The global public health crisis of
antibiotic resistance is in the spotlight. What’s at stake is the impending
loss of antibiotics that threatens modern medicine as we know it.
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| Photo credit: World Health Organisation director-general Margaret Chan at the launch of a new global campaign against antibiotic resistance. Reuters/Pierre Albouy |
There has been a dramatic increase in
multi-drug-resistant bacteria in the last few years. This is happening in the
community, with examples such as gonorrhoea, and in hospitals where some
“superbugs” are now either virtually, or completely, untreatable. Currently
700,000 people die each year from resistant infections. That number is set to
rise to ten million by 2050 if no action is taken.
Far from being someone else’s problem, the
release of a World Health Organisation (WHO) multi-country survey describes
public awareness around antibiotic resistance, and highlights common
misconceptions that are driving the current crisis. Here are seven of them.
1. Antibiotics won’t cause resistance if
I take them correctly
False.
Antibiotic resistance is all about Darwinian
natural selection. For thousands of years bacteria have had to protect
themselves from chemical substances produced by other bacteria and fungi,
designed to kill them. Since 1928, when Alexander Fleming discovered
penicillin, we have harnessed these substances as antibiotics.
The bacteria that are able to resist have a
survival advantage and will survive an attack by an antibiotic. Some sensitive
bacteria can also acquire resistance genes from other bacteria, also rendering
them resistant. Whenever we use an antibiotic it kills all the bacteria that do
not have a resistance mechanism – that is, those that are sensitive, but leave
any that are resistant.
Given the right circumstances, the
resistant bacteria will replicate and can either cause infection in the treated
person, or colonise the skin and body surfaces. They are then able to be
transferred to another person, for example by touch. This is one way in which
antibiotic-resistant bacteria are spread, especially in healthcare settings, if
healthcare professionals do not practice good hand hygiene.
However well you take an antibiotic, it can
still cause resistance.
2. It’s our bodies that become resistant
to the antibiotic
Nope, sorry, it’s the bacteria, not our bodies.
Therefore, there is nothing we can change
about our bodies that will overcome the resistance to antibiotics in the
bacteria.
3. Antibiotics are the cure for the
common cold and flu
False.
Antibiotics are only active against
bacteria. The common cold and flu are caused by viruses against which
antibiotics have absolutely no effect. And the more antibiotics we use, the
more resistant bacteria will be selected out and will increase in number.
The overuse and misuse of antibiotics for
viral infections is one of the single biggest drivers of the increase in
antibiotic resistance worldwide. The only result of taking an antibiotic for a
cold is to:
do yourself harm through unwanted side
effects of the antibiotic; and
do yourself, your family, friends and
society harm by increasing antibiotic resistance.
The majority of respondents across the 12
countries surveyed by WHO incorrectly believe that viruses such as colds and
flu (64%) can be treated with antibiotics. Nearly 70% of the 1002 South African
respondents shared this misconception, which often translates into pressure put
on doctors and nurses by patients to prescribe an antibiotic when they feel
ill.
Overall, reported antibiotic use was higher
in the lower income countries included in the survey, where 42% of people say
they used antibiotics within the past month compared with 29% of people
surveyed in higher income countries.
4. If I feel better, I can stop my
antibiotics
False.
But there is a caveat. It clearly depends
on whether you are taking the antibiotic for a bacterial infection, or
incorrectly for, say, a viral infection. If this is the case, then the shorter
the time you are on an antibiotic the better.
But if you have a bacterial infection that
needs treating with an antibiotic, then it is vital that you take the course as
prescribed. Our symptoms commonly improve before all the bacteria are killed
and dealt with by the body.
If you stop your antibiotics early, or if
you miss doses, then the amount of antibiotic available to kill the bacteria is
not enough and the bacteria are still able to replicate. It is easier for
bacteria to become resistant if there is too little antibiotic present. So
always complete your course and don’t stop just because you feel better.
5. I can take leftovers, or some from
family or friends
False.
Never take antibiotics that are left over
from past treatments or given by family or friends. Only take antibiotics
prescribed from a doctor or nurse. There are two good reasons for this:
antibiotics past their date are more likely
to cause resistance as the active ingredient may be impaired; and
antibiotics from other people may not be
the correct choice. There are many different types of antibiotics used to treat
different infections, which means that your infection will not be treated
correctly, also increasing the chance that bacteria can become resistant.
6. Resistance only happens from repeated
courses
False.
Antibiotic resistance can occur whenever
you take an antibiotic, whether it is a single course or multiple repeat
courses. The more courses you take, the more resistance can occur. But that
doesn’t mean it doesn’t occur with a single course.
On top of that, a single course of
antibiotics can lead to life-threatening unwanted side effects and potentially
catastrophic changes to the normal bacteria that live in our guts. The
imbalance can allow dangerous bacteria like Clostridium difficile to
predominate and cause severe diarrhoeal illness.
7. It’s the medical professions fault
It is fair to say that the medical
profession has failed the general public. We need to do a lot more to educate
and raise public awareness around the problem of antibiotic resistance and the
appropriate use of antibiotics.
But the difficult truth is that we are all
in this together. The pressure on doctors and nurses to prescribe antibiotics
from the public can be intense. Good practice is often undermined by
uncertainty either due to lack of knowledge and/or lack of point-of-care
diagnostics. Patient pressure to prescribe compounds the problem.
The bottom line is that we are all
responsible for our future. Antibiotics are a global common good. They belong
to everyone, so what one person does affects the next one. It’s time we all
became “Antibiotic Guardians” to retard the relentless rise of bacterial
resistance through correcting inappropriate use of this vital resource.
Marc Mendelson, Professor of Infectious
Diseases, University of Cape Town
This article was originally published on
The Conversation. Read the original article.