The trouble with antibiotics

Susan Farrell, MD
Susan Farrell, MD, Contributing Editor

Most people are aware of the potential downsides of taking an antibiotic. These side effects can range from allergic reactions to stomach upset, diarrhea, mental confusion, and in some cases, Clostridium difficile colitis – painful colon inflammation caused by a disruption in the normal balance of bacteria in the large intestine.

However, more recently, concerns regarding the emergence of antibiotic-resistant bacteria are increasingly in the news.

“Antimicrobial stewardship” promotes the appropriate use of antimicrobial agents, including antibiotics, in order to improve patient outcomes, reduce drug resistance, and limit the spread of infections caused by drug-resistant bacteria. This concept is not new. Calls for optimizing the use of antibiotics, particularly in outpatient settings, have existed for decades. As of 2013, the U.S. Centers for Disease Control and Prevention listed 18 antibiotic resistant microbes. In 2016, the CDC reported that antibiotic-resistant infections affect 2 million people. There are a number of reasons for the increase in bacteria that are resistant to antibiotics, making some of those antibiotics less effective, but inappropriate prescribing and misuse are big contributors. In 2015, the White House National Action Plan for Combating Antibiotic Resistant Bacteria set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020.

A recent study published in the Journal of the American Medical Association (JAMA) reported on the prevalence of inappropriate antibiotic prescriptions written during US ambulatory care visits between 2010-2011. The researchers used data from the National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Surveys to collect information on outpatient and emergency department patient visits to estimate when, how, and why providers prescribe antibiotics. Of more than 184,000 patient visits, 12.6% were associated with an antibiotic prescription.

The authors noted that variations in prescribing patterns could be related to regional location and the patient’s age, but based on recommended expert guidelines; they estimated that 30% of outpatient oral antibiotic prescriptions may have been inappropriate.

Because antibiotic use is the primary driver of antibiotic resistance, it is important to know when an antibiotic is truly necessary. For example, pneumonia and urinary tract infections almost always require antibiotic therapy. In contrast, sinus infections and sore throats may not. While antibiotics are not necessary for most upper respiratory infections, bronchitis, and the flu, as many as 34 million antibiotic prescriptions in the 2010-2011 study were written for these very illnesses. While there were some limitations to the study, the results should still give us all pause.

So, where does antibiotic resistance come from? It is important to note that resistance is not a characteristic of an infected person. It is a characteristic of bacteria that have evolved through genetic changes and mutations that elude the bacteria-killing methods of antibiotics. These genetic changes can persist throughout bacterial strains when the genetic code for these mutations is spread between them.

What causes this spread? When antibiotics are used in farm animals as growth enhancers or when antibiotics are prescribed too often or incorrectly for humans, bacteria develop mutations to protect themselves. Inappropriate medical prescribing can occur when an incorrect diagnosis results in an antibiotic prescription or when antibiotics are used for conditions that do not require them, such as upper respiratory infections. In addition, when patients don’t complete a full course of a necessary antibiotic – usually because they are feeling better – any remaining bacteria in the body will be left to grow and change in ways that encourage their own resistance. The use of broad-spectrum, second line antibiotics in the outpatient setting also contributes to the rise of resistance.

Prescribers and patients can help fend off antibiotic resistance

Limiting the spread of antibiotic resistant bacteria will be everyone’s responsibility.

Health care providers who prescribe antibiotics should:

  • Use available point-of-care testing to quickly and accurately determine if a bacterial infection is the cause of a patient’s symptoms.
  • Follow expert guidelines on the use of antibiotics for specific illnesses and explain these guidelines to patients when discussing treatment options.

Patients can take a more active role in their care:

  • Be aware that not all infections need or benefit from antibiotics. Often you will get better in a reasonable amount of time simply by treating symptoms. Of course, do go back to your doctor should you not improve or get worse.
  • When getting an antibiotic prescription, ask if that antibiotic is the best choice for the infection you have.
  • Take the medication exactly as prescribed.

Related Information: Harvard Health Letter

Comments:

  1. Maggie

    It’s an interesting topic. I have a recurrent sinusitis issue. Most doctors over the years have continued to push antibiotics on me. However, my new ENT recently put me on ezc pak. It’s done wonders for me and cut down my antibiotic need this summer. We’ll see how this winter season goes!

  2. Jeanne

    I was on Cipro/Flagyl for Diverticulitis. It nearly killed me. I was so sick, I ended up in the ER. I understand these drugs are the protocol for Diverticulitis, but the downside is terrible.

  3. Kelley Larrew

    I used to get sinus infections twice a year, almost like clockwork, for years. For years, I took antibiotics for these infections.

    When I finally got better insurance coverage, I found out (in my 30’s), that I have many environmental allergies.

    Once I got the allergies under control with Flonase, the sinus infections ceased.

    Occasionally I have to take an antibiotic, but it is very rare now. When I do, I make sure to take a quality probiotic, to keep up intestinal and vaginal flora. This eases colon problems and prevents yeast infection.

    I hope this helps someone. Sinus infections are miserable and the antibiotics made me feel even worse. It’s a real blessing to have finally gotten quality care. I have not had a sinus infection in years now, and still use the generic Flonase daily.

    In Him,
    Kelley

  4. Elise

    If it weren’t for antibiotics, my recurring cellulitis with edema
    would have caused osteomyilitis . Bad enough being hospitalized for 3 days with leg in traction. Now, I’m automatically tested for MRSA. Just got discharged again in 2015 with 2 antibiotics.

  5. Kim

    If you or a family member or friend have a known syndrome it would be important to have an immune system evaluation by a specialist , as quite a few people have inborn or acquired immune system problems where they need prophylactic antibiotics, especially if they have undiagnosed heart problems. Congenital heart defects are the number one birth defect worldwide.

    Recently , there has been an antibiotic ciprofloxacin which can give people acquired QT syndrome where their hearts electrical signal is disrupted or stops which can cause syncope or sudden death. An example of the cure being worse than the disease/infection.

  6. Daniel

    Why would you ‘Have’ to ask your doctor ‘if’ he’s prescribing the proper medication? Unless it’s a matter of life or death, Never Take Antbiotics!