Fighting the good fight: respect antibiotics

This week let’s talk about a topic that is near and dear to my heart: antibiotics. As a physician who works with the sickest patients in the hospital, I consider antibiotics lifesaving therapy. I truly respect antibiotics. They are to be used only when necessary. I see too many people (both physicians and non-physicians) overusing antibiotics. Some people want antibiotics to treat every single ailment imaginable. Then, you have the opposite end of the spectrum: those people who will not take antibiotics even if they actually need them! We have to reach a midpoint. We need judicious use of antibiotics, without overuse, but being ok using them when we need them.  

What is so great about antibiotics anyway?

Ok, antibiotics were a massive discovery! In the 1930’s and 1940’s, we discovered the first antibiotics. These changed the medical landscape and public health arena big time. I mean, a major game changer. You see, before the discovery of sulfanilamide in 1936 and penicillin in 1942, physicians were great at diagnosing infections, but that was about it. They had very little in the realm of therapeutics. They would diagnose their patients and then hope for the best. People were dying. Dying from diseases that we are able to treat today (for now, anyways 😱, more on that later).

Just to help you see the impact antibiotics had, consider this: the mortality from having a pneumonia that you acquired while you were out and about in the community decreased at least by 25%. That means ¼ less people died from pneumonia after antibiotics. For infections of the heart tissue, mortality decreased by 75%! Infections of the brain and surrounding tissue, like meningitis, had a reduction in mortality of about 60%! Once we discovered antibiotics, conditions that were nearly a death sentence could be treated.

Ok great, so now we can treat bacterial infections, what is the big deal?

Unfortunately, as often happens with our species, we went a little too gung ho. I am not judging anyone because hey, if I went from having nothing to treat my dying infected patients to finding the golden egg, I would probably be sharing the golden egg with all my patients. However, as time went by, this pattern continued. Unfortunately, we failed to see damage that overuse of antibiotics could create. We did not respect antibiotics.

We did, however, have brilliant minds warning us about this from the start. Of course, we did not listen. Even the British scientist, Alexander Fleming, who discovered penicillin, warned about the occurrence of antibiotic resistance back in the 1940’s:

“.. the thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism”

 

What is the problem with antibiotic resistance?

Well, as you may have guessed, bacteria smartened up. As all organisms, they needed to survive. So, as we repeatedly exposed them to the same antibiotics to kill them, they developed various defense mechanisms. They found ways to inhibit the activity of the antibiotic or simply ways to get around them. It is a kill or be killed world with bacteria. In the 1990’s, we started to realize the magnitude of the problem we had created.

Antibiotics that used to be extremely effective against certain kinds of bacteria were no longer effective. To make things worse, new antibiotics weren’t being discovered.

It wasn’t just giving antibiotics to humans that were creating these problems with resistance.

Animals and antibiotic resistance

As industrial farming developed, with livestock living in deplorable conditions and in close proximity to one another, infections developed. These animals needed antibiotics to prevent huge epidemics that would wipe out entire livestock. Oh, and if you consume industrial meat (of any kind), go and take a look at their practices. Consider going on a day trip and seeing the conditions of the food you are consuming. You may completely change your preferred meat supplier. Otherwise, consider watching this eye opening documentary on industrial/factory farming: Food, Inc. 

With the overuse of antibiotics in farming, the animals also started developing resistance to the antibiotics. Guess what happened to those farmers who were around that treated livestock day in and day out? Even worse, guess what happened to us when we handled the raw meat from these industrial animals? Yep, we started getting those resistant bacteria as part of our normal flora. By the way, if you want to know more about the microbiome, check out this past post.

Between us, livestock and other uses of antibiotics, just in the United States, we expose our environment to 15 million kilograms of antibiotics. Clearly, most of us don’t respect antibiotics. Personally, I find this to be extremely alarming and scary. How could anyone not see this as a problem?

What can we do?  

We need to be judicious about prescribing (as physicians) and asking for (as patients) antibiotics. One common misconception that I hear a lot is: “I have a cold, so I am going to ask my doctor for antibiotics.”

Guys, antibiotics treat only bacteria. The common cold is caused by a virus. You could take antibiotics until the cows come home and you will NOT be treating your cold. This is a great post by a fellow pediatrician who tells her own personal story as a patient with a cold being prescribed antibiotics! 

If you are concerned about a possible bacterial infection, ask your doctor to run some blood tests. Although not 100% certain, there are several parameters we can measure in the blood, that when taken together, can help guide the physician’s decision as to the type of infection. This way we can be more careful about using antibiotics. Please don’t use old antibiotics you had kept or go to your drugstore (for people outside the US) and have the pharmacists give you antibiotics. Just go and talk with your healthcare provider.

The opposite end of the spectrum

Now, if your doctor determines you have a high likelihood of having a bacterial infection or if a culture from any body fluid comes back positive for bacteria, please take the antibiotics.

This is exactly why we have them and luckily, we still have various antibiotics or combinations of these that work. This may not be the case forever if the antibiotic resistance rate continues as is, without new antibiotics in the horizon. Interestingly, as I am finishing this post I saw two news reports on antibiotics resistance.

If you are concerned about your microbiome and your gut health, probiotics can help with that. You can take probiotics while you are taking your antibiotics (I would argue you should take them always, as discussed in this post) to protect your gut and minimize the effects of antibiotic associated diarrhea. Obviously your priority should be to treat the infection. A healthy microbiome is no good if you are dead 💁🏻, just saying.

And that’s a wrap

Hope this helped give you perspective no matter what side of the antibiotic battlefield you are on!

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