Antibiotic Resistance: Too Much of a Good Thing

Antibiotics improve our lives in innumerable ways, but there is growing concern that their overuse is increasingly exposing the public to drug-resistant bacteria. Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die as a direct result of these infections. Many more people die from other conditions that were complicated by an antibiotic-resistant infection.

“In many ways, antibiotics are victims of their own success,” said Dr. Scott Weissman, an infectious disease specialist at Seattle Children’s Hospital. “When antibiotics first came into being in the 1940s, they were hailed as miraculous, and they were, but it is possible to have too much of a good thing.”

This week, the Centers for Disease Control and Prevention (CDC) is observing its annual Get Smart About Antibiotics Week. During this time, the CDC, along with other healthcare organizations and partners, is highlighting the importance of appropriate antibiotic use. Weissman, a nationally-known expert who is in Washington D.C., participating in some of the events for Get Smart About Antibiotics Week, took time to answer some questions about what antibiotic resistance is and what we can do about it.

What are the current recommendations for giving antibiotics to children?

First, there is no single solution or strategy that is right for every situation. Antibiotics should be given only when necessary, but I think we can all agree that the standard practice of many providers has been far less disciplined. This has led many to view receiving a prescription for antibiotics as the expectation of a doctor’s visit rather than the exception.

We need to begin to rethink our relationship with antibiotics on a fundamental level, and that can start in the doctor’s office. Parents, of course, are looking for a quick way to make their child feel better, but those of us in healthcare need to take the time to explain when antibiotics are and are not likely to work.

To your point, the CDC reports that 50% of all the antibiotics prescribed for people are not needed or are not effective as prescribed, could you talk about the effects this overuse can have on the body?

The thing that made antibiotics such wonder drugs in the first place is that they are really good at killing bacteria. The problem is that not all bacteria are bad. If you think of the human body as an ecosystem, what you really have is a delicate balance between the trillions of bacteria that each of us has in our systems. While antibiotics kill bacteria, they do so indiscriminately, and they tend to have the same effect as a forest fire, wiping out everything in their path. In these situations, the only bacteria that remain are those most resistant to the antibiotics.

Thus, the only bacteria left are the biggest, baddest microbes on the block, and now they have plenty of room to multiply as you have removed all the other healthy bacteria that previously would have slowed them down. This process is still highly desirable in instances where a bacterial infection overruns our immune system, but you could see why we wouldn’t want to be doing this needlessly.

We know that overuse of antibiotics is the single most important factor leading to antibiotic resistance around the world, and cutting out unnecessary prescriptions would go a long way in addressing this problem.

Can one person’s antibiotic use affect the resistant bacteria in another person?

Yes, bacteria are by their very nature transmissible. This is a situation where we all need to do better, and this notion is in many ways what Get Smart About Antibiotics Week is all about. There isn’t a singular solution to this problem, and by bringing together organizations like the CDC along with both local and regional healthcare providers, patients and leaders in agriculture, we are really pushing to make this topic a larger part of the public dialogue.

Much has been made recently of the role antibiotics play in how our meat is produced. How does this affect the increase in antibiotic-resistant bacteria?

In many cases, it is routine for antibiotics to be added to the feed of livestock to increase their growth and prevent disease. Much like in the human body, this broad over-dosing increases the amount of antibiotic-resistant bacteria in their system, which we as consumers are exposed to when we come into contact with the meat. This process adds fuel to the growing fire that is antimicrobial resistance, as we are only increasing the amount of resistant bacteria we can come into contact with on a daily basis.

However, the exposure this topic has gained more recently has shown that this is an area where consumers have a great deal of power to affect change. As we in turn demand a higher quality product, this process will only continue to improve.

Are antibiotics as effective as they used to be?

Right now in the majority of cases, antibiotics are still effective. That said, what we have seen is a startling increase in untreatable infections caused by antibiotic-resistant bacteria. While these cases are still rare, we have also seen many common infections become more difficult to treat. Things that once were routine are no longer routine, which in turn can mean more antibiotics, so one could see how it begins to feel like a bit of a feedback loop.

Without effective antibiotics, there is no routine surgery, no chemotherapy and a whole host of other procedures we have come to take for granted, so this is certainly an issue that warrants our concern.

What makes you hopeful that we will be able to properly address the issue of antimicrobial resistance?

It’s worthwhile to note that while they seem commonplace now, antibiotics haven’t been around very long. As with any innovation, sometimes the pendulum swings a bit too far in one direction, and we need to make adjustments.

The important thing is to ensure that everyone is informed about the risks that antibiotic-resistant bacteria present. Organizationally as well as individually, we will all have a role in correcting this problem.

What broader, institutional changes will be necessary going forward?

• Careful use of antibiotics (Antibiotic Stewardship): As healthcare providers, we need to reinforce the notion that just because someone doesn’t come away from the doctor’s office with a prescription, doesn’t mean that they came away with nothing. Treatment is by its very nature a process, and sometimes that process means treating the symptoms of the infection and leaving the rest to the body’s immune system.
• Better diagnostics (better tests): Part of the reason that antibiotics are being overprescribed is that there is not always a clear-cut standard of practice. If we had better, more affordable tests that could determine whether or not an infection was bacterial as opposed to viral (e.g. Strep throat test), we could more easily cut down on the number of unnecessary prescriptions being given.
• New antibiotics: We need to continue to develop new and more targeted antibiotics.

What advice do you have for parents and caregivers?

• In the doctor’s office, become part of the conversation: Every time an antibiotic is being prescribed, there should be a discussion. With some infections, it is best to wait, see and evaluate after a day or two. This approach is often used with ear infections in children.
• Buy antibiotic-free meat: To help, parents and families can read labels while out shopping. Look for phrases that mention “antibiotic-free” or “organic.” Also, do research online to find out where your local restaurants and food chains get their meat.
• Take steps to prevent preventable infections:
  • Wash your hands
  • Make sure you and your children are up to date on your vaccinations
  • Stay home when sick
  • Prepare food safely