THE OVERUSE OF ANTIBIOTICS: ANTIBIOTIC RESISTANCE: ONE OF THE GREATEST PUBLIC HEALTH ISSUES OF OUR TIMES.

This post is intended to raise awareness of the reader to this specific problem so we may all do our part to minimize the effects of this deadly problem:

Antibiotics ushered in an era of medicine that maybe regarded as one of greatest leaps in Medical sciences.
Alexander Fleming, a professor of bacteriology at St. Mary’s Hospital in London, discovered Penicillin in 1928. This was the first antibiotic ever. ( source1). Penicillin saw its introduction for general use in 1940s. In itself the story of this landmark discovery is fascinating, but perhaps another time.

Antibiotics are most commonly used to treat bacterial infections. When infection gets severe, it leads to septic shock or severe sepsis.
Septic shock is a condition where life threatening infection leads to low blood pressure and organs in the body stop working properly. ( source 2).
The death rate from septic shock or severe sepsis is 40-60%. ( source 3).
It is a scary number but also realize that even at this devastating level of disease, modern medicine successfully treats nearly half these patients.
Death rate without antibiotics in severe sepsis is expected to be approaching 100%. The great impact of antibiotics in survival of patients severe sepsis can also be understood by another important fact. In severe sepsis delay of antibiotic administration increases mortality by 7.6% for every hour of delay. ( source 4).

IMPORTANT NOTE: INFECTIONS CAN RALIDLY PROGRESS AND LEAD TO SEVERE SEPSIS. EARLY RECOGNITION AND TIMELY ANTIBIOTICS CAN SAVE YOUR LIFE. I URGE THE READER TO LEARN ABOUT SEPSIS. A GOOD WEBSITE IS NOTED BELOW AS SOURCE 5.

THE OTHER SIDE OF THE STORY:
ANTIBIOTIC RESISTANCE
Antibiotics are commonly used in every corner of the world. We are seeing rapid rise of infections that are resistant to known antibiotics. According to CDC stats for USA, 8 “Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.” (source 6).
WHO report on this issue has alarming words of caution that I will share with you.

1. Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process.
2. A growing number of infections – such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective.
3. Where antibiotics can be bought for human or animal use without a prescription, the emergence and spread of resistance is made worse. Similarly, in countries without standard treatment guidelines, antibiotics are often over-prescribed by health workers and veterinarians and over-used by the public.
   Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill.

Thus a great urgency is recognized now and the misuse and overuse of antibiotics must be stopped. Many hospitals implement ANTIBIOTIC STEWARDSHIP PROGRAMS.
“A growing body of evidence demonstrates that hospital-based programs dedicated to improving antibiotic use, commonly referred to as “Antibiotic Stewardship Programs (ASPs)”, can both optimize the treatment of infections and reduce adverse events associated with antibiotic use”. (Source 7).
How these programs are successfully implemented requires development and adherence to certain core performance principles. The interested reader is referred to source 7 for further reading. Such programs are being implemented in Hospitals and now nursing homes and physician offices.
It is my personal opinion that in the US, implementation in offices can be difficult. In hospitals there is a multi- disciplinary approach to the problem. Effectiveness can be measured, monitored and programs can be tailored to effect. The process is more private when the interaction is between a patient and a physician only without monitoring programs in place.

HOW CAN YOU AND PLAY OUR PART?

It is truly important to understand the following as reported by CDC.
Viral infections should not be treated with antibiotics. Common infections caused by viruses include
Colds
Flu
Most sore throats
Most coughs and bronchitis (“chest colds”)
Many sinus infections
Many ear infections
( source 8)

We often call our doctors or make office visits for symptoms of above infections. In my practice, the patient’s expectations seems to be immediate issue of antibiotics. I think this is also the cultural norm. There are very particular reasons when to intervene with antibiotics when a patient presents with symptoms of above diseases. As resistant infections populate our planet, it becomes a more dangerous place for humans. We will not leave this planet a better place for our future generations if we don’t change our habits now. Public education and a cultural shift is important. Next time you have symptoms of above noted diseases, take a few extra minutes to discuss with your doctor whether you need antibiotics or not. If your physician tells you you that antibiotics are not not needed, then know that by not taking unnecessary antibiotics you have made the world a better place.

SOMEWHAT RELATED TO THE ABOVE POST IS A LINK TO A NEWYORK TIMES ARTICLE THAT MAKES MENTION OF THIS AUTHOR.
https://www.nytimes.com/2015/04/30/sports/golf/wifes-illness-leaves-marc-leishman-with-new-outlook.html

THE MORE IMPORTANT ASPECT IS THAT THE SURVIVOR HAS DEDICATED HER LIFE TO FIGHTING SEPSIS. HERE IS A LIMK TO HER FOUNDATION.
http://beginagainfoundation.com/about/marc-audrey/

N. Inayet MD, FCCP
EMAIL: [email protected].

( image source: Google images in category, public awareness) .

SOURCES:

1. https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicillin.html
2. https://www.nhs.uk/conditions/septic-shock/
3. https://www.google.com/search?q=sepsis+survival+rates&ie=UTF-8&oe=UTF-8&hl=en-us&client=safari
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254938/
5. https://www.cdc.gov/sepsis/basic/index.html
6. https://www.cdc.gov/drugresistance/index.html
7. https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.html
8. https://www.cdc.gov/antibiotic-use/community/about/antibiotic-resistance-faqs.html