Based on “Microbial Armageddon” from WhiteCoat’s Call Room.

It’s a sad fact of medicine that antibiotics are generally overused. We are taught in medical school that we will be practicing in the “Post-Antibiotic Era.” That is, we will no longer be able to rely on the efficacy of antibiotics at some point in the (not-so-distant) future. One might ask the question why this is developing. Let’s talk through it quickly. (Note to health professionals, biologists, etc., this is going to be an extremely simplistic view of the reality of resistance, but I want it to be understandable and accessible. My wife HATES biology, so I’m writing to her level.)

First, I want to address legitimate use of antibiotics. There are some diseases that are best treated with antibiotics. Any time we use antibiotics, however, we run the risk of “breeding” a bacteria resistant to the antibiotics. The average individual has at least ten times as many bacterial cells as human cells in their body (1). This means that even without the bacterial overgrowth of an infection, there are about 100,000,000,000,000 bacterial cells in an individual (that’s 100 trillion cells!). Because of mistakes in genes, some of these cells are bound to be resistant to the antibiotic by random chance. So we kill off the bacteria that are sensitive which essentially leaves more food for the resistant bacteria to multiply rapidly. If the body does not finish clearing off the infection, we now have a resistant bug in that individual. The next time we need to use that antibiotic for that person, it is less likely to work.

Eventually (and, indeed, this is already happening), we will select for a bug that is resistant to multiple antibiotics (called a Multiple Drug Resistant Organism, or MDRO). One example of this with which many people are familiar is MRSA (which is “Methicillin Resistant Staphylococcus aureus” or a “Resistant Staph infection”).

Often, antibiotics are prescribed for non-bacterial illnesses. Let me be perfectly clear here: Antibiotics have no effect on viral illnesses. When patients demand antibiotics for illnesses which are often viral, they tend to start feeling better within about 5-10 days. They usually attribute this to the antibiotic, but it is the same time it takes your body to clear a viral infection. The antibiotic likely only gave the patient diarrhea and other side effects. There are also examples where bacterial infections should not be treated with antibiotics. One will follow. Bottom line here: Let your doctor decide if antibiotic therapy is an option for you. Please do not demand antibiotics.

So why don’t doctors just start using antibiotics more sparingly? There are a few problems. The first is that there are governmental regulations which require antibiotic prescriptions in certain illness which may or may not actually be bacterial as “Standard of Care” (2). Probably the largest issue, however, is that patients EXPECT antibiotics if they are feeling ill (3). They expect them even when antibiotics could make the problem much, much worse.

There is a bug that is a type of E. coli (you know, the one in the uncooked hamburger) called O157:H7. He doesn’t respond well to antibiotics. Initially, he causes a horrible diarrhea and very often results in dehydration. Pretty bad right? Well, if we give antibiotics for this infection, it causes a disease called HUS. 5-10% of individuals who develop HUS will die from that episode. In this case, the best treatment is NOT antibiotics. Rather, the best treatment is oral rehydration (essentially Gatorade) and, if that fails, fluids through an IV. The diarrhea will clear in…you guessed it…5-10 days. So even with certain bacterial infections, antibiotics are not a good choice.

So where does all this leave us? That’s a valid question. The World Health Organization (WHO)┬áis anticipating that if nothing changes in the near future, we will start to see increasing deaths from diseases (and complications from those diseases) that used to be very treatable. Diseases like pneumonia, urinary tract infections (UTIs), skin infections, even strep throat.

Okay, now the silver lining: The one thing that bacteria (and viruses, but we haven’t really been talking about them very much) have a difficult time counteracting is the body’s own immune system. So vaccines should continue to work even if the rest of our defenses fall apart.

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