While we are obviously very big proponents of using antibiotics, when necessary, we are also big proponents in educating the public about how antibiotics work and why we need to improve our level of understanding about them.
Unfortunately, for too long it has been common practice to inappropriately prescribe antibiotics. This is true not just in our western culture, but worldwide. We have a global problem in which antibiotics are given when not medically necessary and are prescribed at incorrect doses and durations. Couple this with the patients that inappropriately take their antibiotics, and we have a problem with potentially major consequences for all of us.
To be clear, we are not taking shots at your local urgent care or family doctor. Rather, we are looking to raise awareness about the ways antibiotics are used outside our healthcare system.
Not only do doctors prescribe antibiotics, but farmers give antibiotics to their livestock, and veterinarians prescribe antibiotics for our pets. While there is sometimes solid reasoning for this widespread use of antibiotics, there are also consequences to these actions. What do we mean here? What we are talking about is antibiotic resistance.
An emerging health crisis?
Antibiotic resistance may be the greatest challenge facing the next generation, so it is worth our time to understand as much as possible about it. The World Health Organization (WHO) keeps tabs on this problem globally, and they highlight “alarming resistance rates among prevalent bacterial pathogens.” Scary stuff.
So, how do we go about solving this problem?
First, a Little History...
The discovery of antibiotics was a very exciting time, and transformed how medicine was practiced. It drastically launched healthcare forward. Penicillin was the first antibiotic to become widely available, and new classes of antibiotics were discovered not long after. These new medications were saving people from life threatening bacterial infections and continue to do so today.
Before antimicrobials were discovered, death from infectious disease was by far the leading cause of mortality among the human race. Antibiotics certainly changed this narrative, but at the time there was not enough research as to any harmful effects that antibiotics may be having on our health. This would come many years later.
History revised?
There is an often-overlooked piece of history regarding the beginning of the “antibiotic era”. While Penicillin was widely known as the first antibiotic, there was actually a class of antibiotics discovered an entire decade earlier. This class of drugs is known as “Sulfonamide” antibiotics or more commonly known as “Sulfa” drugs.
So, then why wasn’t this class of antibiotics known as the first antibiotic? Seems odd considering we still use this class of antibiotics today. The reason? Antibiotic resistance.
Just a few short years after Sulfa antibiotics were made available to the public, physicians and scientists were quite disheartened to discover that the bacteria they were treating had become resistant. This means that these new wonder drugs were no longer a viable weapon against many bacteria.
Side note for those wondering:
To be clear, we do still use derivatives from the Sulfa antibiotic family in today’s world and thanks to the many years of continued research in the field, this class of antibiotics can still be used effectively against certain types of bacteria.
The takeaway:
The lesson learned from sulfa drugs is extremely relevant to our current battle against microbes. Antibiotic resistance is a major global threat and will continue to be unless we drastically change our ways or science advances significantly in the antimicrobial realm. We don’t know about you, but we would like to continue to have these lifesaving medications available to us.
"Arms Race Between Man and Microbes"
Many people have now heard of the term “superbugs". Superbugs are basically strains of bacteria that are resistant to several types of antibiotics. Resistance means these smart bacteria bugs have evolved a defense system to survive in the presence of antibiotics.
It is also common knowledge that the inappropriate use of antibiotics is closely tied to antibiotic resistance and the emergence of these superbugs.
Historical significance: Even the man who discovered Penicillin warned of the misuse of this drug. He warned that using too little of the drug or using it for short durations could lead to resistance. Did he nail it or what!
Along with the WHO, our global medical community has been sounding the alarm about antibiotic resistance for over a decade.
They believe that the first step in combatting antibiotic resistance is to better educate the public.
So, how did we get here?
Facts that help tell the story:
While medical professionals today are well aware of the need to preserve antibiotics for true bacterial infections, inappropriate antibiotic prescriptions are written every day. Antibiotics are still prescribed for “prophylactic” use for things like viral upper respiratory infections, cold, or even bug bites. “Prophylactic” means a medication is to be used as a preventative treatment. In this case, the hope is the antibiotics will prevent a potential bacterial infection from setting in. While this is certainly warranted in some patients, it does not hold true for everyone. It is hard to blame doctors however, because they are trying to do right by their patients.
Don’t believe us?
The CDC reports that up to 28% of antibiotic prescriptions written in the United States are unnecessary. Furthermore, the British Medical Journal estimates that up to 50% of antibiotics are inappropriately prescribed.
Surprising Fact: Over recent decades, a strong relationship has developed between the rising level of antibiotic-resistant bacteria and the amount of antibiotics prescribed. Worldwide, antibiotic use increased by 65% between the years 2000 and 2015. That is a huge number!
So why does it keep happening?
There are a few reasons for this:
1. Doctors often feel pressured by patients to prescribe antibiotics when they are not needed:
This is especially true for viral upper respiratory infections and highlights why educating the public is so vitally important.
But that Z-pack always works for me! Remember, many antibiotics have strong anti-inflammatory effects in addition to being able to kill bacteria. Sure, if you take a Z-pack for a viral infection you probably will feel better, but trust us, it is not worth creating new superbugs.
