Antibiotic resistance (part two)

More than at any other point in history, people are more likely to seek and receive treatment for medical issues.  This is good news.  Due to vaccination and antibiotics, many diseases that used to be fatal are unheard of.   In first world countries, a lot of those that still crop up are more annoying than dangerous.  When it comes to infections, people worry more about missing work than serious injury or death. 
 

The flipside to this widespread use of the healthcare apparatus is that we live in an increasingly consumerized world.  People expect to get something if they are paying for, even if that something is unhelpful.  I see this first hand a lot.  People go to their primary care doctor with a bad cold or sinus congestion and become enraged when they are not given a prescription for antibiotics.  “She said it was probably a virus,” they say with disdain.  “She wouldn’t give me an antibiotic.”

And while they’re rolling their eyes, all I can think is, Thank you.

Penicillin was discovered in 1928 but wasn’t used broadly until 15 years later due to production issues.  Less than five years later, microbial resistance to the drug was found.  This fact is not unusual.  Often, within a decade of widespread use of an antibiotic, resistance will be found.  Here’s why that happens.

Let’s say there are five bacteria.  They are all the same species of bacteria, but four of them are blue and one of them is yellow.  Now let’s say you put an antibiotic in their environment.  The blue bacteria are susceptible so they die.  But the yellow bacterium is resistant.  Now that those blue bacteria are dead, only the yellow bacterium is left to reproduce.  So instead of mostly blue bacteria with some yellow, you get all yellow, resistant organisms.  A real life example of this is CDiff (C. difficile.)  When you take certain antibiotics, they can kill off all your good bacteria in your colon, but CDiff is resistant, so it takes over. 

This problem gets exponentially worse when you use multiple antibiotics over long periods of time.  Maybe the antibiotic we used in the above example didn’t kill the yellow bacterium, but another antibiotic probably will.  But if you do the same experiment with many different types of antibiotics, you will eventually find an organism that is multi-drug resistant (MDR.)  This is called “selecting for the resistant strain.” 

As a society, we select for resistant strains in many ways.  The first is through widespread use of antibiotics in livestock.  The animals take the antibiotics, deposit their waste (containing antibiotics) into the soil, where it kills off all but the resistant bacteria.  Use of hand sanitizer kills off all but the resistant organisms.  Antibacterial or antimicrobial polymers are being used more and more.  And, of course, patients.

A lot of doctors will write an antibiotic prescription even if they aren’t sure the infection is not viral.  Antibiotics do not treat viral infections.  And guess what?  Viruses are really common.  They can cause the same symptoms, in many cases, as bacterial infections. 

Furthermore, in many situations where the infection is truly bacterial, use of antibiotics doesn’t hasten recovery or decrease symptomatic days.  Sinus infections are a good example of this.  For true bacterial sinus infections, you can expect to be sick for about two weeks, whether or not you use antibiotics.  Often, your immune system can clear the infection without antibiotic treatment. 

Antibiotic resistance is ancient, because antibiotics are made by microbes to kill their competitors.  In many instances, the genes that make an organism resistant are found on a small circle of DNA called a plasmid.  These plasmids can be exchanged between organisms.  There have been studies demonstrating that

I think that people think that antibiotic resistance is this slowly developing situation that will be problematic in the future.  It’s not.  This is not a spark turning to a slow burn.  The world is on fire.  We are seeing infections with multi-drug resistant organisms like Pseudomonas spp., MRSA, VRE and so on.  These infections can be fatal.  In those who survive, there is often organ damage, limb amputation or serious, lifelong disability. 

If you truly get repeat, frequent infections of the same nature, you need to see an infectious diseases specialist.  What people often discover at these appointments is that their doctors have been treating them empirically for years, and that they never even had an infection. 

The people most likely to suffer the consequences of antibiotic resistant infections are those with weakened immune systems who spend a lot of time at the hospital.  So, people like me.

Antibiotics are serious drugs that have serious implications for our future.  Please be responsible with them.