Vive la résistance? Non!

Antibiotic resistance is a major public health threat

/ Author:  / Reviewed by: Joseph V. Madia, MD

If the Centers for Disease Control has it's way, the legions of bacteria that cause disease won't be gathering together for the final, inspirational chorus of Les Miserables vowing to continue the resistance.

This week is the third annual Get Smart About Antibiotics week, an initiative put forth by the CDC with the hope of raising awareness of antibiotic resistance. Dr. Thomas Frieden, director of CDC, stated "Antibiotics are essential to combat life-threatening bacterial infections...Unfortunately, misuse of antibiotics is widespread and contributes to resistance. We have to better promote appropriate use of antibiotics to preserve these life-saving tools." Over $1.1 billion dollars is spent annually on unnecessary antibiotic prescriptions for respiratory illness alone, and over 50% of antibiotic prescriptions are inappropriately prescribed. Most distressing, however, is that antibiotic resistance leads to an increase in patient mortality.

Current Threat

Antibiotic resistance is “a serious threat to patient safety” stated European Center for Disease Prevention and Control director Marc Sprenger. “[it reduces] options for treatment and [increases] lengths of hospital stay[s], as well as patient morbidity and mortality.” Several antibiotic resistant species are already commonplace in the United States, including Methicillin-Resistant Staph Aureus, Clostridium Difficile resistant to clindamycin, and multidrug resistant Pseudomonas Aeruginosa, all of which cause billions of dollars in added healthcare costs and mortality every year.

How Does Antibiotic Resistance Occur?

How does this affect healthcare for humans? There are several factors that contribute to antibiotic resistance, but the main thing to consider is that antibiotics must be used in the proper dose for the proper length of time for the proper condition. A problem with any of these three factors can lead to antibiotic resistance. How does this work?

  • Proper Dosage – The dosing of antibiotics is important. Think of it like a burning building...if firefighters drenched only 90% of a burning house, is the fire really out? Not having a strong enough dose allows a number of bacteria to 'survive' the antibiotic, and the ones that are left can be selected for their ability to 'resist' the fire.
  • Taking the whole prescribed dose – Many times a patient will get a real infection that requires a properly prescribed antibiotic. But the patient will often feel much better long before the prescribed dose is finished, say five or six days into a ten day prescription, and will not finish the whole dose. Without taking the whole dose, the strongest bacteria that were able to live through the first few days have been exposed to an antibiotic, but not killed. They may have undergone a change that now allows them to resist that antibiotic that was prescribed to kill it.
  • The right antibiotic – When antibiotics are prescribed for a viral infection (which is useless as antibiotics cannot kill a virus) or a patient takes an antibiotic they have from a previous prescription that they saved in their medicine cabinet, all this is doing is exposing bacteria to a drug that they might develop a resistance to.

Keeping Safe

Unfortunately, bacteria will continue to evolve faster than medicine will provide new antibiotics. Reducing the progression of antibiotic resistance is something that the public has to do as a collective effort. The FDA recommends the following:

  • Follow the prescription exactly as written – The dose and length of time an antibiotic is prescribed is for a reason. Follow the instructions exactly as written, and make sure if you're prescribed an antibiotic, you take the full dose, especially if you feel better before you're finished.
  • Don't save antibiotics – If you followed the advice above, you shouldn't have any leftover medicine. If for some reason your doctor tells you that you don't have to finish a prescription, don't save it in your medicine cabinet for some other time.
  • Don't take someone else's antibiotics – All antibiotics are no the same, just as all bacterial infections are not the same. Your doctor will prescribe a specific drug for your specific infection, and taking the wrong antibiotic for an infection only exposes that bacteria to an antibiotic that it can become resistant to. 

If you follow this advice and make sure yuor doctor does as well, you can help win the battle against antibiotic resistance and make the world a safer place, excpet for bacteria. 

Reviewed by: 
Review Date: 
November 16, 2010