Stopping the threat of drug resistant bacteria

Well, this isn’t good news.

The CDC has compiled an extensive report of the top US health risks from infections. Called “Threat Report 2013,” their evaluation shows that the three most worrisome risks have all been created by our own indiscriminant overuse of antibiotics. The biggest baddies:

Carbapenem-resistant Enterobacteriaceae. The carbenapenem antibiotics were first developed in the 1970s and grew into wide use in the late 1980s. They had been the biggest, baddest antibiotics, ever — capable of killing just about anything. Not any more. Many gram negative bacteria have become resistant to all carbenapenems, leaving essentially no other medications available for treatment. If you’ve got a carbenapenem-resistant bug, you are in very serious trouble. They cause pneumonias, other invasive infections, and death, especially in people in hospitals.

Clostridium difficile is a tiny bacteria that can live peacefully in your gut. But if the balance of C. diff versus other bacteria is disturbed, C. diff can grow out of control, releasing toxins and causing a life-threatening colitis that can be very difficult to treat (one potential treatment is a transplant of stool from a healthy volunteer through a tube down your nose. Quite the ick factor, but it can work.) Why does C. diff get out of control? When antibiotics suppress other gut bacteria. And it may not take much — a simple, ordinary course of amoxicillin can cause fatal C. diff colitis. It’s happening, and it’s happening more and more.

Drug-resistant Neisseria gonorrhoeae. Gonorrhea? Seriously? This was a bug that used to die quickly if it even smelled penicillin nearby. Not any more. Resistance is rapidly spreading worldwide, and antibiotics that were reliably effective a few years ago are now worthless. Untreated gonorrhea can lead to infertility, pelvic inflammatory disease, septic abortion, blindness, and other bad things you don’t even want to think about.

We used to think we had won: we found the drugs, the drugs killed the bugs, and we could relax. Not any more. The bugs have been around a long time, and they’re patient, and evolutionary pressure from antibiotics means that antibiotic-resistant strains push out the wimps. Can we keep making new drugs fast enough to kill the bugs as quickly as they learn to fight back? That’s a maybe.

A better plan is to do what we can to prevent bacteria from becoming resistant.

Preventing infections is always better than treating infections. Wash your hands, stay away from sick people, and get those vaccines you and your family need to stay healthy.

Avoid using any antibiotics unless they’re really necessary. Sinus infections? Bronchitis? Sore throat? Fever? Most of these are caused by a virus, not a bacteria. Ask the doctor: do I really need to take this antibiotic? For routine, non-emergency symptoms, avoid urgent cares and ERs — just about everyone leaves those places with an antibiotic prescription. Don’t go to the doctor at all for the symptoms of a minor cold, cough, or sore throat. If your own primary care doc is Dr. Quick-Draw McZithromax, change to someone else.

If you do need to take an antibiotic, make sure your doctor chooses the “narrow spectrum” ones — ones that are like a laser beam, killing only the bacteria you want to kill. You don’t need a shotgun or a nuclear weapon to kill an ordinary infection. Save those big guns for when they’re really needed.

Do not hoard antibiotics, and don’t take them on your own “just in case.” Complete every antibiotic prescription the way it was written. Never take someone else’s antibiotics, and don’t push doctors to prescribe them.

On a society level, we need to stop pumping antibiotics into healthy animals to increase farming yields. Of course, vets need to use antibiotics to treat sick animals — but in today’s agricultural world, almost all of the antibiotics used are “preventive” or “supplementary.” That’s ridiculous and needs to stop. Yes, the antibiotic resistant germs in animals make their way to humans. You think they care if they’re infecting a cow or your child?

Finally, doctors. We all know it’s quicker to just prescribe than explain, and we all know that Press Ganey satisfaction scores might just be better if we shut up and write the damn antibiotic prescription. Still. If we stick together and do the right thing, we might be able to change perceptions and get this barge moving in the right direction. We started this mess. We need to fix it.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.

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  • Suzi Q 38

    Several people I knew contracted C difficile while in the hospital.
    My 84 year old mother got MRSA and C difficile during her month-long hospital stay five years ago.
    I had to go into the hospital for a surgery almost a year ago.
    I saw the dirty floors, countertops, and bathroom.
    I never saw a cleaning person the 30 hours I was there.
    I decided to see if I could go home ASAP with my daughter, who is a nurse. My family was also very supporting and helpful.

    I knew that it was better to get out of there, within reason.

  • karen3

    So here’s our story. Hospital A has poor infectious disease control, as found by Medicare/State survey. They require zero changes. Mom gets a CRE Klebsiealla infections. We complain to Medicare about that, inspectors sent, inspectors find a problemm “someone” changes the report, and hospital not required to fix anything. Hospital edits out reference to CRE Klebsiella from the discharge report. Nobody at the place she’s sent to knows about the CRE Klebsiella. Every single patient is put at risk. We complain to Medicare. Medicare does nothing. Who is the final decisionmaker on this: Patrick Conway and Marilyn Tavenner. She deserves a buggy website. Who said there’s not justice in the world.

    Add someone kicking Medicare’s sloth filled collective rear end as a part of the problem.

    • Suzi Q 38

      This is sad.
      Reaffirms my thoughts about those who are hired to care for you.
      Have you tried the CDC? They probably wouldn’t care either.

  • Suzi Q 38

    Sorry to hear about your friend.
    I used to try to stay in the hospital after the births or each child. I would no longer recommend doing so.

  • Suzi Q 38

    My students from China say that the medical doctors there hand out prescriptions for antibiotics automatically. They will even approve refills so that you can keep ample antibiotics on hand for the next illness.

  • Thom

    If only doctors denied patients antibiotics with as much zeal as they deny patients painkillers.

    Why not put a black mark on the permanent record of any patient who dares request antibiotics, a double black mark if they request one by name?

    Write blog post after blog post gloating about how you knocked back X number of patients this week. Put them on nationwide databases. Get them damned as “drug seekers” so that they will know not to ask or else never receive decent care from any physician ever again.

    Painkillers pretty much only harm the people who are taking them inappropriately. Antibiotics harm the whole community.

  • Victor Trismegistus Lyc-Vamp D

    Last week was international antibiotic awareness week. Who really cared? We must do far better than that. Bacteria were on the planet for way too longer than men, and have shown to be too much adaptable to our poor antibiotic and chemic defenses. Who shows the highest potential to win inthe long run?