The cold and flu season is quickly approaching, making this an apt time to consider one of the biggest fears of public health experts: The arrival of a post-antimicrobial era—one in which bacterial infections cannot be effectively treated or cured with existing antibiotics.
Let’s take a closer look at antibiotic resistance so we can separate legitimate concerns from hype and find out what steps we can take to protect our families.
What is antibiotic resistance?
Bacteria are single-celled organisms that can adapt and change for survival in varying environmental conditions. Because of this ability to adapt, bacteria can become resistant to the effects of the antibiotics that are designed to destroy them. The amount of antibiotics used and the ways in which they are used are the primary catalysts of resistance. Why? Antibiotics kill off susceptible organisms, allowing resistant ones survive and thrive.
What activities contribute to the development of antibiotic resistance?
There are a number of activities that contribute to the development of antibiotic resistance. We can’t examine all of them here, but we’ll take a look at four.
- Imprudent use of antibiotics in humans. Antibiotics are ineffective in treating viral infections (i.e., antibiotics kill bacteria but not viruses). However, many physicians prescribe antibiotics after diagnosing patients with viral infections. Why do they do this? It’s often because patients request a medication to treat their symptoms and their physicians don’t want to disappoint them.
In some areas of the world you don’t need a prescription for antibiotics—they are available over-the-counter (OTC). The situation in Nigeria illustrates the risks associated with OTC access to antibiotics. Though there is no medical indication to do so, 24% of female university students in Nigeria report self-medicating with antibiotics to treat menstrual symptoms (e.g., cramping, heavy menstrual flow, pimples). Subsequently, Nigeria has high rates of community-acquired MRSA infections, as well as the highest rate of antimicrobial-resistant urinary tract infections in the world.
- Imprudent use of antibiotics in livestock. In the U.S., 87% of all antibiotic use is in animals. Antibiotics are routinely added to the food and water of healthy livestock to preemptively control disease, to improve metabolism, and to reduce dietary requirements. Resistant bacteria have developed in the animals themselves and can be found in animal-based food products, farm workers, and in the water, air, and soil near animal feeding operations.
One study in Massachusetts looked at antibiotic-resistant bacteria among family members on a chicken farm. The family’s chickens were fed tetracycline-resistant feed. The chickens were found to have tetracycline-resistant E. coli bacteria 24-36 hours later. Family members developed tetracycline-resistant E. coli five to six months later. These family members had not eaten chickens from the farm, but had been exposed by feeding and otherwise caring for the chickens.
- Imprudent use of antibacterial cleaning and hygiene products. Several consumer products contain antimicrobial agents that are marketed for their germ-fighting abilities (triclosan is one of the most common). The findings on triclosan use and antibiotic resistance are inconclusive; however, there is compelling evidence that triclosan generates cross-resistance to the anti-tuberculosis treatment isoniazid. What does this mean practically? Doctors are losing one of their weapons against tuberculosis.
- Discharge of antibiotics into the environment from hospitals and drug manufacturers. Researchers have found high concentrations of active pharmaceutical ingredients in wastewater from hospitals and in effluent from water treatment facilities that serve pharmaceutical manufacturers. The precise implications of antimicrobial pollution are unknown, but it may contribute to antibiotic resistance. More research is needed.
What can we do to protect our families?
Antibiotics can be life-saving medications, so I’m not discouraging their use when it’s medically warranted. However, we do need to make sure we’re using them judiciously and we need to take other actions to discourage the development of antibiotic resistance.
- Let your doctor decide if an infection requires antibiotics. Avoid the urge to pressure your doctor into giving you antibiotics for a viral infection (e.g., the flu, a common cold). Even many childhood ear infections do not need to be treated with antibiotics.
- Take medications as prescribed. If your doctor does prescribe antibiotics for a bacterial infection, take them exactly as the doctor tells you. Complete the prescribed course even if you are feeling better.
- Limit triclosan use. Avoid purchasing personal hygiene and home cleaning products that contain triclosan. Triclosan-free alternatives work just as well and are safer.
- Participate in pharmaceutical “take-back” programs. Do not flush old or expired medications down the toilet or throw them in your regular trash. Take them to pharmacies that offer take-back programs so the drugs can be disposed of safely.
- Engage in advocacy. Write your government officials to let them know that you are concerned about antibiotic resistance. You can also support efforts that advocate for the following:
-Eliminating the practice of feeding livestock subtherapeutic levels of antibiotics that are important in human therapy.
-Limiting the number of animals in concentrated feeding operations and improving the quality of these operations.
-Regulating the wastes discharged from pharmaceutical manufacturers.
-Reducing the availability of antibiotics in countries where they are currently available without a prescription.
This is a lot of information to take in, but it’s very important! At the bottom of this post I’ve listed the numerous journal articles I used as references.
Had you given much thought to antibiotic resistance? Have you already taken or do you plan to take steps to discourage the development of antibiotic resistance?
References: Aiello et al. 2003. Lancet Infect Dis 3:501-506. | Aiello et al. 2004. Antimicrob Agents Chemother 48:2973-2979. | Aminov 2009. Environ Microbiol 11:2970-2988. | Cooney 2010. Environ Health Perspect 118:242. | Davies et al. 2010. Microbiol Mol Biol Rev 74:417-432. | Diwan et al. 2010. BMC Public Health 10:414-422. | Emanuele 2010. AAOHN Journal 58:363-365. | Gilchrist et al. 2007. Environ Health Perspect 115:313-316. | Kessler 2010. Environ Health Perspect 118:383. | Levy 2002. Antimicrob Chemother 49:25-30. | Martinez 2009. Environ Pollut 157:2893-2902. | McBain et al. 2003. Appl Environ Microbiol 69:5433-5442. | Rosenblatt-Farrell 2009. Environ Health Perspect 117:244-250.
This is another health topic that I’ve heard of but knew nothing about. I’ve always assumed antibiotics were a “safe” medication (you know, that we don’t have to think much about if or how to use them).
You’ve given me a lot to think about.
Hi Rosie,
As scary as it is to think about, there’s always some risk anytime we take anything into our bodies (even food and water). The situation with antibiotics provides a great reminder to scrutinize everything we consume.