Overuse Of Antibiotics Can Cause Resistance And Superbugs

Question: I am an infection control nurse at our hospital. I have seen a lot of patients come to our hospital with infections caused by germs that are resistant to many antibiotics. Can you please let the public know about the danger of overuse of antibiotics?

Answer:

Thank you for asking this question. In North America, like the rest of the world, health care professionals have seen a dramatic increase in the number of germs that have become resistant to commonly used antibiotics. This has caused great concern because we depend on antibiotics to kill bacteria that infect our body. However, when antibiotics are used improperly, not only is it ineffective, but it can lead to bacteria developing resistance.

The first antibiotic, Penicillin, was discovered and became available around the end of the Second World War. At that time, it was effective in killing most of the bacteria that caused infections in human. Very quickly, however, some bacteria developed resistance to Penicillin. Scientists tried to overcome this by modifying Penicillin, and produced antibiotics called Ampicillin and Amoxicillin, which were very effective for a while.

Unfortunately, some bacteria again developed resistance to these new antibiotics. Scientists then discovered how smart the bacteria are: they can use different systems inside their single cell bodies to produce resistance. Since bacteria can multiply very rapidly, they can change their genetic makeup much faster than other living things, therefore giving them the ability to develop resistance to new antibiotics very quickly.

In the last few decades, scientists have produced many kinds of antibiotics that can fight different types of bacterial infection. This is one of the attempts to fight bacterial resistance. Even if one germ was able to develop resistance to one or two antibiotics, there would always be others that can still be used to fight the infection.

This strategy had worked until the last twenty years or so, when bacteria that are resistant to most antibiotics started to show up around the world. At the beginning, these so called “multiply resistant bacteria” were found only once in a while. Even though it was alarming, it didn’t cause too much concern until more recently.

In the last few years, these “superbugs” have become much more common, especially in large, referral hospitals that treat a lot of seriously ill patients. Because of the severity of their conditions, these patients often require one or more antibiotics, sometimes for fairly long time.

In a few situations, these superbugs are resistant to all approved antibiotics, and doctors have to resort to those that are still at the research stage, and sometimes these still won’t help. The situation has caused a great deal of concern.

However, when we step back and look at the whole problem, most of us agree that it likely started from the overuse of everyday antibiotics in patients where their use is not necessary. The best example being upper respiratory tract infections, more commonly called colds and flu. These are caused, by and large, by hundreds of different viruses.

Many patients with colds and flu are quite miserable, with a sore throat, stuffy nose, sometimes fever and cough. They often go to the doctor to look for something that could relieve their misery. Many, by mistake, think that taking an antibiotic can help the cold go away faster. The truth is that antibiotics are completely useless against virus infections. The colds will get better no matter what.

Many physicians feel the pressure from their patients and prescribe antibiotics even though they know that these are not necessary. The worrisome thing is that many excellent new antibiotics released in the last few years are being prescribed for colds and flu. If this trend does not stop, these effective antibiotics will lose their ability to kill bacteria when we truly need them in more serious bacterial infections.

I would urge everyone to help us in our fight against overuse of antibiotics. If you have a simple cold or flu, try to let your body overcome the virus infection, and build up your own immunity, so that you won’t get infected with the same virus in future. Resting the body is most important at this time. Don’t run to the doctor right away. And if you do get a prescription, you can ask whether you really need the antibiotic, or just wait and see whether you can get better without it.

With the co-operation of the public, we can win the war against bacteria and their great ability to develop resistance against antibiotics. Of course, trust and good communication between you and your doctor are important to make this successful.

It is also important to recognize that if antibiotic is necessary for a particular bacterial infection, it has to be taken as directed and the course has to be completed. Some people make the mistake to stop the antibiotic when they feel better. If the bacteria are not completely eliminated, they have a better chance of developing resistance, so that the next time around the antibiotic may not be effective anymore.

Vaccines are also very important so that we don’t get infected in the first place. Vaccine for Haemophilus influenza type b (a germ that causes meningitis) has been given routinely to all Canadian children for almost a decade. It has virtually eliminated this serious infection in our children. Vaccines for other bacteria are being investigated and likely will become available in the next few years.

Influenza vaccine is another one that is already available and should be used more widely. It prevents the serious influenza that causes high fever, headache, sore throat, stuffy nose, as well as aches and pain. Many people will suffer complications like pneumonia, ear and sinus infections which will require antibiotics. Although it is recommended for seniors over 65 years, and younger people with conditions like asthma, heart, liver, and kidney ailments, every one of us can benefit from the vaccine. It can prevent influenza and its complications, and reduce the need for antibiotics.

[Note to Readers: Although this column was written more than two decades ago, the overall information is still correct. We are having more problems with antibiotic-resistance; superbugs are killing many people around the world. There are many more vaccines available in preventing serious bacterial infections like pneumonia and meningitis.]