1-anibiotic-resistance-cycleWhen antibiotics first came out they were hailed as miracle drugs, which they seemed to be because they cured serious diseases. Over the years, research and development on antibiotics took on new fervor and many new and different classes of antibiotics were discovered. Even in the various categories of antibiotics newer drugs came out as second generation, third generation and fourth generation drugs. These were supposed to work smarter and more effectively against various strains of microorganisms and bacteria.

Antibiotics are given via different delivery systems. Orally antibiotics are available as capsules, pills and syrups, as ear, nose and eye drops, skin creams, ointments and lotions, through injections or intravenously through a drip. Antibiotics may also be available as vaginal pessaries for vaginal and cervical infections.

Are antibiotics virtually a cure-all drugs for infections?

Surely antibiotics work against many diseases, some of which were regarded as virtually incurable in older times. Respiratory tract infections, skin infections, pre and post surgery complications, dental problems, sexually transmitted diseases, meningitis, pneumonia, typhoid, jaundice and many contagious diseases can all be successfully treated by antibiotics. If it is a bacterial or parasite infection, it can usually be treated by antibiotics. However, a course of antibiotics will not work against viruses, unless viruses cause secondary bacterial infections. If your disease is virus induced then some anti-virals may work.

Different antibiotics work differently and on different diseases. Some of the antibiotics currently in use are:

• Penicillins – like penicillin V, flucloxacillin, and amoxicillin. These are often given for respiratory tract infections and urinary tract infections
• Cephalosporins – like cefaclor, cefadroxil, cefalexin. These may be given in septicemia, meningitis or respiratory tract infections.
• Tetracyclines – like tetracycline, doxycycline, and minocycline. These are broad spectrum antibiotics and used for respiratory tract infections, acne, post surgery and more. They are not given to children below 12 years as they cause yellowing of the teeth.
• Aminoglycosides – like gentamicin, amikacin, and tobramycin. These are generally used for septicemia, complicated intraabdominal infections, complicated urinary tract infections, and nosocomial respiratory tract infections.
• Macrolides – like erythromycin, azithromycin, and clarithromycin. These are used for people who may be sensitive to penicillin and cephalosporins. Recently research has shown that azithromyin is implicated in heart attacks.
• Clindamycin. This is used to treat serious infections like toxoplasmosis, vaginal infections bone and joint infections and others.
• Sulfonamides and trimethoprim – like co-trimoxazole. These are used to treat urinary tract infections, bronchitis, bone and joint infections and more.
• Metronidazole and tinidazole. These are often used to treat stomach infections and food poisoning.
• Quinolones – like ciprofloxacin, levofloxacin, and norfloxacin. These are used for various infections and also to treat diseases like typhoid.

Antibiotics work in two different ways: the drugs may be bactericidal or bacteriostatic. Bactericidal drugs work by killing the bacteria while bacteriostatic ones work by stopping them from reproducing, thus limiting the infection and allowing the body’s own immune system to take over. Doctors normally do not or should not provide antibiotics till tests have shown that an infection as been caused by bacteria, though occasionally, the doctor may use his or her clinical judgment to empirically prescribe these drugs. Usually these drugs have a fixed course of treatment ranging from a few days to weeks, depending on the ailment and the drug.

Some frightening statistics

According to an article published in CBS News that carried out a survey regarding antibiotics:

• 44 percent Americans (of those in the survey) are aware of a minor problem in antibiotic drug resistance.
• 90,000 Americans die each year due to health care associated infections, most of which are due to antibiotic resistance.
• 39 percent people were not aware that taking these strong drugs when not required would help in developing antibiotic resistance.
• From 1993 to 2005 hospital stays that included MRSA went up from 1,900 to 368,000 in the U.S. alone.
• From 1999 to 2007, the death rate from treatment resistance C.difficile bacteria rose from 1,999 to 14,500.

This is only the tip of the iceberg.

World Health Organization (WHO) Director-General Dr. Margaret Chan at a conference in 2012 said, ‘We are losing our first-line antimicrobials. Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units.’ She also said that 50 percent of the patients who get infected by any drug resistant bacteria will die because of complex treatment options, which are not guaranteed to work along with increased toxicity of the medicines.

