Help Antibiotics Get their Advantage Back

When I started my clinical practice in 1999, it became apparent that people generally consider antibiotics the cure-all for infections. Every sneeze, sore throat, cough and runny nose was to be blown away with a prescription of some new drug. People didn’t have time to be sick. Parents couldn’t stand the idea of their children being lethargic, losing their appetites, and running the risk of developing epilepsy from a fever-related convulsion. There certainly were some common ideas about how things worked and how colds, flus, diarrhoeas and the like were to be managed. Antibiotics were first line for everything. Pain and fever medicines were hot on their heels and given freely. 20 years on, and largely as a result of the attitudes of patients and practitioners alike, the world is now on the edge of one of its most pressing public health epidemics – antibiotic resistance.

So, what is that exactly?

Antibiotic resistance is the ability of bacteria to defy the effects of the drug intended to either weaken or kill them. Antibiotic resistance occurs when bacteria undergo changes that reduce the efficacy of drugs. This is then compounded as sensitive bacteria (ones that antibiotics can still attack) die, and resistant bacteria are left to multiply and take over. At its core, antibiotic resistance is a survival adaptation of the bacteria that renders the drug intended to wipe them out, ineffective. With that understanding it’s not difficult to recognize the problems that antibiotic resistance pose. With bugs that can now overcome the treatments given to take them out, infections last longer, require more doctors’ visits to manage, lead to more antibiotics and other expensive and toxic medications being prescribed, and, in the end, result in deaths that could have been prevented.

IMAGE FROM THE CDC WEBSITE: https://www.cdc.gov/getsmart/community/about/antibiotic-resistance-faqs.html

The medical community has grown in its awareness of both the problem and the severity of it. When otherwise healthy people end up dying from complications of resistant bugs after being hospitalized for things like routine knee and hip replacement surgeries, we know that things are already out of hand. That’s the reason for an increasing drive by institutes such as the WHO (World Health Organization) and CDC (Centers for Disease Control and Prevention) to increase the awareness and educate as many people as they can on the size and seriousness of the crisis at hand. People like me also write articles, give talks, and take time to explain to patients, family, and friends that this problem is one we can all contribute to solving.

Part of getting that right is developing the understanding of what constitutes and underlies overuse and misuse of antibiotics. This is the main area that needs to be addressed. In other words, if we can get a handle on when and why antibiotics are taken unnecessarily, we can be better informed about how we can all cut back on using them. The more people there are that understand this and change their behaviour, the greater the chances of us regaining the upper hand in the battle against these microscopic enemies. To help with all this, here are things I’ve borrowed from the CDC website:

Facts about Antibiotic Prescribing Resistance

  • Overuse of antibiotics is the major modifiable cause of increases in drug-resistant bacteria.
  • At least 30% of antibiotic courses prescribed in the outpatient setting are unnecessary, meaning that no antibiotic is needed at all. Most of this unnecessary use is for acute respiratory conditions, such as colds, bronchitis, sore throats caused by viruses, and even some sinus and ear infections.
  • Total inappropriate antibiotic use (which includes unnecessary antibiotic use plus inappropriate antibiotic selection, dosing, and duration) may approach 50% of all outpatient antibiotic use.
  • Antibiotics are the most frequent cause of adverse drug events (ADEs) leading to emergency department visits in children, and 7 of the top 10 drugs involved in ADEs leading to emergency room visits are antibiotics.

The bottom line is that if we all committed to applying some commonsense and taking antibiotics only when genuinely necessary, rather than for every sniffle, scratchy throat, earache and sinus problem, we would go a long way in relieving a bad situation.

A few more specific things you can do to help

  • Tell your healthcare professional that you are concerned about antibiotic resistance.
  • Ask them if there are steps you can take to feel better and get symptomatic relief without using antibiotics.
  • Never pressure your healthcare professional to prescribe an antibiotic.
  • Don’t self-medicate with antibiotics (common problem in the UAE).
  • Take the prescribed antibiotic exactly as your healthcare provider tells you.
  • Never save some antibiotics for the next time you get sick (discard any leftover).
  • Never take an antibiotic for a viral infection like a cold or the flu.

Some of these things are easy enough to follow through with. But, when it comes to differentiating between bacterial infections and viral ones, and possibly even certain allergies, that’s when it can be a bit trickier. In saying that, the odds are on our side. That’s because most of the upper and even lower respiratory tract infections you and your family might get will be viral. This means that throat, ear, sinus, and chest infections will generally not need antibiotics. The same is true for upset stomach and diarrhoea. These are the most common infections affecting the average family and they can be well managed with supportive complementary and alternative treatments. The past 20 years have confirmed this for me. In reality, when care is taken to clinically differentiate between bacterial and other infections, and well selected homeopathic and herbal medicines are used in conjunction with good hydration and rest, antibiotics can, for the most part, be avoided. In saying this, I do recommend that the use of alternatives even be under the guidance of a qualified healthcare provider. That’s because monitoring the progress of the condition is imperative. Most conditions will resolve without complication, but in the event of a secondary bacterial infection developing, it is best to detect early and manage with the antibiotic to which the bacteria has, ideally, been confirmed sensitive.

By adopting the advice on offer here, I am confident that the frequency of antibiotic use can reduce and resistance be overcome. This is what is needed. Since their discovery, antibiotics have added more to the average life expectancy than any other invention. To completely lose the advantage they bring to the battle of bacterial infections would be a tragedy to countless people. With the knowledge that you can make a difference, I encourage you to do just that.