So now we know. Antibiotics are not what we thought they were, a miracle drug with no downside. As it turns out antibiotics have a huge downside. And that’s the message a panel of infectious disease experts wanted to get across in a public forum, “Battling Drug – Resistant Superbugs: Can We Win?” held at the Harvard School of Public Health this year.
Here’s the thing. Antibiotics don’t work for the common cold, the flu, most ear infections and respiratory problems, because they’re typically viral-based illnesses. So not only does the antibiotic not help, it turns out there’s an unintended consequence we didn’t anticipate: antibiotic use drives resistance. That means the more we use them the less effective they become, not just for the person taking them but for everybody else too. In that sense antibiotics are a “societal drug,” because individual use affects others in the community. No other class of drugs does that.
The upshot is a lot of unnecessary harm. In the US alone, for example, over 2 million people a year succumb to infections that are resistant to antibiotics ; over 23,000 of whom die, almost half of them because of MRSA. Even when MRSA doesn’t kill it does very bad things to you . You may face having to amputate a limb as happened to this NFL player, or it could leave you blind as happened to this robust teenage boy from north Detroit.
The reason for the “resistance movement” by bacteria – the ability to render antibiotics ineffective – is that they are “born” with the ability to fight antibiotics. Their only job in life is to survive, and they’ve done that quite well now for some 3 billion years. In order to have survived that long they had to develop ways – “resistant mechanisms” – to fight the people in their world that threaten them; other bacteria, viruses, fungi, and so on. And that they did. Then along we come in the 1940s and try and knock them off with what we naively think are these invincible antibiotic drugs, and their response is like, “Whatever dude, we’ve seen all this stuff before.”
These critters are clever. Not only will the bug fight off the antibiotic you’re taking, penicillin say, but at the same time the bug will develop the ability to fight off other antibiotics too; for example, methicillin, amoxicillin, and tetracycline. The bug will then transfer the resistances it developed to those 4 antibiotics, to all his little bug buddies. This transfer will take place not just within a single species, E. coli to E. coli for example, but also between species, say from E. coli to Salmonella to Shigella (a bug that causes dysentery). In other words, when you take an antibiotic a whole other world of bugs that become resistant to multiple antibiotics develop inside you, thus leaving you more vulnerable to disease than ever.
But here’s the wicked part. Guess what you do with all these bugs you’re growing that are resistant to multiple antibiotics? You give them away, although not just to anybody. You’re most likely to give them to those closest to you, your family and friends. So when they get sick and need an antibiotic it won’t work for them. And it’s because of you: you’ve given your family and friends bugs that are already resistant to multiple drugs – you have effectively “immunized” them against antibiotics – not a good thing.
So what’s the answer? Stop asking for antibiotics. One of the panelists, Aaron Kesselheim, MD, of the Brigham and Women’s Hospital, Boston, says his number 1 patient complaint is “I want an antibiotic.” That is the very attitude the HSPH is trying to change. So if your doctor prescribes an antibiotic for you be sure to ask her why. Ask how she knows you have a bacterial-based illness and not a viral-based illness. Because unless she has swabbed for the bug and taken it to the lab for analysis you cannot know for sure what germ is making you sick.
Stuart Levy, MD, another panelist, and author of the book “The Antibiotic Paradox,” (the paradox is that the more you use them the less effective they become), wound up the discussion with this thought: If I had $800,000 to spend on fighting infectious disease, he said, I’d spend $700,000 of it on educating the community: “They need to be a partner in using antibiotics properly.”
As Kesselheim points out, “We’re all in this together.”
Here’s the video of the enlightening panel discussion: