We Are Aware That Antibiotics Are Becoming Obsolete!
So what can we do about it? A Medical student’s perspective.
We are losing the war against common and dangerous micro-organisms. These uni-cellular devils are intelligently fighting back against commonly prescribed antibiotics, which have taken billions of Dollars to design. But this is common knowledge. We frequently come across articles highlighting the evolution of “Super-bugs” and “Killer infections with no cure” and that some of the potent drugs we use on a regular basis are slowly becoming ineffective.
What do we do?!
Is this a job/concern our healthcare professionals or is there something we can do at the individual level to help? I think we all need an “attitude” change with regard to the way we use antibiotics.
One of the foremost causes for the rapid evolution of drug-resistant organisms is the injudicious and excessive prescription of common antibiotics. There are other studies which give evidence of the ubiquitous use of antibiotics in agriculture, for livestock, which promotes the growth of these deadly organisms- A heavy price we pay for healthy livestock !
Trying to control drug-resistant infections when they reach epidemic proportions will be ridiculously difficult and the time to act is NOW. Actions taken at the institutional level include pharmaceutical regulatory bodies in some countries, well-established drug protocols in hospitals, European Antibiotics Awareness days and so on. Large scale studies have been conducted to identify the best treatment protocols for various infections and it is up to healthcare professionals-physicians, surgeons, nurses- to follow these guidelines.
Is there anything people, in the general population, can do to ensure “judicious” and “responsible” use of antibiotics? Is there a role for the common man, the people without medical education, for the parents of the boy who cut his knee while skating, or the kid with a sore throat? In my opinion there is.
NOTE: Some of you may argue that this article I am writing would be better read in a health column or something but I am targeting a much younger and accessible audience to bring awareness about what can be done at the community level with regard to drug resistance, and I think medium.com is an amazing place to start.
I will now try to put forth some facts about the way antibiotics should be used. Not because the reader doesn't know about it, rather just as a reminder. It is neither possible to go through antibiotic protocols and guidelines to anticipate treatment from our physicians, nor is it wise for people (you know who you are) to self-medicate based on “Google searches”.
We don’t commonly deal with major infections on a regular basis at the community level- I’m talking about the killer diseases (some of which are endemic in developing and tropical countries) like cholera, Tuberculosis, Malaria and so on. Antibiotic resistance against drugs used for treating these disease is wreaking havoc on the Healthcare industry and millions of people are losing their lives. I’m sure some of you have heard of MRSA (Methicillin-Resistant Staphylococcus Aureus) which is the scourge of surgical wards and a total nightmare for surgeons! If such organisms become ubiquitous, the consequences could be disastrous.
Some infections are more common and we are more prone to be exposed to them on a regular basis. These include the flu, urinary tract infections, diarrhea, pneumonia and so on. It is well beyond the scope of this post to specifically address each disease and how it should be approached/treated. I’ll try my best to give examples to get some important points across.
Trivial medical conditions like a sore throat, diarrhea, cough & cold are excessively and unnecessarily treated with antibiotics. MOST SORE THROATS ARE VIRAL ! Antibiotics are absolutely ineffective against viruses.
It is extremely tough to get this message across to most parents. When their kid is sick, they panic and rightfully so. But some parents even go to the extent of demanding their primary care physician to prescribe antibiotics even when it is not indicated.
Antibiotic resistance arises by two mechanisms:
- Unnecessary prescription of antibiotics: For VIRAL infections/conditions, which DO NOT get better with them at all. As the saying goes- If you treat a cold, it goes away in a week. If you don’t? It goes away in seven days ! Seasonal flu, with just a cold and cough, do not require anything more than symptomatic treatment with over-the-counter medication and everyone will be fine. I promise.
WAIT ! How can you be so damn sure that my kid is not suffering from a Strep throat (Sore throat caused by the bacteria Streptococcus)? Yes, doctors get asked this a lot. When should you treat it with antibiotics? According to guidelines laid down by the Centers for Disease Control and Prevention (CDC, Atlanta) antibiotics are indicated for something trivial like a sore throat ONLY after a confirmed diagnosis by a throat-swab, which your physician will recommend if the signs and symptoms point to a bacterial infection. According to the prestigious Mayo Clinic, these include:
- A sore throat lasting longer than a week.
- A fever more than 101 F
- Difficulty in swallowing or opening your mouth.
- Rashes.
- Concurrent ear aches.
Now hang on a second. This is not a health magazine. What am I trying to convey here? Simply that not every sore throat needs antibiotics. Most importantly parents need not panic, unless their child shows the above warning signs, for which appropriate treatment can then be provided. These bacteria are sometimes present in our throats without causing any infection and when we treat viral sore throats with antibiotics, they become resistant.
