Antibiotic Resistance – Bug Killer

Antibiotics are chemical substances that fight against bacteria. Bacteria are small one-celled organisms found almost everywhere on earth and even on the moon. While most bacteria are harmless and many even beneficial, there are certain bacteria that can cause illness. The range of clinical diseases from bacterial infections is extremely diverse, with severity ranging from mild to life threatening. Antibiotics are the everyday miracle that enables us to treat these infections, from strep throat and ear infections to dangerous cases of meningitis.

Prior to the early 20th century, there were few reliable ways to treat serious bacterial infections. While not the first antimicrobial substance discovered, a breakthrough appeared with the discovery of penicillin G, a chemical substance secreted by a mold that inhibits growth of bacteria around it. “Penny G” was first purified in 1942, and since then we’ve had a long time to research and develop newer and better chemicals that kill or stop the growth of bacteria whilst being minimally toxic to ourselves. Meanwhile, the bacteria have been in their own arms race for survival.

I am sure we’ve all watched news segments of hospital worries over so-called superbugs. These are hardy bacteria (or other microbes; fungi and viruses can evolve resistance to antifungals and antivirals, respectively) that are resistant to multiple major classes of antibiotics. Resistance in bacteria can arise in two main ways – natural genetic mutations, or the sharing of existing antibacterial genes from one bacterium to another. In the United States, at least 35,000 people die each year from drug-resistant bacteria, and at least 2.8 million endure difficult to treat infections from these bacteria.

Part of the effort in this battle, besides developing new anti-bacterial treatments, involves reducing the environmental “selection pressure” on these bacterial genes responsible for antibiotic resistance. These measures include infection control practices, clean water and sanitation, vaccine development (vaccine immunity makes serious infections, and therefore antibiotics use, less common), and antibiotic stewardship. This is because, by far, the leading driver of antimicrobial resistance is the overuse and misuse of these medicines. While the widespread use of antibiotics in the agricultural industry shares some blame, physicians and prescribers, as well as the general public, have a duty to be aware of antibiotic overuse.

Antibiotic stewardship is a set of coordinated strategies meant to encourage healthcare practitioners and patients to follow evidence-based prescribing of antibiotic medicines. The goal of such strategies is to both curb antibiotic misuse and halt spreading antibiotic resistance. An example of antibiotic misuse is prescribing an antibiotic such as amoxicillin for a viral upper respiratory infection, i.e., the common cold. In this case, amoxicillin has no benefit whatsoever to the patient suffering from cold, and in fact can only do harm – the amoxicillin may cause diarrhea, upsetting the normal flora of “healthy bacteria” in the gut, or worse. While it may be true that “the dose is the poison,” there is no such thing as a completely benign medication. Exposure to antibiotics has risks, and these risks come with no reward when they are prescribed for the wrong reasons.

In many office visits, physicians face pressure from patients (or patient’s parents) to prescribe antibiotics in inappropriate situations. This is coupled with the natural urge to be helpful - to “do something” for the sick child in front of you. These pressures are weaknesses exploited by the bacterial enemy.

Knowledge and evidence-based practice is a better way to demonstrate compassion and do the right thing for patients.

Antibiotics must be used responsibly in both people and animals. While we all look forward to returning to the normal of “pre-Covid,” no one wants to return to a world before penicillin.

Dr. Duong is a resident physician who sees patients of all ages and provides obstetrical services at Lone Star Family Health Center, a non-profit 501©3 Federally Qualified Health Center operating facilities in Conroe, Spring, Willis, Grangerland, and Huntsville, and serving as home to a fully integrated Family Medicine Residency Program to increase the number of Family Medicine physicians for Texas and our community.