The side effects of antibiotics

Strong medicines often cause serious side effects. Additionally if a patient is known to be penicillin sensitive he or she cannot take any of the penicillin derivative drugs. Or if a patient has G6PD (a blood sensitivity) certain drugs can aggravate his condition. However, any patient can have an allergic reaction to any kind of drug, including antibiotics and people who are known to have a history of allergic reactions should be given antibiotics only if they are sufficiently monitored.

Other side effects are numerous and often include gastrointestinal disturbances, nausea and vomiting. Some antibiotics may cause serious side effects in some people, including chest pains and musculoskeletal pains. For example, ciprofloxacin has a strange side effect – it can cause tendon rupture. It can also cause retinal detachment, seizures, kidney damage, neuropathy and more. Some little known side effects of erythromycin are skin blisters, deafness and jaundice. Of course, these side effects are rare, but a person who suffers a side effect feels the aftermath for a long time.

The dangers of strong medicines

Over a period of time, bacteria exposed to antibiotics also develop antibiotic resistance. When a person gets an infection and the antibiotic does not work, he may be given a stronger antibiotic. This also perpetuates antibiotic resistance and the bacteria get resistant to many different antibiotics when exposed to different drugs.

You may think that this means that the patient will be given another antibiotic, an even stronger one, but there are times when antibiotics simply don’t work. That is when antibiotic resistant infections occur. These infections can be very dangerous as no antibiotics and affect the bacteria and the doctors don’t have medicines left to give.

Another way that bacteria develop resistance to antibiotics is when patients do not complete their course of antibiotics. Different drugs have to be given for a certain number of days, but as these drugs work fast, people feel better and then stop taking the medicine. While this may seem fine in the short term, for an individual patient, if the bacteria are still present even in smaller numbers, they develop resistance to the antibiotic.

When doctors overprescribe these strong drugs, often when there may be no need for them or the doctor does not ask for tests to check whether the infection is caused by virus or bacteria and gives the drugs empirically, the germs develop resistance to the medicines. There are specified guidelines for prescribing antibiotics, including when, where, which, how much, how long, the dosage and more and when doctors do not follow these guidelines, antibiotic resistant bacteria thrive. Another problem that occurs in many countries that have less stringent drug laws is when people can just walk into a chemist or pharmacy and buy a drug or can order it from the internet. When patients start self medicating for minor problems, they are not aware of the dangers of antibiotic abuse and the problems associated with bacteria resistant antibiotics.

What is antibiotic resistance anyway?

If you wonder what antibiotic resistance is, it occurs when the medicine is no longer effective against the bacteria. This happens in certain conditions: when bacteria are exposed to an antibiotic a number of times, it can mutate and develop immunity towards that antibiotic. If even one bacterium escapes the effects of the medicine, it was able to do so due to certain inherent factors. When it multiplies these factors are passed on to the new bacteria and this way all the bacteria then has the power to ward off the effects of the medicine. Bacteria, like viruses and other micro-organisms have a short life span and can mutate very fast.

Different bacteria develop work differently to overcome the effects of the antibiotic. They can neutralize the antibiotic, remove the antibiotic from their systems, or change the antibiotic so it stops having an effect. It is virtually a given that over time bacteria develop resistance to antibiotics and that is why new antibiotics have to developed to combat the stronger bacteria against which older medicines are ineffective.

Antibiotic resistance is a growing concern

When antibiotics were originally launched they were hailed as miracle drugs, and they have proven their mettle against a number of different diseases that have been untreatable. However, with newer and more efficient antibiotics being manufactured, antibiotic resistance has become a major concern as bacteria mutate rapidly and develop resistance to the antibiotics. This results in drug resistant diseases that are often incurable.

One of the places where drug resistant diseases thrive is a hospital. It is no secret that a hospital has, despite a supposedly sterile environment, millions of bacteria, germs and viruses. What is worse that people who are in hospital for any medical reason whatsoever already have a weakened immune system and so are prone to infections more easily.

