Antibiotics – Damned If You Do, Damned If You Don’t

Posted on  June 13, 2018

 

Forget zombies and serial killers in clown outfits. Many health practitioners think the most frightening movie they have ever seen is Contagion, a 2011 film that follows the simple act of a bulldozer in an Asian rainforest disturbing a bat resulting in the death of 26 million people worldwide. Although (mercifully) fiction, the nightmares many people suffered after viewing the film came because unlike zombies, this could, conceivably, become fact.

Bacteria are as cunning as they are clever. No sooner does a human being find ways to kill them, the organisms find ways to revive, mutate and thrive.

The threat

Experts have long warned about the overuse of antibiotics, but patients aren’t listening – particularly worried parents. The emotional pull of a sick child will cause the most rational adult to “do what it takes” to make him/her better again.  They don’t expect to leave the doctor’s office empty handed and will fight hard if necessary. No wonder some doctors give in to the request for the drugs.

It’s time to take the threat that comes with over prescribing antibiotics seriously. The Center for Disease Control and Prevention states that antibiotic resistance has been called one of the world’s most pressing public health problems.

So, what to do?

A 15 month study recently found that there were ways smaller hospitals could effectively reduce antibiotic overuse via stewardship programs designed to help physicians use antibiotics properly, thus preventing the growth of antibiotic-resistant bacteria.

While doctors understand the problem, some are nonetheless still prescribing in cases where the issue is viral. This is because many, including doctors in rural areas of countries such as China, don’t have access to diagnostic equipment to confirm full identification of a disorder. Other reasons include the fact that, in some areas, there are limited financial and human resources to continually run antimicrobial stewardship programs or doctors are exposed to financial incentives from drug companies to prescribe these medicines.

Day-to-day vigilance

It’s obvious that doctors should only prescribe antibiotics when they are necessary. It may be less than easy for a busy, overworked doctor. Stewardship programs educate medical professionals regarding the difference between viral and bacterial-driven infections and why they must resist the temptation to dispense unnecessary antibiotics to an insistent patient. If antibiotics are necessary, it’s important to remember to stress to patients when prescribing that they need to use the antibodies exactly as instructed –skipping a dose, not finishing a round of prescribed medicine or saving antibiotics for future use are to be avoided at all costs.

There’s also a need for more patient education. Many people think “oh, I’m just one person, what difference will it make if I take antibiotics when I really don’t need them.” Perhaps if they understand how it will affect them personally, it will make more of a difference. Tell them that one dose of unnecessary antibiotics affects the level of drug resistant bugs in your own body.

The CDC points out that many doctors need to change their own habits. In an article entitled Core Elements of Hospital Antibiotic Stewardship Programs, the industry body outlined some examples, such as prescribing antibiotics for urinary tract infections that are asymptomatic.  It, too, states the case for more stewardship programs being established and supported.

The Catch 22 of Antibiotics

This issue also causes concern for researchers helping to keep some of the most disadvantaged people alive. Several years ago, it was discovered that children in several Ethiopian villages were living far beyond the average number of years (many typically died at the shockingly low age of five).

The researchers were initially treating them for trachoma (which causes blindness) with periodic use of antibiotics, but then, something surprising happened.  For 200,000 children in villages and the surrounding countries, the number of deaths dropped an average of 13.5 percent in the communities where kids received antibiotics compared to those treated with placebos.

This provided an upbeat outcome, but also resulted in an ethical dilemma described in an article as “The Catch 22 of Mass-Prescribing Antibiotics.” Herein lies the problem that will face the medical profession for many years to come.

What are your thoughts on this topic?

 
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