Antibiotic resistance

Taking fewer antibiotics can reduce resistance

A recent article in the News-Leader documented the saga of a young wrestler who developed a serious infection with a resistant Staphylococcal Aureus bacterium (MRSA). The article mentioned the usual advice about careful hand washing and good hygiene, and briefly included advice from an infectious disease specialist about not using unnecessary antibiotics and finishing those you have been prescribed. The statement then was made that there was hope there would soon be new and stronger antibiotics to combat these resistant organisms.

This search for the Holy Grail of antibiotics, which would combat the most resistant bacteria, has proved futile to date. There frequently are new, promising antibiotics, but bacteria always have been able to develop resistance. This is not likely to change in the future. In the past, antibiotics have been referred to as “wonder drugs” and we still tend to have this attitude today. In fact, there are no “wonder drugs”– -only “wonder bugs” which seem to be able to adapt to anything we throw at them. The World Health Organization states that antibiotic resistance is one of the greatest threats to life on our planet. This resistance is primarily the result of overuse and misuse of antibiotics. Yet the United States has been slow to recognize and react to this threat.

Norway, rather than pinning its hopes on newer and stronger antibiotics, has taken a very different and seemingly very successful path. They are doing less, rather than more, and have seen remarkable results. They have sharply curtailed the use of antibiotics in the country and have all but eradicated deaths from MRSA, as contrasted with the U.S., which has over 19,000 deaths from this bacterium per year. In Norway, drugmakers are not allowed to advertise. While Norwegian doctors prescribe antibiotics when truly needed, they prescribe fewer than those in any other country, so people do not develop resistance to them. Several of the newest broad-spectrum antibiotics are not even licensed for use, and older, simpler (and much less expensive) antibiotics have again become effective. Almost every case of MRSA seen in Norway now can be traced to someone who has been abroad.

Small-scale efforts to duplicate these results elsewhere — in England, Japan and the U.S. — have shown remarkable decreases in MRSA infections, but there has been no widespread program to curtail antibiotic usage in the U.S. and our percentage of resistant infections keeps rising. So while we continue to rely on treatment with the newest antibiotics, often for virus infections (which don’t even respond to antibiotics), limiting their usage has been associated with less serious infections and less complications and fatalities. This would not only save lives, but also markedly reduce the cost of health care.

Until we can get past our infatuation with so-called “wonder drugs” and our feeling that there is a drug for every purpose, we will continue to see increasing bacterial resistance, increased illness, deaths and cost. Maybe it’s time to ask our doctors not to prescribe unless absolutely necessary.