which an infection proved resistant
to the powerful antibiotic.
This is particularly devastating for patients with impaired immune
systems, like those with cancer and AIDS. About 90 percent of AIDS
patients who get multiple-drug resistant Tuberculosis (TB) die.
TB, a bacterial lung infection, has long been responsive to antibiotics.
But not anymore. WHO estimates that TB affects 7.5 million people
globally and kills more than 2.5 million people in each year. It
is the leading cause of death among infectious diseases. According
to the WHO, the pathogen infects one-third of all humans.
With an increasing number of TB strains testing resistant to antibiotic
therapy, New York City at one time was the U.S. city with the highest
number of TB infections. Just a short decade ago, NYC had a TB rate
of 222 per 100,000 people - more than 20 times the U.S. average.
At that time, NYC unfortunately also cared the distinction of being
the headquarters of the drug resistance problem, with 61 percent
of the national caseload in 1991.
It has also been estimated that about 40 percent of pneumococcus
germs - the source of sinus and ear infections and often cause bacterial
pneumonia, bloodstream infections and meningitis- are now resistant
to penicillin, up from about five percent in the 1980s.
The good news is that NYC's TB epidemic has decreased in recent
years because of programs that closely monitor TB therapy from start
to finish. But the problem, though smaller, still remains. About
five percent of patients at Harlem Hospital have drug-resistant
TB and about two to three percent have multi-resistant strains.
Remember the anthrax scare and the rush by many to stock up on
the powerful antibiotic, Cipro? Here again, research has begun to
show an increase in infections resistant to the drug.
Some medical causes of antibiotic resistance
So how does a physician decide if antibiotic treatment is necessary
for a patient? Actually, it's kind of a guessing game. If a doctor
isn't really sure of the source of infection, but thinks it's bacterial,
they often prescribe a broad-spectrum antibiotic. However, studies
suggest that these super antibiotics are best used for critically
ill patients - the ones who need treatment immediately.
The down side to this "broad" treatment is that while
it targets the "bad" bug, it also targets "good"
bacteria as well. In light of this, physicians are encouraged to
use the most "specific" antibiotic they can. But, in order
to do this, cultures must be obtained and tested to identify the
source. Many times these cultures and tests are not performed due
to time constraints, difficulty in obtaining a culture, expense,
etc.
Patients should not demand antibiotic prescriptions they might
not need. Studies show that doctors often dispense unnecessary
antibiotics because patients "think" they need it to get
better. Most of the infections antibiotics are prescribed to treat
clear up on their own.
According to a 1997 WHO study conducted in Europe in the mid 1990s,
many physicians said that patient pressure is the No. 1 reason why
they prescribed the wrong antibiotics. In the U.S. 95 percent of
the physicians surveyed had seen an average of seven patients in
the previous six months who had requested specific drugs as a result
of drug company advertising.
WHO's study concluded that primary care physicians who responded
to the survey about their own practice indicated that purulent discharge
and diagnostic uncertainty were the most important factors leading
to unnecessary prescriptions. The second most common reason was
to appease the patient. The study's findings conclude by suggesting
a more aggressive approached
The US Center for Disease Control and Prevention (CDC) estimates
that about one-third of the 150 million outpatient antibiotic prescriptions
written each year are unnecessary. A majority of these patients
suffer from colds and upper respiratory tract infections and other
ailments often caused by viruses.
And it can be harmful to take unnecessary antibiotics. Taking
antibiotics causes bacteria to become resistant. People who have
taken antibiotics recently are more susceptible to infections with
bacteria that are resistant and may pass them on to family members
and friends. It may also reduce the numbers of healthy bacteria
in your body, leaving you more susceptible to diarrhea, gas, and
bloating.
Still one of the main problems that has allowed the resistant bacteria
to spread on a global scale is that many major drug companies are
focusing their efforts on finding cures for chronic diseases like
Alzheimer's, heart disease and other chronic disease. For example,
most scientific breakthroughs have been largely confined to finding
a cure for cancer and finding an anti-viral agent that could be
used in the treatment of AIDS.
What role does the agricultural use of antibiotics play in this
dilemma?
While medical misuse of antibiotics is thought to be largely responsible
for the increase in antibiotic resistance, another major source
is thought to be the current high agricultural use. Some of our
most powerful antibiotics are mixed into the daily feed for
our farm animals.
About 50 percent of antibiotic production in the U.S. is used to
prevent disease, encourage growth, and treat sick livestock, as
well as poultry. Penicillin and Tetracycline make up about 80 percent
of that total. Some antibiotics are also used as crop pesticides.
But although the U.S. government, along with the FDA, etc., has
requested studies into this issue, we are not aware of any formal
action that has yet been taken in an attempt to solve these health
threats from America's heartland.
What about the use of antibacterials in the home?
