The Growing Threat of Antibiotic Overuse?>

The Growing Threat of Antibiotic Overuse

by Peter Jaret

Antibiotics were heralded as wonder drugs when they first came along many decades ago, and with good reason. These potent medications effectively changed the course of human life. Diseases that had once been almost invariably fatal could now be cured. Infections from serious wounds and injuries could be prevented and cured.

But today, experts warn, we’re running out of effective antibiotics as the bacteria they target become increasingly resistant. Some bacterial agents have evolved into “superbugs,” resistant to virtually every drug doctors throw at them. According to the CDC, antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the United States each year.

What’s behind the antibiotic crisis?

We’re partly to blame. As evidence, consider the results of a November/December 2019 report from the National Poll on Healthy Aging, directed by the Institute for Healthcare Policy & Innovation at the University of Michigan.

Researchers asked a sample of 2,256 American adults between ages 50 and 80 about their attitudes toward and use of antibiotics. Here’s what they learned:

  • Among respondents who filled a prescription for an antibiotic in the previous two years, one in eight didn’t finish taking the prescription as directed. One in three said they stopped as soon as they began to feel better.
  • Nearly two in three respondents who had antibiotics left over said they kept the remaining pills instead of discarding them. The most common reason: in case they got another infection.
  • More than half of those with pills left over said they had taken antibiotics in the past without talking to a health care professional.
  • Among those who discarded their unused antibiotics, one in five said they flushed the pills down the toilet.

The results also showed that many older Americans demand an antibiotic even when it’s not likely to help. Two in five said that if they have a cold that lasts long enough for them to visit the doctor, they expect to be prescribed an antibiotic. (In fact, colds are caused by viruses, not bacteria, so an antibiotic isn’t appropriate.)

If there’s any good news in the Healthy Aging poll on antibiotic use, it’s this: Almost nine in ten respondents were aware that overuse and misuse of antibiotics can lead to resistance, increasing the risk that an antibiotic will become less effective. About the same number said they try to be cautious about using antibiotics.

A Glossary of Infection-Fighting Agents

With so many terms used to describe drugs used to treat infections, it’s easy to get confused. Here’s what you need to know.

Survival of the fittest

Bacteria are single-celled organisms that reproduce by dividing in half. We tend to think of bacteria as bad germs. But in fact, only relatively few types of bacteria cause human illnesses. Many types of “friendly” bacteria reside in our bodies and perform essential functions, such as helping digest food. Like all living things, bacteria evolve. As soon as bacteria are exposed to a new antibiotic, in fact, they begin to change in ways that allow them to resist it and survive. Antibiotic resistance is a classic example of evolution at work as organisms adapt to their environment to survive.

More than two decades ago, researchers began warning about a post-antibiotic era when antibiotics would no longer be of use in treating infections because of antibiotic resistance. Today, leading experts say, we’re at the beginning of this new era, rapidly approaching that time. Older people are at especially high risk for antibiotic-resistant infections, in part because they’re more likely than younger people to develop problems like bladder infections that require antibiotics and to need surgical procedures that may expose them to antibiotic-resistant bacteria. Older people are more likely than younger ones to be hospitalized, which increases the risk of exposure to highly resistant bugs.

Resistant infections can take weeks and even months to fight. They can also prove deadly. But the dangers of antibiotic resistance go beyond nightmare infections. The rise of antibiotic resistance has begun to make many medical procedures that we take for granted more risky because of the danger of infections that don’t respond well—or at all—to antibiotics.

Is It Bacteria or a Virus?

Antibiotics work wonders against infections caused by bacteria. They do not treat infections caused by viruses. Not sure which type of infection you have? This chart can help you make the call.

What each of us can do

While researchers around the world scramble to develop new antibiotics, there’s plenty we can all do to make the wisest use of the medications we have:

  • Use antibiotics exactly as prescribed. Doctors prescribe a course of antibiotics with the goal of wiping out all the disease-causing bugs. Stopping an antibiotic as soon as you begin to feel better increases the danger that antibiotic-resistant germs will be left behind. When you start taking an antibiotic, the most susceptible bugs will die off at first. If you continue taking the drug, even those that are less susceptible will succumb—and ideally, the antibiotic wipes out all the bad bugs. But if you stop taking an antibiotic as soon as you begin to feel better, chances are that plenty of bad bugs are still in your system. And since they’ve survived the first assault, they’re likely to possess at least some resistance to the antibiotic. Now they’re free to reproduce and spread.
  • Only take antibiotics your doctor has specifically prescribed. In the National Poll on Healthy Aging, a high number of people admitted they had taken an antibiotic without their doctor’s knowledge—leftover medication they’d saved from an earlier infection or pills a friend or family member had offered. This is troublesome since not all infections, such as those caused by viruses, respond to antibiotics. And antibiotics are selective in which bacteria they destroy; penicillin, which works well for strep, won’t work against staph.
  • Dispose of unused pills safely. Don’t flush unused antibiotics down the toilet or throw them in the trash. Antibiotics disposed of improperly can find their way into the environment, where bacteria exposed to low levels can begin to develop resistance. Some community organizations and health care centers collect unused medications. For more information, visit the FDA’s website.
  • Don’t insist on an antibiotic. According to the CDC, doctors’ offices and emergency departments prescribe about 47 million courses of antibiotics a year for infections that don’t need an antibiotic often because they yield to pressure from patients to do so. That makes up about one in three antibiotics prescribed in those settings. Obviously, responsibility falls on prescribing doctors. But we as patients can also do our part. When you’re suffering the symptoms of a cold or flu, it’s natural to want your doctor to do something. But antibiotics target bacterial infections, such as bladder infections, some forms of ear infections, and infected cuts and wounds. They aren’t effective against infections caused by viruses, such as colds and flu. And taking an antibiotic when you don’t need it can be hazardous to your health since these powerful medications can kill off populations of friendly bacteria that reside in your intestines, leading to severe diarrhea. Other common side effects of antibiotics include rash, dizziness, nausea, and yeast infections.
  • Practice good hygiene (and common sense). Some of the most effective ways to prevent infections don’t require a prescription. Wash your hands frequently with soap and water, which can dramatically lower your risk of colds and other infections. Make sure your vaccinations are up to date. Keep cuts clean and covered until healed. Always wash your hands thoroughly after touching or caring for animals. When cooking, clean your hands, cooking utensils, and surfaces.

This article first appeared in the February 2020 issue of UC Berkeley Health After 50.

Also see Curbing Antibiotic Overuse in Animals.