By Nick Bennett, MBBChir, PhD, co-director of Antimicrobial Stewardship at Connecticut Children’s Medical Center
This week is “Get Smart” week, the annual CDC-led effort to help us all “Get Smart” about the use of antibiotics. As an infectious disease doctor I get to use antibiotics all the time – in fact I get to use some antibiotics that NO-ONE ELSE gets to use! But I also spend a considerable amount of my time working with colleagues to reduce their use of antibiotics. So why the contradiction?
Antibiotics are a modern luxury – without them something as simple as an ear infection could lead to meningitis, or a simple cut could lead to sepsis and never mind trying to perform complex abdominal surgery without antibiotics! We have become complacent about them though, and year by year we have been faced with more and more bacteria becoming resistant to the antibiotics. This means that the infections have become more difficult to treat, and more people have become sick as a result. The path to new antibiotic development has proven very difficult and slow, and so we have to protect what drugs we have left and reduce the rise of resistant bacteria. By one estimate, 23,000 people die every year in the United States from resistant infections.
Antibiotics work by either killing or slowing down the bacteria. They work together with a healthy immune system – which is why people with lower immune systems tend to get more infections. If an antibiotic stops working it’s not because the patient has become resistant to the antibiotic – it’s because the wimpy bacteria have all been killed off and only the resistant ones are left. There are several ways antibiotics can affect bacteria; by affecting their protein production, their DNA replication or directly damaging their cell wall. Unfortunately, we don’t have a lot of new ideas on how to kill bacteria – a big problem in the development of new drugs over the last few decades.
One downside of using antibiotics is of course resistance, but they have other side effects too. Rashes and other allergies can happen; diarrhea is a common problem and can be serious (especially in older adults); some antibiotics used in hospitals can even damage the kidneys or affect blood counts. These are all reasons to avoid using them unless absolutely necessary!
Sometimes it is hard to distinguish a viral infection (an infection that doesn’t need antibiotics) from a bacterial infection (an infection that often does). Ear infections, pneumonia, sore throat – can all be caused by BOTH viruses and bacteria. Sometimes it’s okay to watch, wait and see what happens – I joke that ear infections often get better in 7 days with an antibiotic, and a whole week without one!
Parents can join the fight against antibiotic resistance by not requesting antibiotics for things like runny noses or mild cough (almost always viral), and instead asking their doctor for a “Wait and see prescription,” which is only filled if the family is concerned about their child not getting better. The WASP has been shown to reduce antibiotic use by half for ear infections, with no increase in length of symptoms.
Immunizations can also play a helpful role when it comes to antibiotic-resistance. In fact, when a child is immunized they are at a MUCH lower risk of catching bacterial infections. In fact, at least one vaccine was designed specifically to reduce antibiotic-resistant infections that cause pneumonia.
Of course, I would be very happy if there was no more antibiotic-resistance, but as long as we continue to use antibiotics there will be antibiotic-resistant bacteria. We all have to work together to protect ourselves from ourselves!