Monday, November 13, 2017

How Overuse of Antibiotics Is Creating Drug-Resistant Bacteria

By John P. Fardal, DO
Austin Family Physician

Editor's Note: November 13-19 is Antibiotic Awareness Week. The following post explains the differences between bacterial infections and viral infections, and how antibiotics can be used to treat bacterial infections but not viral ones. It also explains how overusing antibiotics can be harmful to public health, and urges patients to think twice before automatically asking their physician for antibiotics when they are ill.

Some bacteria split every eight minutes. They can go from a single cell to more than a trillion in less than half a day.

One of the most important advances in health care was the discovery of the antibiotic penicillin. It gave people a very big stick with which to fight bacterial infections. Unfortunately, one of the biggest health threats facing the world is the rise of drug-resistant bacteria, and part of the reason for that rise is the overuse of antibiotics.

How bacteria work:

Bacteria are everywhere, and are mostly beneficial. They help digest food, provide essential vitamins, and compete with bad bacteria. The bad bacteria, however, can make people very sick. Luckily, bacteria are different enough from human cells that scientists have been able to discover or invent chemicals that target them. This is how antibiotics usually work, either disrupting bacterial cell structure or shutting down their molecular workshops.

How viruses work:

Viruses, however, are very different from bacteria. While bacteria stay outside of human cells, viruses invade them and hijack our molecular workshops. Viruses then use their own blueprints to make what they need. They make thousands of copies of themselves in each cell they invade, and then burst out of the cell to invade more cells and repeat the process. Because they hide inside our own cells and use our own workshops, it's hard to shut down their production without shutting down our own normal body processes.

It's not possible to shut down viral workshops, but it is possible to go after the viruses directly. This is where antivirals come into play. They are the viral version of antibiotics, but they are different in an important way ― they generally target one virus strain, while antibiotics usually affect many different bacteria.  There are a lot of viral strains out there. The common cold has more than 200 viral strains all by itself. Antivirals are only effective for a few select viral infections.

How your immune system works:

Our immune system is usually very good at fighting both bacteria and viruses. In rough terms, it first has to notice that something is in our body that doesn't belong there. Once the intruder is noticed, our workshops ramp up production of antibodies that target it so the rest of our immune system can kill it. This can take a few days and is when people usually feel worst.

The problem with antibiotic overuse:

When we use antibiotics, they effectively kill a very large portion of the bacteria, but some bacteria are able to survive through variations of their genetic code ― also known as just being lucky. Usually, our immune system kills off those last few lucky bacteria, but every now and then one slips out with a cough or sneeze, and is able to set up shop in another person. Now there is a strain of the bacteria that can't be killed with that antibiotic, and it can make a trillion copies of itself in half a day. It's ironic, but antibiotics use is the single most important factor in the development of antibiotic-resistant bacteria worldwide.

Drug-resistant bacteria are scary ― really scary. In the days before antibiotics, people died from bacterial infections at a rate we would have a hard time believing today. Last year, about 2 million people in the United States were hospitalized with a drug-resistant bacterial infection. There are a few very strong antibiotics that are kept in reserve just to be used for those resistant bacteria, but eventually, the bacteria will become resistant to them as well. Luckily, it is possible to slow the development of this particular catastrophe by only using antibiotics when fighting a bacterial infection. And that's where the virus comes back into the picture.

Antibiotics are for bacterial infections, not viral infections

Most people go to the doctor with upper respiratory symptoms and expect an antibiotic prescription. They believe antibiotics can make their illness go away much faster than just relying on their immune system to do the job. And they are right ― antibiotics can be very helpful when someone has a bacterial infection. However, when they have a viral infection, all the antibiotic will do is kill off good bacteria. This may give the patient diarrhea, and every now and then cause a resistant bacteria to emerge, all without making the patient's infection any better. Nevertheless, some health care providers prescribe antibiotics when it's much more likely that their patients have viral infections, such as the cold, because they want to both keep their patients happy and cover a possible bacterial infection in situations where the diagnosis is not clear cut.

This is where we can all help to save the world in a very literal sense. If your physician thinks you have a viral infection and does not recommend that you use an antibiotic, please consider giving it a few days, to see if your immune system ramps up and fights the virus off on its own. If it doesn't, odds are better that it's bacterial, and a physician will almost always be happy to prescribe antibiotics at that point.  Waiting just a few days can make a really big difference.

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