Here is another Graphic I have borrowed from a CDC awareness program called “Get smart” (all these public awareness guidelines are downloadable for anyone on the CDC.gov website by the way, I’m just making your job easier).
SERIOUSLY ? MAJOR CONSEQUENCES OF ANTIBIOTIC RESISTANCE FROM SOMETHING AS TRIVIAL AS A SORE THROAT ?! TAKE A LOOK:
Courtesy: CDC- ANTIBIOTIC RESISTANCE THREATS IN THE UNITED STATES, REPORT 2013: This is the burden of drug-resistant Streptococcus, the culprit of a bacterial sore throat. (Image above)
The unchecked use of antibiotics for common conditions like a cold, or the excessive or unsupervised use of antibiotics for Streptococcal throat disease will result in the evolution of dangerous strains of bacteria. Streptococcus causing Pneumonia has become resistant to common drugs, a huge health hazard and a ridiculous economic burden.
Wait a second, Doc! So, it’s a bacterial infection (sore throat or whatever). Now what? Here comes mechanism 2 of bacterial antibiotic resistance and perhaps the most important and AVOIDABLE cause!
2. Incomplete course of treatment: FINISH THE PRESCRIBED COURSE OF ANTIBIOTICS !!! I cannot emphasize this any more powerfully. When your physician prescribes a course of antibiotics for 5 days or more, you take it. No questions asked. An incomplete course of treatment results in some bacteria not being killed. These are only weakened and the “host” usually feels better. These sneaky weak bacteria survive and develop resistance to the antibiotics which are in low concentrations, all thanks to you not finishing the course as recommended.
Sometimes it’s better not to prescribe antibiotics, like in diarrhea. No, I’m not insane. Hear me out. Diarrhea is the body’s way of expelling either toxins or harmful bacteria and it is best left alone. Anti-motility drugs and antibiotics are indicated if it is associated with fever, vomitings, going to the loo more than 4 times in 8 hours etc (CDC Guidelines). In all cases however, hydration is essential and of course a trip to your primary healthcare provider.
Let the body defend itself. Have some faith. I am NOT saying “do not take antibiotics”. Go to your physician, GET A DIAGNOSIS OF A BACTERIAL INFECTION, and then complete the course of treatment. Most episodes of diarrhea are trivial and are self-limiting. What happens if we treat each and every single tummy upset with powerful antibiotics? You create super-bugs which will be “sticking the finger” to all the commonly used drugs!
The CDC published a very detailed report on antibiotic resistance and the burden on the American Healthcare Industry and the economy. Titled as “Antibiotic Resistance Threats in the United States, 2013", it paints a grim picture of the situation, and how they are trying to fight back. It gives detailed statistics and management guidelines (for both healthcare professionals and general public alike) for all the major diseases we are facing drug resistance troubles with.
There’s one statistic which you should pay attention to.
Antibiotics can be very dangerous if misused or abused ! Dangerous side-effects are common especially in the pediatric age-group. They should be used only with a prescription. The right micro-biological diagnosis is essential and the effective drugs against that organism have to used ensuring total eradication.
The complete CDC Report can be found here: http://www.cdc.gov/drugresistance/threat-report-2013/
The availability of antibiotics to be misused and abused varies between countries. In the USA or the UK, there is a well established system of primary care physicians who deal with hundreds of cases on a regular basis. Patients can get their hands on antibiotics only when they produce a formal prescription at a registered pharmacy.
The situation is very different in some Asian countries like in India where these drugs are available “over the counter” (OTC). They can be easily purchased without a prescription. There are advantages and disadvantages to this system. The biggest disadvantage is you end up with a huge population of people who self-medicate with antibiotics when they are not indicated at all. Unnecessary antibiotics, unsupervised, improper dosage, incomplete course of self-medication- A recipe for disaster.
Forget antibiotic resistance, this ridiculous usage of drugs without the prescription of a doctor can result in life-threatening side-effects. This is the population that needs to be made aware of the consequences of injudicious drug use. Regulating the availability of drugs is easier said than done.
It wont be easy, but it’s the only way forward. People have to wake up and show some common sense and responsibility when it comes to using antibiotics and while prescribing it (stupidly almost, without medical training) to their own family or friends.
So in conclusion, be intelligent about how you use antibiotics. Use them when needed. Complete the prescribed course, right up to the last pill. More importantly spread the word and ensure your family and friends follow these simple rules. These small steps will add up, to strengthen our chances against common diseases, which could become killer-diseases if left unchecked.
To anyone with the sniffles: Get well soon ☺ without Antibiotics !
Also, I wish you all a very Happy and Prosperous New Year !
If you think this was useful, please recommend it so that I can reach a larger audience and do not hesitate to let me know what you feel/if I should have addressed any issue in particular. Thanks !
praharshamulpur9@gmail.com