2. Patients will often stop taking the prescribed antibiotics BEFORE the course is completed: For example, many people think that since they feel all better after 4 days from taking an antibiotic, they can discontinue the course before the full 7 days are up. Stopping an antibiotic early is a huge contributor to antibiotic resistance, as the bacteria are not fully eradicated and this allows them the opportunity to build resistance.
3. Poor Regulation:
In some countries around the world, antibiotics are not well regulated. This means that a medical professional is not overseeing the use of antibiotics. People can walk into a local pharmacy and pick up an antibiotic over the counter. While this sounds pretty nice and convenient, this has serious ramifications. The average person does not know how to correctly make the following decisions for whatever infection they believe to be treating:
- The appropriate class of antibiotic
- The correct dose of antibiotic
- The correct duration or length of time to take the antibiotic for
- Treating a potential misdiagnosis (for example, treating a fungal or viral infection with an antibiotic)
Other important factors contributing to antibiotic resistance:
1. Commercial use of antibiotics:
Since the 1950s, farmers have been injecting animals and adding antibiotics to the feed for their livestock for two main reasons:
- Attempts to prevent mass casualties of their animals due to disease.
- Certain antibiotics can act as growth stimulants, making the animals grow larger in size.
However, ongoing research in this field has shown that the widespread use of antibiotics in farm animals is resulting in antibiotics being found in our soils. It has been discovered that significant amounts of active antibiotics are found in waste left by farm animals. Both humans and animals have been found to excrete between 30%-90% of active antibiotics in the stool.
Alarming Fact: Research has shown that 3 antibiotics are often found in pig feces while 8 different antibiotics are routinely found in cow feces!
2. Food and water contamination:
Antibiotics are making their way into our water and food supply through water runoff and the consumption of antibiotic treated animals/plants. Thought plants were safe? Plants are being affected by contaminated soil and have detectable levels of antibiotics in them! So, even if you haven’t taken a course of antibiotic in years, there is a good chance you have been exposed to them.
How is Our Global Science Community Working to Help Solve this Problem?
Sadly, if we continue with our current trend, the long-term outlook is grim. Deaths resulting from multi-drug-resistant organisms, or MDRO’s, are already startlingly high and rates are only increasing.
In 2019, infection from antibiotic resistant organisms was the cause of death in 1.27 million people. That is just in 1 year. The nightmare scenario involves a global spread of a bacteria that is “pan-resistant”, which means it is resistant to all clinically available forms of antibiotics.
Sound like a science fiction movie? Unfortunately, such bacteria already exist. If infected by one of these bacteria, humans have a 50% chance of dying from infection.
These statistics are not meant to scare you, but rather to educate and inform you so that we all can contribute to a more positive future when it comes to fighting microbial resistance.
The good news is with a little caution from everybody, along with the optimistic and fast paced technological advances in the science world, we will likely discover new ways to protect ourselves against microbes.
Here are a few exciting ways the science community is working towards that goal:
1. Continuing to modify our existing classes of antibiotics
This has been and continues to be an ongoing battle for many decades.
Interesting Fact: The last new class of antibiotics was discovered in 1984. That was 40 years ago!
While this is good, it is likely not the most sustainable solution. Based on our history with bacteria, we know that sooner or later bacteria will figure out how to beat these modified versions of antibiotics. They have existed on this planet much longer than we humans have.
2. Taking a good look at nature
More research is focused on learning about the various benefits of herbal and plant extracts. There is evidence showing certain naturally occurring compounds can break down bacterial cell walls. In fact, many antibiotics we use today are produced by nature. Many herbs have antimicrobial properties, but we would need a deeper understanding with regards to standardized dosing for combating bacterial infections.
3. Monoclonal Antibodies
You may have heard of these as a tool to combat COVID, but these may be an alternative therapy to fight back against bacterial antibiotic resistance. Some studies have already shown them to be a safe and effective treatment against two specific bacterial infections: Clostridium difficile and Staphylococcus. We still have a long way to go in regard to making this treatment more affordable and widespread, but it is an exciting alternative therapy on the horizon!
4. Peptides
Peptides are gaining popularity as a more “natural” option for a wide variety of health issues. Peptides are naturally occurring strings of amino acids or proteins bonded together that are responsible for a wide variety of metabolic processes within the body. This is a promising therapy because scientists are continuing to advance their understanding of how peptides work so that we can recreate specific peptides for targeted purposes.
There are peptides in development today that have antimicrobial properties. This means they can either kill or inhibit the growth of bacteria in the body. This is a new frontier of medicine, and it will be fun to see what other peptides get discovered!
For example: A very popular peptide being used across the country right now is called semaglutide. Most people know it as “Ozempic” or “Wegovy”, and it is used for weight management and diabetes. Another peptide used every day in the world is injectable insulin.
The good news…
Technology and science are moving at an exponentially faster pace all the time. So, while in today’s world antibiotics are currently desperately needed to help save people from severe bacterial infections, we may not be too far away from discovering more viable and lifesaving options!
Besides the Rising Antibiotic Resistance Debacle, What are the Health Effects of taking Antibiotics?
While it is obviously true that antibiotics save lives, it is also equally true that antibiotics have some negative side effects, both short term and long term. Let’s take a deeper dive so we can learn some ways to protect ourselves when antibiotics are needed.