A team of researchers led by Brad Spellberg at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center has concluded in a report that the CDC estimates of hospital infections are actually much less than the reality. CDC had said that there was an 11 percent resistance to Carbapenems (the strongest antibiotics currently available) for infections caused by acinetobacter (A. baumannii), though the actual resistance was more than 50 percent. Carbapenems are no longer used for intensive care unit infections as they are ineffective and other drugs also don’t work or are toxic. In fact, according to estimates by CDC, 50 percent of the patients who get carbapenem-resistant enterobacteriaceae blood infections are likely to die. Similarly though CDC estimated resistance to E. coli to third generation cephalosporins to be five percent, the real figure is between eight and 11 percent. For klebsiella (K. pneumonia) the cephalosporin resistance was 20-27 percent when compared with CDC’s figures of only five percent. This report is slated to appear in Antimicrobial Agents and Chemotherapy

The researchers also feel that hospital acquired drug resistant infections require newer antibiotics that still need to be developed. Additionally a different approach as to disease treatment may help and give a fresh perspective to research and develop new drugs.

New research on antibiotic resistant bacteria

In order to address the issue of antibiotic resistant bacteria in hospitals and other places, a nationwide research program has been launched, guided by researchers at Duke Medicine and UC San Francisco, to study methicillin-resistant Staphylococcus aureus (MRSA) and E. coli. Called the Antibacterial Resistance Leadership Group the team is led by Vance Fowler Jr., MD, MHS, professor of medicine at Duke and Henry “Chip” Chambers, MD, professor of medicine at UCSF and chief of the Division of Infectious Diseases at San Francisco General Hospital and Trauma Center. Starting with an initial funding of $2 million, the research is slated to continue till 2019 and receive total funding of $62 million.

The research will focus on gram negative bacteria like E. coli, gram positive bacteria like Staphylococcus aureus and also focus on other areas such as which antibiotics are effective without the overuse of these strong drugs. Diagnosis of the infections also needs to be done on a priority basis and this is another challenge faced by doctors as often it takes too much time to identify the pathogens and treatment cannot be started before investigation. The research will also include clinical trials at a later stage.

Can eating meat increase the incidence of antibiotic resistance?

There is great concern on how the meat and poultry industry feeds sub-therapeutic antibiotics to animals and birds. This is supposedly not only to ward off disease, but also add to the animals’ weight, thus giving more meat. Unfortunately, giving sub therapeutic levels of drugs constantly allows the bacteria to mutate faster and these resistant pathogens can easily spread to humans if meat is not cooked properly or lying in unhygienic conditions during food preparations or through many different ways. Though the people who work with the animals and in the industry are the first people to get infected, people who finally buy and consume the meat, too, can easily get infected. While the FDA says there are not enough studies in place to regulate the use of antibiotics in the meat processing industry, there seems to be a growing body of evidence to support the need for some regulations. In fact various strains of the flu virus have had their origins in the bird industry and there is sufficient evidence to show that micro-organisms spread from animals to humans and mutate.

Another report about antibiotic resistant bacteria found in meat

The Environmental Working Group (EWG) analyzed data collected by the National Antimicrobial Resistance Monitoring System, a joint project of the federal Food and Drug Administration, Centers for Disease Control and Prevention and U.S. Department of Agriculture that found supermarket meat samples collected in 2011 contained significant amounts of salmonella and E. coli that were antibiotic resistant. Of the samples tested, 53 percent of raw chicken had antibiotic resistant E. coli. In the case of salmonella found in chicken samples, 74 percent were antibiotic-resistant and 26 percent tested positive for resistant Campylobacter.

This report was published earlier in April 2013, but did not receive sufficient media attention. The possibility of diseases spread by meat that harbors antibiotic resistant bacteria also points to the profit-making by pharmaceutical companies at the cost of human health considering that 80 percent of the antibiotics produced in America alone go into the meat industry and only 20 percent are used by people.

After this report, came another one: investigators from Consumer Reports purchased 257 samples of ground turkey from various retail shops and tested them. Enterococcus was found in 69 percent, E. coli in 60 percent; in smaller percentages, three other bacteria strains were found including salmonella, staphylococcus aureus and campylobacter. Half the enterococcus and E. coli samples were resistant to three or more related groups of antibiotics. Three of the samples had MRSA and 12 had salmonella, some of which were resistant to three or more groups of antibiotics.

With global travel and a global marketplace where all kinds of meat products, both processed and frozen are available, the spread of antibiotic resistant bacteria is on the rise. Medical researchers and scientists simply don’t have any more weapons in their arsenal. That is why it is all the more important that people take antibiotics only when absolutely needed.

Have you had a bad experience with antibiotics or suffered from any antibiotic resistant infection? What did you do?