When I was a little kid in the‘60s any sign of a sore throat, nagging sniffle, or early flu symptom had my mom running for the medicine cabinet to grab some leftover antibiotic pills. The antibiotics were remnants of a prescription she’d squirreled away for this very reason. The family doctor had written the antibiotic prescription for somebody in our family at an earlier time. The medicine had then been taken until the symptoms were gone. Funny, there always seemed to be a few pills left over. So my mom’s logic was, "Why throw good antibiotics away? They kill germs, don’t they? We’ll save them for a brush with another bug."
Today we know there were two big no-no’s in this family arrangement that’s led to crisis in the use of antibiotics. First, the entire prescription of antibiotics should have been taken. Either the doc didn’t tell us to do this or we didn’t listen. As a result of not taking the entire course of treatment, the symptoms of whatever we had disappeared (prompting us to stop the medicine early) but a few bacteria may well have remained. Worse, those remaining bugs could develop resistance to the antibiotics and pass on that resistance to other bacteria. Secondly, despite her good intentions, when mom gave me those few left-over antibiotics, they were most likely useless against what I had. Colds and flu are caused by viruses which antibiotics don’t affect. And, again, a partially taken prescription probably encouraged the growth of yet more resistant strains.
Bugs + Drugs = More Bugs!
I tell this story because my family was not unique in its mismanagement of antibiotics. In fact, antibiotic misuse among families and friends ("Hey, Henry, I’ve got something for that cold of yours") is cited by scientists as a significant reason "antibiotic resistance is becoming a public health nightmare."
Congress got a wake-up call on this debacle last May when the General Accounting Office reported that, worldwide, more kinds of bacteria are becoming resistant to multiple drugs.
Medical doctors, the gatekeepers of prescriptions, have been willing accomplices in this looming threat. Stuart B. Levy, M.D., a scientist at Tuft’s University School of Medicine who’s president of the Alliance for the Prudent Use of Antibiotics recalls a seminar he conducted in which 80 percent of the physicians admitted to having written antibiotic prescriptions on demand against their better judgement. Dr. Levy, who wrote The Antibiotic Paradox: How Miracle Drugs are Destroying the Miracle (Plenum Press, 1992) says it’s the result of a societal mentality for quick solutions: "Give me something to get me better, now!" Ironically, the federal Centers for Disease Control (CDC) reports that about half of all the antibiotic prescriptions written for outpatients are needless. Most all viral infections are unaffected by antibiotics.
As a result of this overuse, worst-case scenarios are being played out across the country. Patients have died because no antibiotic could be found to kill the bacterial infections ravaging their bodies. 70 percent of infections that people get while hospitalized are now resistant to at least one antibiotic according to the CDC. Drug-resistant bacteria causing meningitis, pneumonia, children’s middle-ear infections, women’s bladder infections, blood infections, and abscesses, to name a few, have doctors reaching for advanced generations of more powerful antibiotics. These are last ditch attempts and the hope is that their effectiveness doesn’t run out as the bacteria mutate into even more resistant forms. There’s a term for these mutated bacteria: Multidrug-resistant (MDR). As in MDR-TB.
MDR-TB: 42 States & Counting
Until the development of antibiotics in the 1940s, tuberculosis (TB) was the leading cause of death from infectious disease in this country. Antibiotics put an end to that; it was believed that TB was defeated. But the infection caused by Mycobacterium tuberculosis has gained antibiotic resistance and is rearing its ugly head again. According to the CDC, drug-resistant TB has been found in 42 states. One-third of TB cases are now said to be resistant to one or more tuberculosis drugs.
It’s so serious that California has a program to lock-up TB patients who refuse to take their antibiotics, the reason being that if they don’t finish their full course of treatment, drug-resistant TB strains can emerge and spread to the population at large. Six years ago, an MDR-TB outbreak swept through a California high school infecting 13 students. The drug-resistant TB strain was blamed, in part, on the first two students diagnosed. They had failed to complete their antibiotics dosing schedule.
Be Nice to Bacteria Day?
All right, I accept the fact that antibiotics have been overused, misused, and generally abused. I repent. So get those nasty bacteria away from me!
Not so fast.
Bacteria are our friends. "Bacteria are getting bad PR," says Dr. Levy. "People want to eliminate it in their homes, clean it up and sterilize their houses." Dr. Schmidt agrees. "Our body houses over 400 species of bacteria not only in our GI tract but on our skin and most mucous membranes (i.e. mouth, nose, throat, vagina) where they occupy space and minimize pathogenic exposure."
| Antibiotic Use in the U.S. Per Year All figures are estimates from FDA reporting | |
| Total | 50 million pounds |
| Human use | 25 million pounds |
| Animal use | 24 million pounds (80 percent used for growth promotion) |
| Plant Agriculture | 300,000 pounds (used as pesticides) |
| Source: The Institute of Medicine Report on Antibiotic Resistance, 1998. | |
Parents, Are You Listening?
