Antibiotic resistance is an urgent threat to public health worldwide. Every year, at least two million people get a serious infection from bacteria that is resistant to one or more antibiotic drugs. At least 23,000 people die annually as a direct result of antibiotic-resistant infections. The additional cost of treating these infections is more than $70 billion a year. An additional 14,000 deaths occur annually as a result of C. difficile infections. It is caused when antibiotics kill the normal healthy bacteria what would prevent it.
Several key antibiotics are already useless for specific infections such as pneumonia or staph. According to Lauri Hicks, medical director of the Centers for Disease Control and Prevention (CDC), “We should be thinking of antibiotics not as a magic bullet, but as a precious resource that we should only use when absolutely necessary.”
Bacteria, viruses and parasites are emerging at a rate that is currently outpacing the development of effective new drugs. Methicillin-resistant Staphylococcus aureus (MRSA) alone kills more than 19,000 Americans every year – more than emphysema, HIV/AIDS, Parkinson’s disease and homicide combined.
What causes resistance?
Antibiotic resistance means that antibiotics used to treat infections don’t work as well as they used to or don’t work at all. Since antibiotics were first used to treat infections in the 1940s, bacteria have shown a relentless ability to become resistant to every antibiotic. The more antibiotics are used, the more quickly bacteria change and develop resistance. Some bacteria can change every 40 minutes.
When you take an antibiotic or even use antibacterial soap or hand cleaners, bacteria are killed, but resistant germs may be left to grow, multiply and cause more illness. In addition to bacteria, many fungi, viruses and parasites have adapted and no longer can be stopped by antibiotics.
Antibiotic resistance occurs as part of the natural process of evolving bacteria. It can be slowed but not stopped. Humans will always need new antibiotics and new diagnostic tests to track the development of resistance.
Antibiotics are powerful drugs but they can cause harm. Antibiotics are responsible for 20 percent of emergency department (ED) visits for adverse drug events; they are the most common cause of ED visits for adverse drug events in children. Antibiotics can cause side effects including allergic reactions and interfere with other drugs you’re taking for another condition.
Antibiotic resistance is a growing threat to public health for several reasons:
- Overprescribing and prescribing antibiotics when they cannot help are the two main causes of antibiotic resistance. About half of all antibiotics used in children and adults, as well as in animals is unnecessary and ineffective as prescribed.
- Antibiotics only work on bacterial infections. But, many patients have a mistaken belief that antibiotics can cure all infections. Especially during the winter months, doctors’ offices are full of people with illnesses caused by viruses such as the common cold. Even though antibiotics are powerless to fight viruses, many patients ask for or expect an antibiotic prescription. Health care providers can be too willing to satisfy a patient’s expectation for an antibiotic prescription. This expectation must change if we expect antibiotics to work in the future.
- Prescribing the wrong antibiotic or when it will not help happens too frequently. It can result from failure to order laboratory tests to confirm that bacteria are causing the infection.
- “The agricultural use of antibiotics in food-producing animals also contributes to the emergence, persistence and spread of resistant bacteria. Resistant bacteria can be transmitted to humans through the foods we eat,” according to the CDC. Antibiotic resistance is also present in other foods, in our pets and in the environment.
What you can do
- Prevent infections. Prevention is the best way to prevent the spread of resistant bacteria.
- Wash your hands frequently because handwashing is the most important action you can take to prevent infections. Avoid touching your eyes, nose or mouth – even if your hands are clean.
- Keep immunizations current, including an annual flu shot; pneumonia shot, if indicated.
- Practice safe food preparation. Use hot water and soap to keep your kitchen and utensils clean before, during and after food preparation. Avoid antibacterial cleaners.
- Take antibiotics exactly as directed and use them only when absolutely necessary. Don’t skip doses; take all the pills even if you start feeling better. Stopping treatment too soon can allow bacteria to survive and re-infect.
- Don’t ask for an antibiotic for a viral infection such as a cold, flu, most coughs and bronchitis, sore throats (except if caused by strep throat), and some ear infections. It will not help you get better. Taking antibiotics for an infection caused by a virus causes weaker antibiotics, the rise of diseases resistant to antibiotics, fewer effective antibiotics and increases your risk of developing a resistant infection in the future.
- Be patient with viral infections. Give yourself time to rest and heal. Treat viral infections with rest, force fluids, use a vaporizer and acetaminophen or ibuprofen for pain. Don’t infect others by going to work or school when you’re ill.
- Insist on a culture so your doctor can more accurately prescribe what will help, not harm you.
- Never take antibiotics prescribed for someone else. The wrong medicine may delay correct treatment and give bacteria time to multiply.
- Practice safe sex. Sexually transmitted diseases (STDs) have become much more common and harder to cure with antibiotics. Safe sexual behaviors include abstinence, mutual monogamy, and correct and consistent condom use.
- Ask for antibiotic-free meat, fish and poultry from your local grocery store. Antibiotics are widely used in food-producing animals. The U.S. Food and Drug Administration says there are more antibiotics sold in the United States for food-producing animals than for humans. This use contributes to the emergence of antibiotic-resistant bacteria in food-producing animals. People can develop antibiotic-resistant infections by consuming the meat or poultry from animals that carry resistant bacteria.
- Ask your veterinarian to limit antibiotic use in your pets.
- Antibiotic stewardship is crucial. Use health care providers, hospitals and clinics that practice antibiotic stewardship, including consumer and health care provider education about safe antibiotic use. Antibiotic stewardship means only using antibiotics to treat disease, choosing the right antibiotic and administering them in the right way in every case. Good stewardship should include the dose, duration and indications on all antibiotic orders, prescribing based on a culture and reassessing antibiotic use after 48-72 hours.
Developing new antibiotics
Relying on the pharmaceutical industry to develop new antibiotics is not a solution for the immediate future. The failure rate for antibiotics from discovery to drug approval is 97 percent. Because hospitals tightly control new antibiotics so they can prevent the emergence of newly resistant strains, new antibiotics are less profitable than other types of drugs. The industry cannot charge more for the new drugs to compensate for slow adoption because they must compete with older and less expensive generic antibiotics.
Medical advances could be lost
Many of the advances in medical treatment such as joint replacements, cardiac bypass, organ and bone marrow transplants, cancer therapy, dialysis, and treatment of chronic diseases (diabetes, asthma and rheumatoid arthritis are examples) depend on the ability to fight infections with antibiotics. If that ability is lost, many of the life-saving and life-improving medical advances will be lost.
When first- and second-line antibiotics are limited by resistance or are unavailable, third- or fourth-line antibiotics must be used. They are more toxic, less effective and frequently more expensive. Patients with resistant infections are much more likely to die. If they survive, they have significantly longer hospital stays, delayed recuperation and more long-term disability. Health care costs double when treating infections that are resistant to antibiotics.