Antibiotic Failure Involves Everyone … and Their Dog

Antibiotics are powerful, lifesaving medicines. However, when overused they can become tragically powerless against harmful germs. Overuse – in humans, pets and in agriculture – makes antibiotic resistance much more likely. It is increasingly one of the most dangerous threats to public health.

Antibiotic resistance happens when germs develop the ability to overpower the antibiotics created to kill them. It’s not your body that becomes resistant to antibiotics, but the infection-causing germs that become resistant.

It is very difficult – if not impossible – to kill antibiotic-resistant germs. Getting an antibiotic-resistant infection likely means a long hospital stay, multiple follow-up doctor visits, and often costly and toxic alternative treatments to cure the infection.

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.

 What causes resistance?

Like no other drug, antibiotics used by one person can reduce their effectiveness in another person. That’s because the more antibiotics are used, the more quickly bacteria can mutate and develop resistance. Some bacteria can change every 40 minutes. Bacteria are emerging or changing faster than the development of new antibiotics. As soon as antibiotics were first developed about 75 years ago, bacteria began to develop resistance. Antibiotic resistance is part of the natural process of evolving bacteria. Resistance can be slowed, but not stopped.

When you take an antibiotic or even use antibacterial soap, bacteria are killed, but some resistant germs are left to grow, multiply and cause more illness. In addition to bacteria, many fungi, viruses and parasites have also changed and can no longer be stopped by antibiotics.

Here’s how resistance happens. Germs enter your body and, for several reasons (age, poor health, chronic conditions, recent surgery), they overwhelm your immune system. Your doctor prescribes antibiotics that kill most of the bacteria. But, the resistant bacteria continue to multiply. They can give their antibiotic-resistant traits to other bacteria, making them resistant, too.

Your doctor may prescribe a second antibiotic, but it may meet similar resistance. When first- and second-line antibiotics fail, third- or fourth-line antibiotics are used. These are more toxic, less effective and 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 antibiotic-resistant infections.

More than 2.25 million people a year get a serious infection from bacteria that is resistant to one or more antibiotics. Several key antibiotics are already useless for specific infections such as pneumonia or staph. Patients receiving antibiotics have a seven- to 10-fold increased risk of developing a 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.

Who’s at risk?

Every one of us faces the potential risk of antibiotic-resistant infections. Every time antibiotics are used, there is risk for resistance to develop.

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 ineffective.

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.

In addition to overprescribing, risk is increased because of the widespread use of antibiotics in agriculture and production of meat, poultry and fish. Veterinary medicine also contributes to resistance through overprescribing for our pets.

Prevention is best strategy

To prevent more antibiotic resistance, we must use proven public health strategies: vaccines, infection control, food supply protection, antibiotic stewardship, and consumer and provider education. Try these successful prevention tips:

• You and your family should be current on all vaccines, including annual flu shots, tetanus boosters every 10 years and pneumonia shots, if indicated.
• Be patient with viral infections and give yourself time to rest and heal. Don’t infect others by going to work or school when you’re ill. Viral infections can be treated with rest, lots of fluids, using a vaporizer, and acetaminophen or ibuprofen for pain.
• Frequent hand washing is the best way to prevent infections. Always wash your hands after bathroom visits, before and during food preparation, changing a baby’s diaper, and contact with animals or their waste. Avoid touching your eyes, nose or mouth – even if your hands are clean.
• Prepare food safely. Use hot water and soap to keep your kitchen, utensils and countertops clean before, during and after food preparation. Avoid antibacterial cleaners.
• Practice safe sex. Sexually transmitted infections have become much more common and harder to cure with antibiotics. Safe sex practices include avoiding sex or having only one partner exclusively and always using condoms.
• Take antibiotic medicines exactly as prescribed. Don’t skip doses and take all the medicine even if you start feeling better. Stopping too soon allows bacteria to survive and re-infect. Never take someone else’s antibiotics because the wrong medicine may delay correct treatment and give bacteria time to multiply.

Tips to prevent resistance

• Limit prescriptions. Prescribing antibiotics too often or when they can’t help are the two main causes of antibiotic resistance. This misuse also occurs in our pets and in livestock. About half of all antibiotics used by children and adults, as well as in animals, are unnecessary or ineffective as prescribed, according to the CDC.
• Ask your doctor if a test can tell if your infection was 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 wastes money and sets 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 virus-caused illnesses, such as the common cold. Many patients ask for or expect an antibiotic. This expectation must change if antibiotics are to heal us in the future. Antibiotics can also cause harmful side effects. They are responsible for 20 percent of emergency department (ED) visits for drug reactions. They are the most common cause of children’s ED visits for drug reactions. Antibiotics can cause allergic reactions and interfere with other drugs you’re taking for another condition.
• Change the way you think about antibiotics. Many patients have a mistaken belief that antibiotics can cure all infections. Antibiotics only work on infections caused by bacteria. The attitude that, “maybe I don’t need it, but it can’t hurt” is wrong and dangerous. Using them when they cannot help is dangerous. Think of antibiotics as a precious resource that should only be used when absolutely necessary.
• Consider reducing your use of products that contain antibiotics 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.
• Consider buying antibiotic-free meat and fish. Food-producing animals are routinely given antibiotics to promote growth and prevent illness, even when they’re not sick. This is a key cause of 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 that has animal wastes can also spread antibiotic-resistant bacteria to humans.
• Pets 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 when your pets are sick.
• Antibiotic stewardship is crucial. Stay safe by using doctors, hospitals and clinics that practice antibiotic stewardship. Good antibiotic stewardship means only using antibiotics to treat disease, choosing the right antibiotic, administering it the right way every time, prescribing is based on a lab culture and antibiotic use is reassessed after 48-72 hours. If it’s not working, it needs to be stopped and another antibiotic prescribed.

Relying on the drug industry to develop new antibiotics is not an immediate solution. There’s very little profit in developing a new antibiotic. The failure rate for antibiotics, from discovery to drug approval, is 97 percent. Hospitals tightly control the use of new antibiotics to prevent resistant bacteria. Drug companies cannot charge more for the new drugs to compensate for slow adoption. New drugs must be priced to compete with older and less expensive generic antibiotics. Only about 10 new antibiotics have been approved in the past 20 years. Each of them is already experiencing some degree of resistance.

Overuse and misuse of antibiotics is a growing threat to our nation’s health and security. Antibiotics can produce miracles, but some bacteria seem to be able to resist any antibiotic we throw at them. The only solution is to prevent infections and more carefully use the antibiotics we have. The safe use of antibiotics begins with YOU.

PHOTO CREDIT: fotostorm; E+ Collection