The dangers of antibiotic overuse
Imagine a future where organ transplants can’t happen. Where chemotherapy isn’t an option for cancer patients, as the infections that follow the suppression of the immune system can’t be treated. Where infections like TB are commonplace. Where a bout of tonsillitis routinely leads to rheumatic fever. And where ‘‘simple’’ infections, in the chest or skin or kidney, for example, could be deadly.
At the risk of sounding alarmist, this is a highly plausible scenario, and something we need to reflect on seriously.
Antibiotic resistance is very real, and unless we drastically alter how we tackle this issue, at least some of the situations mentioned above could happen in the not-too-distant future.
Since Sir Arthur Fleming first discovered penicillin in 1928, antibiotics have changed the world.
Infections that used to carry high mortality rates are now easily cured. However, we have overused and abused them – in health, agriculture and food production. The cost of that is now beginning to become apparent.
As we know, antibiotics are only effective against bacteria, as opposed to viruses. Narrowspectrum antibiotics target a specific bacterium, or a small group of them – as opposed to broad-spectrum antibiotics that have more of a ‘‘scatter’’ approach, targeting not only lots of types of bacteria, but often also the ones naturally present in our body that protect us, specifically in our gut.
When an antibiotic ‘‘wipes out’’ a bacteria (either by killing or halting the multiplication of it), it often unfortunately wipes out other good bacteria, too. This means that any bacteria around that are ‘‘resistant’’ (ie, have developed an ability to protect themselves from the antibiotic) can multiply and grow as they wish, creating more and more of the resistant strains.
Over the past few decades, it is the over-use and misuse of antibiotics, especially broadspectrum ones, that has led to increasing resistance, which is now rapidly becoming one of the most pressing health concerns around the world.
In August this year, the government launched a five-year plan to tackle this problem. The Ministries of Health and Primary Industries are taking a combined approach, working alongside multiple groups in the sectors of health, agriculture, veterinary medicine, science and food production to raise awareness of this issue, but also come up with some solutions.
For health, the messages are quite simple. It is largely around education – of the public and the prescribers with whom a large proportion of the responsibility lies:
❚ Antibiotics don’t work for viruses, so don’t take them (or prescribe them) for colds, coughs or flu infections. The majority of sore throats are also viral – although it is important to check you don’t have tonsillitis from the streptococcal bacteria, once this has been ruled out antibiotics aren’t necessary.
❚ Antibiotics should be reserved for ‘‘serious’’ infections. If you or your child has a sore ear, for example (however awful this can be), using antibiotics is unlikely to alter the ‘‘natural course’’ of the infection by more than a day or so. This means that if you choose to manage an uncomplicated ear infection with adequate doses of pain relief such as ibuprofen or paracetamol, rest and fluids, you will nearly always be able to avoid using antibiotics, and the potential side-effects they can cause.
❚ If you are prescribed antibiotics, use them exactly as advised. Taking only part of a course of antibiotics, sharing them with someone else, missing doses or ‘‘stock-piling’’ them for a future occasion all contribute to increased resistance in the community.
❚ Try to avoid ‘‘topical’’ antibiotics as they create more resistance (these are antibiotics that are used on the skin rather than taken by mouth). Likewise try to opt for narrow-spectrum antibiotics rather than broad-spectrum ones wherever possible – targeting antibiotics to a specific bacteria is a far more scientific approach than throwing ‘‘big ammunition’’ at it unnecessarily.
❚ Minimise the risk of infection in your community by staying home when you or your family are unwell, and ensuring you are all fully vaccinated.
Despite efforts being poured into research, sadly very few new antibiotics have been successfully developed in recent times, which makes preserving the potency of the ones we do have even more crucial.
For more advice, visit the Ministry of Health’s website health.govt.nz.
❚ Dr Cathy Stephenson is a GP and forensic medical examiner.