Antibiotics can save your life, but if misused, they can kill you. How can these wonder drugs – that cure infections and make organ transplants possible – be harmful? The reason is a growing, worldwide problem called antibiotic resistance.
Antibiotic resistance means antibiotics don’t work as well as they used to or don’t work at all. Bacteria have the ability (by mutating) to be stronger than and overpower the drugs designed to kill them. As soon as antibiotics were developed about 75 years ago, bacteria began to develop resistance.
Like no other drug, antibiotics used by one person can reduce its effectiveness in another person. The more antibiotics are used, the more quickly bacteria change and develop resistance. Some bacteria can change every 40 minutes. Antibiotic resistance occurs as part of the natural process of evolving bacteria. Resistance can be slowed, but not stopped.
We will always need new antibiotics to stay ahead of changing bacteria. Bacteria are emerging or changing faster than the development of new antibiotics. Several key antibiotics are already useless for specific infections such as pneumonia or staph. More than 2.25 million people a year get a serious infection from bacteria that is resistant to one or more antibiotics. At least 23,000 to 38,000 Americans die annually as a direct result of antibiotic-resistant infections. The additional cost of treating these infections is more than $70 billion a year.
Patients receiving antibiotics have a seven- to 10-fold increased risk of developing Clostridium difficile infection (CDI). CDI alone accounts for 453,000 infection cases and 15,000 deaths annually; plus $1 billion in direct health care costs.
Methicillin-resistant Staphylococcus aureus (MRSA) kills more than 19,000 Americans every year – more than emphysema, HIV/AIDS, Parkinson’s disease and homicide combined.
The threat caused by antibiotic resistance is especially dangerous in Arkansas. The Centers for Disease Control and Prevention (CDC) ranks Arkansas sixth in the nation in number of antibiotics prescribed to humans. The CDC says there are 1,155 antibiotic prescriptions per 1,000 Arkansans, compared to the national average of 835 per 1,000 Americans.
Overprescribing antibiotics and prescribing them when they cannot help are the two main causes of antibiotic resistance. This misuse also occurs in our pets and in livestock used for food. About half of all antibiotics used by children and adults, as well as in animals, are unnecessary or ineffective as prescribed.
Antibiotics can also cause harmful side effects. They 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 allergic reactions and interfere with other drugs you’re taking for another condition. They are also responsible for a potentially deadly diarrhea that causes 14,000 deaths a year.
Many of the advances in medical treatment 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. These can include joint replacements, cardiac bypass, organ and bone marrow transplants, cancer therapy, dialysis, and treatment of chronic diseases such as diabetes, asthma and rheumatoid arthritis.
What you can do
- Ask your doctor if there are tests that can confirm if you have an infection caused by bacteria before taking an antibiotic. Viruses cause colds, flu, coughs, bronchitis, sore throats (except strep throat) and some ear infections. Antibiotics are useless against these viral infections. Taking antibiotics for a virus-caused illness not only wastes money, but even worse, it could set you up for antibiotic resistance in the future.
- Don’t pressure your doctor to prescribe antibiotics. Especially during the winter months, doctors’ offices are full of people with illnesses caused by viruses such as the common cold. Many patients ask for or expect an antibiotic prescription. Health care providers want to satisfy a patient’s expectations for antibiotics. This expectation must change if we expect antibiotics to work in the future.
- Try to change the way you think about antibiotics. Don’t expect an antibiotic prescription from your doctor for every cough or sniffle. The attitude that, “maybe I don’t need it, but it can’t hurt” is wrong and dangerous. Think of antibiotics as a precious resource that should only be used when absolutely necessary. About half of all antibiotics used in children and adults, as well as in animals are unnecessary and not effective as prescribed.
- Consider reducing your use of antibiotic products such as soap, household cleaning products, disposable wipes or hand sanitizer. 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 become resistant to medications.
- Consider buying antibiotic-free fish and meat. Food-producing animals are routinely given antibiotics to promote growth and prevent illness, even when they’re not sick. Animals’ resistance is a prime contributor to antibiotic resistance in humans. The U.S. Food and Drug Administration says there are more antibiotics sold in the United States for food-producing animals than for humans. When people eat meat, fish or poultry from animals that have resistant bacteria, antibiotic-resistant infections can spread to humans. Fresh produce irrigated by water contaminated by animal wastes can also spread antibiotic-resistant bacteria to humans.
- Pets can contribute to antibiotic resistance in humans. Through contact with pets, their waste products or bedding, humans can be infected with antibiotic-resistant bacteria. Ask your vet to order lab tests before prescribing antibiotics for your pets.
- Prevent infections. Prevention is the best way to slow the spread of resistant bacteria. Wash your hands frequently because it’s the most effective way to prevent infections. Always wash your hands after contact with animals or their waste products. Avoid touching your eyes, nose or mouth – even if your hands are clean. Keep your immunizations current, including an annual flu shot, tetanus booster every 10 years and pneumonia shots, 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 by your doctor. Don’t skip doses; take all the pills even if you start feeling better. If you stop too soon it can allow bacteria to survive and re-infect. Never take antibiotics prescribed for someone else. The wrong medicine may delay correct treatment and give bacteria time to multiply.
- Be patient with viral infections. Give yourself time to rest and heal. Treat viral infections with rest, extra fluids, a vaporizer and acetaminophen or ibuprofen for pain. Don’t infect others by going to work or school when you’re ill.
- Practice safe sex. Sexually transmitted infections have become much more common and harder to cure with antibiotics. Safe sexual behaviors include abstinence, mutual monogamy, and correct and consistent condom use.
- Antibiotic stewardship is crucial. Use doctors, hospitals and clinics that practice antibiotic stewardship. Antibiotic stewardship means only using antibiotics to treat disease, choosing the right antibiotic and administering them in the right way and in every case. Good stewardship should include the dose, duration and indications on all antibiotic orders, prescribing based on a lab culture and reassessing antibiotic use after 48-72 hours. If it’s not working it needs to be stopped and another antibiotic prescribed.
Developing new antibiotics
Relying on the drug industry to develop new antibiotics is not an immediate solution. The number of new antibiotics has steadily decreased in the past 30 years. Only eight antibiotics have been approved since 2000. Each of them is already experiencing some degree of resistance.
There’s very little chance of making a profit on a new antibiotic. The failure rate for antibiotics from discovery to drug approval is 97 percent. Because hospitals tightly control new antibiotics so they can prevent resistant bacteria, 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.
When resistance limits first- and second-line antibiotics, third- or fourth-line antibiotics are used. These are more toxic, less effective and frequently more expensive.
Antibiotics can produce miracles in transplant surgery, cancer therapy and in the fight against infectious diseases. However, overuse and misuse of antibiotics comes with a serious and growing threat to our nation’s health and security. Some bacteria seem to be able to resist any antibiotic we throw at them and new antibiotics are not being developed fast enough. The only solution to this potential disaster is to more effectively use the antibiotics we have. The safe use of antibiotics begins with YOU.