Antibiotics Aren’t for Everyone

1 08 2011

The boy who lost interest in the Velveteen Rabbit—what archaic malady did he have again? Scarlet fever, that’s what it was. One of those things, like consumption or ague, that you only read about in old books . . . until recently, when it hit the headlines by killing two children in Hong Kong.

Unless you live there or have connections to there, you might not have thought too much about it, but it’s actually the latest harbinger of a dead-scary public health menace coming our way. Unlike most global menaces, there’s actually a lot we can do about this one.

Scarlet fever is a bacterial infection caused by group A Streptococcus, the same germ that causes strep throat.  It’s not vaccine-preventable, but it’s pretty easily treated with antibiotics, so since those have been around, nobody’s been too afraid of scarlet fever.

The recent deaths were caused by a strep strain that has mutated to be simultaneously more contagious and more antibiotic-resistant than the ones we were used to dealing with.

It’s still vulnerable to good old penicillin, but given how many other types of bacteria have become resistant to penicillin, it could just be a matter of time before we lose our last treatment option. Then, it’d be down to a battle between the bacteria and the infectee’s innate defenses.

How does antibiotic resistance happen, anyway? Say you have an infected ear, teeming with all manner of bacteria. You take your first dose of erythromycin (or whatever) and, bam, a whole bunch of the least-hardy bacteria go squealing off into the Great Petri Dish in the Sky. Your second dose takes out the next-wimpiest ones, and so on for four or five days. By then, you’re feeling much better, because there aren’t too many bacteria left to inflame your poor eardrum. So you stop taking the erythromycin, because, hey, why take medicine you don’t need?

Here’s why—those few bacteria left puttering around in your eardrum were the cream of the crop, hardy enough to withstand several days’ worth of antibiotics, and now they’re left with no competition for your delectable ear tissue. They multiply unchecked, and you can bet they’re not going to be content to populate just your ears.

You’ve done a little bit of genetic engineering right there inside your own skull, creating an antibiotic-resistant strain of bacteria that’s going to be a headache (or earache) for anybody who happens to pick it up from you, because throwing erythromycin at these bad boys will just make them snarl and chitter like Gremlins.

Naturally, since creating antibiotic-resistant bacteria is so simple even a child can (and often does) do it, you never know when your next infection will be with somebody else’s home-brewed nasties. Or even those of some random pig! That’s right—livestock get antibiotics too, mostly as a sort of general-purpose illness-preventing measure to grow them as big as they can possibly get.

In fact, 80% of all antibiotics in the U.S. are fed to animals that will themselves become food. It’s not well-documented yet, but researchers suspect resistant bacteria may be carried in the critters we eat.

We owe it to ourselves and those around us to understand how this works and how big a deal it is. Patients still end up getting antibiotics for colds and flu-like illnesses—viral infections which antibiotics cannot cure—possibly because their doctors aren’t current on when it’s appropriate to prescribe them.

Probably the biggest example of the pickle this has put us in is the emergence of methicillin-resistant Staphylococcus aureus—better known as MRSA—vividly described in the book Superbug.

It’s a tremendous problem in hospitals, which are just now figuring out how to get a handle on it, but is easy to catch in ordinary community settings too.

Science isn’t sitting back waiting to see what happens with this. There is research going on to develop new types of antibiotics, although it may just be a matter of time before these, too, are easily evaded by our tiny attackers.

Other projects are working on using things like nanostructures to kill bugs that antibiotics can’t touch, or creating new compounds specifically to defeat resistance mechanisms.

But antibiotic-resistant bacteria are in the here and now, so for today, here’s what each of us can do to minimize risks:

  • Get smart about antibiotics. Don’t pressure doctors to prescribe them. If they’re really necessary, take the whole course as prescribed.
  • Consider putting our purchasing power behind meat from animals raised without antibiotics.
  • When in the hospital, we must be that persnickety patient who insists everyone wash his or her hands before touching us.

Bacteria may outnumber us and reproduce faster, but we may yet outsmart them for good.

By Ms. Health Department

Image courtesy of perpetualplum