Unlike antibiotics, antibacterials are most often found in products
such as detergents, soaps, health and skin care products, and household
cleaners. But because of their rapid killing effect, the non-residue
producing antibacterial agents are not believed to create resistant
bacteria.
Some experts believe that the use of these agents create a false
sense of security that may cause people to lay off their personal
hygiene habits.
It should always be remembered that most bacteria are harmless
and in many cases, even beneficial. However, constant use of disinfecting
agents tends to disrupt the normal bacteria that act as barriers
against invading pathogens. This could possibly cause a shift in
the bacterial population and create a place for disease-causing
bacteria to enter and establish infection.
On the subject of hand washing, the Alliance for the Prudent Use
of Antibiotics states that in most cases, washing with regular
soap and water and rinsing with running water, followed by thorough
drying is still considered the most effective way of preventing
disease transmission
What's being done to combat the problem?
Increasing public awareness of the hazards associated with the
misuse of antibiotics is one of the most important methods currently
being utilized by organizations like the American Medical Association
and many other concerned groups. This educational campaign has focused
on raising physician awareness on the dangers of inappropriate antibiotic
over prescribing and encouraged to share this information with their
patients.
And there has been some success in that area. In a survey conducted
by the National Ambulatory Medical Care, about 3,000 office practitioners
were asked to record patient visits, and what they prescribed, for
a week.
In the 1989-1990 survey, the average annual number of antimicrobial
drugs prescribed in offices to children under age 15 was 45.5 million.
A decade later, the number had dropped to 30.3 million. The rate
of prescriptions fell from 838 to 503 - a decrease of 40 percent.
The rate of children's visits to the doctors that resulted in antibiotic
prescriptions fell from 330 per 1,000 visits to 234 per 1,000 visits
- a decrease of 29 percent.
But although doctors are responsible for writing the prescriptions,
the support of many other groups are also needed to attack this
problem from all fronts - from global organizations to federal agencies
and even state and local health departments. But, ultimately, success
relies on education. These include policy makers, parent and consumer
groups, pharmacist and nurse organizations, and health plans and
managed care organizations.
By increasing public awareness of the potential severity of these
antibiotic -resistant infections, perhaps more public pressure will
result in an adequate amount of funding being appropriated for research
into a new class of super drugs. Sadly enough, scientists say that
much of the funding needed now for research and development is being
used to investigate more chronic diseases.
Some basic guidelines for antibiotic use
- With cold and flu season officially here, clinics will be filled
with patients looking for some relief. But antibiotics do not
work against colds or flu. They are caused by viruses. Do
not request antibiotics from your doctor unless you have a specific
bacterial infection.
- Most sore throats are also caused by viruses. One exception
is strep throat, which is caused by bacteria. A throat culture
can diagnose strep and antibiotic treatment is needed.
- Viruses are almost always the culprit behind most coughs
and bronchitis. However, if symptoms last for more than
two weeks or if the patient has a respiratory condition, they
need to see a doctor to determine if an antibiotic is needed.
- Sinus infections are one of the most common complaints
seen by physicians. These can be caused by bacteria or viruses.
One common misconception is that if the symptoms include yellow
or green mucus, it's a bacterial infection. Not necessarily. A
virus could be the cause. However, antibiotics should only
be used for a SEVERE infection, or one that lasts more
than two weeks because that one is probably being caused by
bacteria.
- When an antibiotic is prescribed, it is extremely important
to take ALL of the doses as directed. Too many people quit
taking their prescription when they begin to feel better. Some
then decide to save the remaining meds for the "next"
time that they get sick. However, if the full round of medication
is not taken, the "remaining" bacteria could bring the
infection back worse than ever. The best defense against an
infection is to take the prescribed number of doses on the prescribed
schedule. (However, one problem that should be noted here is that
in a recent survey of patients who have been subscribed antibiotics,
many say they were never told the importance of finishing the
medication.)
- Use regular soap and water for washing. Avoid products
with antibiotic ingredients on the labels.
- Eat live culture yogurt or probiotics containing acidophilus
bacteria after finishing a course of antibiotic treatment. These
products will help build up the healthy bacteria in your body.
- You can buy meat and eggs from animals that weren't fed
antibiotics. This reduces farm use, and promotes farming that
relies on clean living conditions for the animals.
Links:
AMA
Report on Antibiotic Resistance
JAMA
on Cipro (Ciprofloxacin) Resistant Infections
FDA
Article on Agricultural Antibiotic Overuse
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This document is provided for information only; it is not intended
to diagnose symptoms, prescribe treatment, or to substitute for
consultation with a physician. While we have made every effort to
ensure that this information is accurate and extensive, only your
doctor can tell you if a medication, or drug combination, is safe
for you. Information intended for US residents only. |