So there are a lot of good bugs out there. And, unfortunately, when we attempt to kill off the pathogenic infection with antibiotics, the good bacteria get eliminated too. Dr. Levy believes we just need better management of antibiotics. For instance, he says, only one out of five ear infections are caused by bacterial infections. And, with no drugs and a little patience about half will get better on their own.
Both experts support a sort of "watchful waiting" in this instance. Go with the physician’s "no antibiotic" judgement initially, keep in touch by phone and give it about four days. In addition, Dr. Schmidt likes to see parents working with a nutritionally aware practitioner, "Increasing levels of nutrients such as zinc, selenium, and magnesium along with other things such as curcumin and omega-3 fatty acids have predictable biochemical effects on the inflammatory and immune systems."
Bugs in the Food Chain
Yes, there’s another way to avoid antibiotic resistance, and that’s in the food we eat. Nutrition is one factor, but production is another. We’ve not arrived at this point of alarm in antibiotic resistance solely based on the wayward actions of misguided patients and doctors. Many of the same antibiotics being used by humans are widely applied to the production of our food, both animal and plants.
"Growing" the Animals
According to Tuft’s Dr. Levy, about 40 percent of the antibiotics in the U.S. are given to animals, most of which are mixed into feed to promote growth. This process delivers steady small doses of the drugs which as he puts it, "is a perfect formula for selecting increasing numbers of resistant bacteria in the treated animals...which may then pass the microbes to caretakers and, more broadly, to people who prepare and consume undercooked meat." Adding insult to injury, Dr. Levy says farmers tell him the antibiotics don’t contribute to growth anyway. And, we can’t use the poor excuse that "everyone does it." Europe prohibits in feed additives the use of any antibiotics that are also used in human medicine.
An Apple a Day...
In crop agriculture, antibiotics are used as pesticides to control or prevent bacterial infections in fruit trees. Dr. Levy considers this use of antibiotics "small potatoes" when compared to the other applications (see chart) but says it has wide-ranging implications. When acres of trees are sprayed with the antibiotics, residues linger and encourage the growth of resistant bacteria that stay with the fruit all the way to our kitchen tables. In addition, when the trees are sprayed, this aerosol can be blown considerable distances to other crops. By this time, the antibiotics are dilute but still strong enough to kill off sensitive bacteria and give an edge to resistant versions on these crops. This is yet one more hit to the food chain...we eat the produce and the resistant bacteria are able to again settle in our intestinal tract. The concern is that these resistant bacteria can pass along their resistant traits to other bacteria in our bodies.
But What About Me?
What does this mean in the scheme of things? Does eating organic produce and free range meat, taking appropriate dietary supplementation and avoiding antibiotic use protect you (and your kids!) from the ravages of resistant bacteria?
"Developing a healthy and robust immune system is truly our best way to fight infectious diseases and deal with the crisis in antibiotic resistance," according to Michael A. Schmidt, a biochemistry scientist who has extensively studied antibiotic resistance and documented the effects of overuse in Beyond Antibiotics: 50 (or so) Ways to Boost Immunity and Avoid Antibiotics (North Atlantic Books, 1994) and Healing Childhood Ear Infections: Prevention, Home Care, and Alternative Treatment (North Atlantic Books, 1996).
"That doesn’t mean we won’t get sick but it does mean our immune response is more rapid." He believes a pumped-up immune system will be more thorough in its healing of damage done at the cell level.
And exactly how do you build a robust immune system? Certainly not by eating junk. "If we go to the biochemical level all of these things are influenced by nutrients," says Dr. Schmidt. "If the diet is rich in a variety of nutrients then it provides the immune system with the mechanism to activate itself, to repair itself." He cites an accumulation of research that shows specific nutrients, like the B-vitamins, selenium (a mineral), arginine (an amino acid) and omega-3 fatty acids (a rich source is flax seed oil) have reduced the need for antibiotics.
Don’t Be Anti-Antibiotics
Still, antibiotics are a crucial weapon in the health-supporting arsenal — even for health fanatics. As Dr. Schmidt puts it, "Proper nutrition, rest, and hydration,...all of these different things may not be quite enough in certain circumstances. So antibiotics may be necessary." For example, injuries from a bad accident or a fire immediately compromise anyone’s immune function. The ensuing hospital stay introduces a bacteria picnic. He poses a first-person scenario, "Now I’m exposed and I have to decide whether to consent to IV antibiotics.The hospital isn’t giving me the nutrients that I need to build up my resistance," he adds. "I ask myself,‘Will my own immune system be strong enough to deal with this?’"
Although researchers are rushing to create new drugs to replace those that show bacterial resistance, it’s a fact that the bacteria will eventually evolve ways to resist any drug. Our mission, if we chose to accept it, is to see that the evolution of bacterial resistance can be slowed down from the frenetic pace it’s taken. Commit to judiciously use fewer antibiotics, eat and live "smart," and educate your doctor to be nutritionally aware. All our lives depend on it.
Rebecca Ephraim is a media nutritionist and registered dietitian in Chicago.
Resources
For more information on bacterial resistance contact The Alliance for the Prudent Use of Antibiotics at www.antibiotic.org
Next month: Probiotics